|
HC BOWL
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
27000091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna American Axle |
$146.25
|
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.25
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$157.50
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health SBD |
$141.75
|
| Rate for Payer: UMR Bronson Commercial |
$83.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
|
HC BOWL ATS 55 ML
|
Facility
|
OP
|
$248.50
|
|
| Hospital Charge Code |
27000283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.94 |
| Max. Negotiated Rate |
$223.65 |
| Rate for Payer: Aetna American Axle |
$161.52
|
| Rate for Payer: Aetna Commercial |
$211.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.52
|
| Rate for Payer: BCBS Complete |
$99.40
|
| Rate for Payer: Cash Price |
$198.80
|
| Rate for Payer: Cofinity Commercial |
$173.95
|
| Rate for Payer: Cofinity Commercial |
$213.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.80
|
| Rate for Payer: Healthscope Commercial |
$223.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.22
|
| Rate for Payer: PHP Commercial |
$211.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.95
|
| Rate for Payer: Priority Health SBD |
$156.56
|
| Rate for Payer: UMR Bronson Commercial |
$91.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.38
|
|
|
HC BOWL ATS 55 ML
|
Facility
|
IP
|
$248.50
|
|
| Hospital Charge Code |
27000283
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.34 |
| Max. Negotiated Rate |
$223.65 |
| Rate for Payer: Aetna American Axle |
$161.52
|
| Rate for Payer: Aetna Commercial |
$211.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.52
|
| Rate for Payer: Cash Price |
$198.80
|
| Rate for Payer: Cofinity Commercial |
$173.95
|
| Rate for Payer: Cofinity Commercial |
$213.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.80
|
| Rate for Payer: Healthscope Commercial |
$223.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.22
|
| Rate for Payer: PHP Commercial |
$211.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.95
|
| Rate for Payer: Priority Health SBD |
$156.56
|
| Rate for Payer: UMR Bronson Commercial |
$109.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.38
|
|
|
HC B. PARAPERTUSSIS BY PCR CMPT
|
Facility
|
OP
|
$51.41
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600219
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$57.89 |
| Rate for Payer: Aetna American Axle |
$33.42
|
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$31.56
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Cofinity Commercial |
$35.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$46.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.56
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.70
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$43.70
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.99
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.39
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$57.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: UMR Bronson Commercial |
$19.02
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.56
|
|
|
HC B. PARAPERTUSSIS BY PCR CMPT
|
Facility
|
IP
|
$51.41
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600219
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$46.27 |
| Rate for Payer: Aetna American Axle |
$33.42
|
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.42
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cofinity Commercial |
$35.99
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.13
|
| Rate for Payer: Healthscope Commercial |
$46.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.70
|
| Rate for Payer: PHP Commercial |
$43.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.99
|
| Rate for Payer: Priority Health SBD |
$32.39
|
| Rate for Payer: UMR Bronson Commercial |
$22.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.56
|
|
|
HC B.PERTUSSIS BY PCR
|
Facility
|
OP
|
$51.41
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600218
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$57.89 |
| Rate for Payer: Aetna American Axle |
$33.42
|
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$31.56
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cofinity Commercial |
$35.99
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$46.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.56
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.70
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$43.70
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.99
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.39
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$57.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: UMR Bronson Commercial |
$19.02
|
| Rate for Payer: VA VA |
$35.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.56
|
|
|
HC B.PERTUSSIS BY PCR
|
Facility
|
IP
|
