|
HC ELECTROPHYSIOLOGY PACK
|
Facility
|
OP
|
$261.70
|
|
| Hospital Charge Code |
62200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.83 |
| Max. Negotiated Rate |
$235.53 |
| Rate for Payer: Aetna American Axle |
$170.10
|
| Rate for Payer: Aetna Commercial |
$222.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.10
|
| Rate for Payer: BCBS Complete |
$104.68
|
| Rate for Payer: Cash Price |
$209.36
|
| Rate for Payer: Cofinity Commercial |
$183.19
|
| Rate for Payer: Cofinity Commercial |
$225.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.36
|
| Rate for Payer: Healthscope Commercial |
$235.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.44
|
| Rate for Payer: PHP Commercial |
$222.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.19
|
| Rate for Payer: Priority Health SBD |
$164.87
|
| Rate for Payer: UMR Bronson Commercial |
$96.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.28
|
|
|
HC ELECTROPHYSIOLOGY PACK
|
Facility
|
IP
|
$261.70
|
|
| Hospital Charge Code |
62200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$235.53 |
| Rate for Payer: Aetna American Axle |
$170.10
|
| Rate for Payer: Aetna Commercial |
$222.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.10
|
| Rate for Payer: Cash Price |
$209.36
|
| Rate for Payer: Cofinity Commercial |
$183.19
|
| Rate for Payer: Cofinity Commercial |
$225.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.36
|
| Rate for Payer: Healthscope Commercial |
$235.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.44
|
| Rate for Payer: PHP Commercial |
$222.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.19
|
| Rate for Payer: Priority Health SBD |
$164.87
|
| Rate for Payer: UMR Bronson Commercial |
$115.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.28
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
OP
|
$26,484.59
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,631.15 |
| Max. Negotiated Rate |
$23,836.13 |
| Rate for Payer: Aetna American Axle |
$17,214.98
|
| Rate for Payer: Aetna Commercial |
$22,511.90
|
| Rate for Payer: Aetna Medicare |
$6,903.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,214.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,297.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,297.88
|
| Rate for Payer: BCBS Complete |
$3,813.04
|
| Rate for Payer: BCBS MAPPO |
$6,638.30
|
| Rate for Payer: BCBS Trust/PPO |
$21,354.26
|
| Rate for Payer: BCN Medicare Advantage |
$6,638.30
|
| Rate for Payer: Cash Price |
$21,187.67
|
| Rate for Payer: Cash Price |
$21,187.67
|
| Rate for Payer: Cofinity Commercial |
$22,776.75
|
| Rate for Payer: Cofinity Commercial |
$18,539.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,187.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,638.30
|
| Rate for Payer: Healthscope Commercial |
$23,836.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,539.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,863.44
|
| Rate for Payer: Mclaren Medicaid |
$3,631.15
|
| Rate for Payer: Mclaren Medicare |
$6,638.30
|
| Rate for Payer: Meridian Medicaid |
$3,813.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,970.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,634.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22,511.90
|
| Rate for Payer: PACE Medicare |
$6,306.38
|
| Rate for Payer: PACE SWMI |
$6,638.30
|
| Rate for Payer: PHP Commercial |
$22,511.90
|
| Rate for Payer: PHP Medicare Advantage |
$6,638.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,631.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,539.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,897.69
|
| Rate for Payer: Priority Health Medicare |
$6,638.30
|
| Rate for Payer: Priority Health Narrow Network |
$16,718.15
|
| Rate for Payer: Priority Health SBD |
$16,685.29
|
| Rate for Payer: Railroad Medicare Medicare |
$6,638.30
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,638.30
|
| Rate for Payer: UHC Medicare Advantage |
$6,837.45
|
| Rate for Payer: UMR Bronson Commercial |
$9,799.30
|
| Rate for Payer: VA VA |
$6,638.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,863.44
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
IP
|
$26,484.59
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,653.22 |
| Max. Negotiated Rate |
$23,836.13 |
| Rate for Payer: Aetna American Axle |
$17,214.98
|
| Rate for Payer: Aetna Commercial |
$22,511.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,214.98
|
| Rate for Payer: Cash Price |
$21,187.67
|
| Rate for Payer: Cofinity Commercial |
$18,539.21
|
| Rate for Payer: Cofinity Commercial |
$22,776.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,187.67
|
| Rate for Payer: Healthscope Commercial |
$23,836.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,539.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,863.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22,511.90
|
| Rate for Payer: PHP Commercial |
$22,511.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,539.21
|
| Rate for Payer: Priority Health SBD |
$16,685.29
|
| Rate for Payer: UMR Bronson Commercial |
$11,653.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,863.44
|
|
|
HC ELM IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.16
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$5.73
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.21
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC ELM IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC ELVAREX CHAP STYLE ONE LEG
|
Facility
|
OP
|
$573.09
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$212.04 |
| Max. Negotiated Rate |
$515.78 |
| Rate for Payer: Aetna American Axle |
$372.51
|
| Rate for Payer: Aetna Commercial |
$487.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.51
|
| Rate for Payer: BCBS Complete |
$229.24
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$458.47
|
| Rate for Payer: Cash Price |
$458.47
|
| Rate for Payer: Cofinity Commercial |
$401.16
|
| Rate for Payer: Cofinity Commercial |
$492.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.47
|
| Rate for Payer: Healthscope Commercial |
$515.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$401.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.13