$51.41
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600218
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$46.27 |
| Rate for Payer: Aetna American Axle |
$33.42
|
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.42
|
| Rate for Payer: Cash Price |
$41.13
|
| Rate for Payer: Cofinity Commercial |
$35.99
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.13
|
| Rate for Payer: Healthscope Commercial |
$46.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.70
|
| Rate for Payer: PHP Commercial |
$43.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.99
|
| Rate for Payer: Priority Health SBD |
$32.39
|
| Rate for Payer: UMR Bronson Commercial |
$22.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.56
|
|
|
HC BRACE ADD TO LE PELVIC CONTROL HIP JOINT
|
Facility
|
IP
|
$953.04
|
|
|
Service Code
|
HCPCS L2624
|
| Hospital Charge Code |
27400039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$419.34 |
| Max. Negotiated Rate |
$857.74 |
| Rate for Payer: Aetna American Axle |
$619.48
|
| Rate for Payer: Aetna Commercial |
$810.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.48
|
| Rate for Payer: Cash Price |
$762.43
|
| Rate for Payer: Cofinity Commercial |
$667.13
|
| Rate for Payer: Cofinity Commercial |
$819.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.43
|
| Rate for Payer: Healthscope Commercial |
$857.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$667.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$714.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$810.08
|
| Rate for Payer: PHP Commercial |
$810.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.13
|
| Rate for Payer: Priority Health SBD |
$600.42
|
| Rate for Payer: UMR Bronson Commercial |
$419.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$714.78
|
|
|
HC BRACE ADD TO LE PELVIC CONTROL HIP JOINT
|
Facility
|
OP
|
$953.04
|
|
|
Service Code
|
HCPCS L2624
|
| Hospital Charge Code |
27400039
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$352.62 |
| Max. Negotiated Rate |
$1,419.24 |
| Rate for Payer: Aetna American Axle |
$619.48
|
| Rate for Payer: Aetna Commercial |
$810.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.48
|
| Rate for Payer: BCBS Complete |
$381.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,419.24
|
| Rate for Payer: Cash Price |
$762.43
|
| Rate for Payer: Cash Price |
$762.43
|
| Rate for Payer: Cofinity Commercial |
$819.61
|
| Rate for Payer: Cofinity Commercial |
$667.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.43
|
| Rate for Payer: Healthscope Commercial |
$857.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$667.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$714.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$810.08
|
| Rate for Payer: PHP Commercial |
$810.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$667.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.10
|
| Rate for Payer: Priority Health Narrow Network |
$367.28
|
| Rate for Payer: Priority Health SBD |
$600.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.91
|
| Rate for Payer: UHC Exchange |
$485.76
|
| Rate for Payer: UMR Bronson Commercial |
$352.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$714.78
|
|
|
HC BRACE AFO
|
Facility
|
OP
|
$584.45
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$216.25 |
| Max. Negotiated Rate |
$916.34 |
| Rate for Payer: Aetna American Axle |
$379.89
|
| Rate for Payer: Aetna Commercial |
$496.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.89
|
| Rate for Payer: BCBS Complete |
$233.78
|
| Rate for Payer: BCBS Trust/PPO |
$916.34
|
| Rate for Payer: Cash Price |
$467.56
|
| Rate for Payer: Cash Price |
$467.56
|
| Rate for Payer: Cofinity Commercial |
$409.12
|
| Rate for Payer: Cofinity Commercial |
$502.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.56
|
| Rate for Payer: Healthscope Commercial |
$526.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$409.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.78
|
| Rate for Payer: PHP Commercial |
$496.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.42
|
| Rate for Payer: Priority Health Narrow Network |
$237.14
|
| Rate for Payer: Priority Health SBD |
$368.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.41
|
| Rate for Payer: UHC Exchange |
$347.01
|
| Rate for Payer: UMR Bronson Commercial |
$216.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.34
|
|
|
HC BRACE AFO
|
Facility
|
IP
|
$584.45
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
27000002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$257.16 |
| Max. Negotiated Rate |
$526.00 |
| Rate for Payer: Aetna American Axle |
$379.89
|
| Rate for Payer: Aetna Commercial |
$496.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.89
|
| Rate for Payer: Cash Price |
$467.56
|
| Rate for Payer: Cofinity Commercial |
$409.12
|
| Rate for Payer: Cofinity Commercial |
$502.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.56
|
| Rate for Payer: Healthscope Commercial |
$526.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$409.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.78
|
| Rate for Payer: PHP Commercial |
$496.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.12
|
| Rate for Payer: Priority Health SBD |
$368.20
|
| Rate for Payer: UMR Bronson Commercial |
$257.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.34
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
IP
|
$1,437.97
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$632.71 |
| Max. Negotiated Rate |
$1,294.17 |
| Rate for Payer: Aetna American Axle |
$934.68
|
| Rate for Payer: Aetna Commercial |
$1,222.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.68
|
| Rate for Payer: Cash Price |
$1,150.38
|
| Rate for Payer: Cofinity Commercial |
$1,006.58
|
| Rate for Payer: Cofinity Commercial |
$1,236.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,150.38
|
| Rate for Payer: Healthscope Commercial |
$1,294.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,006.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,078.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,222.27
|
| Rate for Payer: PHP Commercial |
$1,222.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.58
|
| Rate for Payer: Priority Health SBD |
$905.92
|
| Rate for Payer: UMR Bronson Commercial |
$632.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,078.48
|
|
|
HC BRACE AFO WITH INTERFACE
|
Facility
|
OP
|
$1,437.97
|
|
|
Service Code
|
HCPCS L1960
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.05 |
| Max. Negotiated Rate |
$2,254.70 |
| Rate for Payer: Aetna American Axle |
$934.68
|
| Rate for Payer: Aetna Commercial |
$1,222.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.68
|
| Rate for Payer: BCBS Complete |
$575.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,254.70
|
| Rate for Payer: Cash Price |
$1,150.38
|
| Rate for Payer: Cash Price |
$1,150.38
|
| Rate for Payer: Cofinity Commercial |
$1,236.65
|
| Rate for Payer: Cofinity Commercial |
$1,006.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,150.38
|
| Rate for Payer: Healthscope Commercial |
$1,294.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,006.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,078.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,222.27
|
| Rate for Payer: PHP Commercial |
$1,222.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$729.36
|
| Rate for Payer: Priority Health Narrow Network |
$583.49
|
| Rate for Payer: Priority Health SBD |
$905.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$975.72
|
| Rate for Payer: UHC Exchange |
$813.10
|
| Rate for Payer: UMR Bronson Commercial |
$532.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,078.48
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
IP
|
$323.34
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.27 |
| Max. Negotiated Rate |
$291.01 |
| Rate for Payer: Aetna American Axle |
$210.17
|
| Rate for Payer: Aetna Commercial |
$274.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.17
|
| Rate for Payer: Cash Price |
$258.67
|
| Rate for Payer: Cofinity Commercial |
$226.34
|
| Rate for Payer: Cofinity Commercial |
$278.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.67
|
| Rate for Payer: Healthscope Commercial |
$291.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.84
|
| Rate for Payer: PHP Commercial |
$274.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.34
|
| Rate for Payer: Priority Health SBD |
$203.70
|
| Rate for Payer: UMR Bronson Commercial |
$142.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.50
|
|
|
HC BRACE AK PELVIC CONTROL BELT LIGHT
|
Facility
|
OP
|
$323.34
|
|
|
Service Code
|
HCPCS L5692
|
| Hospital Charge Code |
27400038
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.64 |
| Max. Negotiated Rate |
$481.46 |
| Rate for Payer: Aetna American Axle |
$210.17
|
| Rate for Payer: Aetna Commercial |
$274.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.17
|
| Rate for Payer: BCBS Complete |
$129.34
|
| Rate for Payer: BCBS Trust/PPO |
$481.46
|
| Rate for Payer: Cash Price |
$258.67
|
| Rate for Payer: Cash Price |
$258.67
|
| Rate for Payer: Cofinity Commercial |
$226.34
|
| Rate for Payer: Cofinity Commercial |
$278.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.67
|
| Rate for Payer: Healthscope Commercial |
$291.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.84
|
| Rate for Payer: PHP Commercial |
$274.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.75
|
| Rate for Payer: Priority Health Narrow Network |
$124.60
|
| Rate for Payer: Priority Health SBD |
$203.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.19
|
| Rate for Payer: UHC Exchange |
$207.66
|
| Rate for Payer: UMR Bronson Commercial |
$119.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.50
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
IP
|
$129.90
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.16 |
| Max. Negotiated Rate |
$116.91 |
| Rate for Payer: Aetna American Axle |
$84.44
|
| Rate for Payer: Aetna Commercial |
$110.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.44
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cofinity Commercial |
$111.71
|
| Rate for Payer: Cofinity Commercial |
$90.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.92
|
| Rate for Payer: Healthscope Commercial |
$116.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.42
|
| Rate for Payer: PHP Commercial |
$110.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.93
|
| Rate for Payer: Priority Health SBD |
$81.84
|
| Rate for Payer: UMR Bronson Commercial |
$57.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.42
|
|
|
HC BRACE AK PROSTH SOCK SINGLE-PLY/6
|
Facility
|
OP
|
$129.90
|
|
|
Service Code
|
HCPCS L8480
|
| Hospital Charge Code |
27400034
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$116.91 |
| Rate for Payer: Aetna American Axle |
$84.44
|
| Rate for Payer: Aetna Commercial |
$110.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.44
|
| Rate for Payer: BCBS Complete |
$51.96
|
| Rate for Payer: BCBS Trust/PPO |
$33.37
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cash Price |
$103.92
|
| Rate for Payer: Cofinity Commercial |
$90.93
|
| Rate for Payer: Cofinity Commercial |
$111.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.92
|
| Rate for Payer: Healthscope Commercial |
$116.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.42
|
| Rate for Payer: PHP Commercial |
$110.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.79
|
| Rate for Payer: Priority Health Narrow Network |
$8.63
|
| Rate for Payer: Priority Health SBD |
$81.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.27
|
| Rate for Payer: UHC Exchange |
$14.39
|
| Rate for Payer: UMR Bronson Commercial |
$48.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.42
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
OP
|
$1,467.78
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$543.08 |
| Max. Negotiated Rate |
$2,260.66 |
| Rate for Payer: Aetna American Axle |
$954.06
|
| Rate for Payer: Aetna Commercial |
$1,247.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.06
|
| Rate for Payer: BCBS Complete |
$587.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,260.66
|
| Rate for Payer: Cash Price |
$1,174.22
|
| Rate for Payer: Cash Price |
$1,174.22
|
| Rate for Payer: Cofinity Commercial |
$1,262.29
|
| Rate for Payer: Cofinity Commercial |
$1,027.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,174.22
|
| Rate for Payer: Healthscope Commercial |
$1,321.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,027.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,100.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,247.61
|
| Rate for Payer: PHP Commercial |
$1,247.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.29
|
| Rate for Payer: Priority Health Narrow Network |
$585.03
|
| Rate for Payer: Priority Health SBD |
$924.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,022.62
|
| Rate for Payer: UHC Exchange |
$852.18
|
| Rate for Payer: UMR Bronson Commercial |
$543.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,100.84
|
|
|
HC BRACE AK RIGID DRESSING NWB
|
Facility
|
IP
|
$1,467.78
|
|
|
Service Code
|
HCPCS L5460
|
| Hospital Charge Code |
27400033
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$645.82 |
| Max. Negotiated Rate |
$1,321.00 |
| Rate for Payer: Aetna American Axle |
$954.06
|
| Rate for Payer: Aetna Commercial |
$1,247.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.06
|
| Rate for Payer: Cash Price |
$1,174.22
|
| Rate for Payer: Cofinity Commercial |
$1,027.45
|
| Rate for Payer: Cofinity Commercial |
$1,262.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,174.22
|
| Rate for Payer: Healthscope Commercial |
$1,321.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,027.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,100.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,247.61
|
| Rate for Payer: PHP Commercial |
$1,247.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.45
|
| Rate for Payer: Priority Health SBD |
$924.70
|
| Rate for Payer: UMR Bronson Commercial |
$645.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,100.84
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
OP
|
$144.55
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$351.93 |
| Rate for Payer: Aetna American Axle |
$93.96
|
| Rate for Payer: Aetna Commercial |
$122.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.96
|
| Rate for Payer: BCBS Complete |
$57.82
|
| Rate for Payer: BCBS Trust/PPO |
$351.93
|
| Rate for Payer: Cash Price |
$115.64
|
| Rate for Payer: Cash Price |
$115.64
|
| Rate for Payer: Cofinity Commercial |
$101.18
|
| Rate for Payer: Cofinity Commercial |
$124.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.64
|
| Rate for Payer: Healthscope Commercial |
$130.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.87
|
| Rate for Payer: PHP Commercial |
$122.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.84
|
| Rate for Payer: Priority Health Narrow Network |
$91.07
|
| Rate for Payer: Priority Health SBD |
$91.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.34
|
| Rate for Payer: UHC Exchange |
$131.12
|
| Rate for Payer: UMR Bronson Commercial |
$53.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.41
|
|
|
HC BRACE ANKLE STIRRUP SPLINT
|
Facility
|
IP
|
$144.55
|
|
|
Service Code
|
HCPCS L4350
|
| Hospital Charge Code |
27400001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna American Axle |
$93.96
|
| Rate for Payer: Aetna Commercial |
$122.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.96
|
| Rate for Payer: Cash Price |
$115.64
|
| Rate for Payer: Cofinity Commercial |
$101.18
|
| Rate for Payer: Cofinity Commercial |
$124.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.64
|
| Rate for Payer: Healthscope Commercial |
$130.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.87
|
| Rate for Payer: PHP Commercial |
$122.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.18
|
| Rate for Payer: Priority Health SBD |
$91.07
|
| Rate for Payer: UMR Bronson Commercial |
$63.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.41
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
IP
|
$335.10
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.44 |
| Max. Negotiated Rate |
$301.59 |
| Rate for Payer: Aetna American Axle |
$217.82
|
| Rate for Payer: Aetna Commercial |
$284.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.82
|
| Rate for Payer: Cash Price |
$268.08
|
| Rate for Payer: Cofinity Commercial |
$234.57
|
| Rate for Payer: Cofinity Commercial |
$288.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.08
|
| Rate for Payer: Healthscope Commercial |
$301.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.84
|
| Rate for Payer: PHP Commercial |
$284.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.57
|
| Rate for Payer: Priority Health SBD |
$211.11
|
| Rate for Payer: UMR Bronson Commercial |
$147.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.32
|
|
|
HC BRACE ASPEN COLLAR
|
Facility
|
OP
|
$335.10
|
|
|
Service Code
|
HCPCS L0172
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$123.99 |
| Max. Negotiated Rate |
$515.15 |
| Rate for Payer: Aetna American Axle |
$217.82
|
| Rate for Payer: Aetna Commercial |
$284.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.82
|
| Rate for Payer: BCBS Complete |
$134.04
|
| Rate for Payer: BCBS Trust/PPO |
$515.15
|
| Rate for Payer: Cash Price |
$268.08
|
| Rate for Payer: Cash Price |
$268.08
|
| Rate for Payer: Cofinity Commercial |
$288.19
|
| Rate for Payer: Cofinity Commercial |
$234.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.08
|
| Rate for Payer: Healthscope Commercial |
$301.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.84
|
| Rate for Payer: PHP Commercial |
$284.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.64
|
| Rate for Payer: Priority Health Narrow Network |
$133.31
|
| Rate for Payer: Priority Health SBD |
$211.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.49
|
| Rate for Payer: UHC Exchange |
$186.24
|
| Rate for Payer: UMR Bronson Commercial |
$123.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.32
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna American Axle |
$192.46
|
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.46
|
| Rate for Payer: BCBS Complete |
$118.44
|
| Rate for Payer: BCBS Trust/PPO |
$76.03
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.59
|
| Rate for Payer: Priority Health Narrow Network |
$19.67
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.47
|
| Rate for Payer: UHC Exchange |
$30.39
|
| Rate for Payer: UMR Bronson Commercial |
$109.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.08
|
|
|
HC BRACE BK PROSTH SOCK MULTI-PLY/6
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
HCPCS L8420
|
| Hospital Charge Code |
27400024
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.28 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Aetna American Axle |
$192.46
|
| Rate for Payer: Aetna Commercial |
$251.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.46
|
| Rate for Payer: Cash Price |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$207.27
|
| Rate for Payer: Cofinity Commercial |
$254.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.88
|
| Rate for Payer: Healthscope Commercial |
$266.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.68
|
| Rate for Payer: PHP Commercial |
$251.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.27
|
| Rate for Payer: Priority Health SBD |
$186.54
|
| Rate for Payer: UMR Bronson Commercial |
$130.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.08
|
|