|
| Rate for Payer: PHP Commercial |
$487.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.16
|
| Rate for Payer: Priority Health SBD |
$361.05
|
| Rate for Payer: UMR Bronson Commercial |
$212.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.82
|
|
|
HC ELVAREX CHAP STYLE ONE LEG
|
Facility
|
IP
|
$573.09
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$252.16 |
| Max. Negotiated Rate |
$515.78 |
| Rate for Payer: Aetna American Axle |
$372.51
|
| Rate for Payer: Aetna Commercial |
$487.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.51
|
| Rate for Payer: Cash Price |
$458.47
|
| Rate for Payer: Cofinity Commercial |
$401.16
|
| Rate for Payer: Cofinity Commercial |
$492.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.47
|
| Rate for Payer: Healthscope Commercial |
$515.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$401.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$487.13
|
| Rate for Payer: PHP Commercial |
$487.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.16
|
| Rate for Payer: Priority Health SBD |
$361.05
|
| Rate for Payer: UMR Bronson Commercial |
$252.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.82
|
|
|
HC ELVAREX CHAP STYLE TWO LEG
|
Facility
|
OP
|
$1,146.15
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$416.51 |
| Max. Negotiated Rate |
$1,031.54 |
| Rate for Payer: Aetna American Axle |
$745.00
|
| Rate for Payer: Aetna Commercial |
$974.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.00
|
| Rate for Payer: BCBS Complete |
$458.46
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$916.92
|
| Rate for Payer: Cash Price |
$916.92
|
| Rate for Payer: Cofinity Commercial |
$802.30
|
| Rate for Payer: Cofinity Commercial |
$985.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.92
|
| Rate for Payer: Healthscope Commercial |
$1,031.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$802.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$859.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$974.23
|
| Rate for Payer: PHP Commercial |
$974.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.30
|
| Rate for Payer: Priority Health SBD |
$722.07
|
| Rate for Payer: UMR Bronson Commercial |
$424.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$859.61
|
|
|
HC ELVAREX CHAP STYLE TWO LEG
|
Facility
|
IP
|
$1,146.15
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$504.31 |
| Max. Negotiated Rate |
$1,031.54 |
| Rate for Payer: Aetna American Axle |
$745.00
|
| Rate for Payer: Aetna Commercial |
$974.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.00
|
| Rate for Payer: Cash Price |
$916.92
|
| Rate for Payer: Cofinity Commercial |
$802.30
|
| Rate for Payer: Cofinity Commercial |
$985.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.92
|
| Rate for Payer: Healthscope Commercial |
$1,031.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$802.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$859.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$974.23
|
| Rate for Payer: PHP Commercial |
$974.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.30
|
| Rate for Payer: Priority Health SBD |
$722.07
|
| Rate for Payer: UMR Bronson Commercial |
$504.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$859.61
|
|
|
HC ELVAREX KNEE SLANT OPEN TOE
|
Facility
|
OP
|
$281.25
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.06 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$182.81
|
| Rate for Payer: Aetna Commercial |
$239.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.81
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.00
|
| Rate for Payer: Healthscope Commercial |
$253.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.06
|
| Rate for Payer: PHP Commercial |
$239.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.88
|
| Rate for Payer: Priority Health SBD |
$177.19
|
| Rate for Payer: UMR Bronson Commercial |
$104.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.94
|
|
|
HC ELVAREX KNEE SLANT OPEN TOE
|
Facility
|
IP
|
$281.25
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$253.12 |
| Rate for Payer: Aetna American Axle |
$182.81
|
| Rate for Payer: Aetna Commercial |
$239.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.81
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.00
|
| Rate for Payer: Healthscope Commercial |
$253.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.06
|
| Rate for Payer: PHP Commercial |
$239.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.88
|
| Rate for Payer: Priority Health SBD |
$177.19
|
| Rate for Payer: UMR Bronson Commercial |
$123.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.94
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.82 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna American Axle |
$162.24
|
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: Priority Health SBD |
$157.25
|
| Rate for Payer: UMR Bronson Commercial |
$109.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
OP
|
$249.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.35 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$162.24
|
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: BCBS Complete |
$99.84
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: Priority Health SBD |
$157.25
|
| Rate for Payer: UMR Bronson Commercial |
$92.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
IP
|
$249.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.82 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna American Axle |
$162.24
|
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: Priority Health SBD |
$157.25
|
| Rate for Payer: UMR Bronson Commercial |
$109.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
OP
|
$249.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.35 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$162.24
|
| Rate for Payer: Aetna Commercial |
$212.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: BCBS Complete |
$99.84
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cash Price |
$199.68
|
| Rate for Payer: Cofinity Commercial |
$174.72
|
| Rate for Payer: Cofinity Commercial |
$214.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.68
|
| Rate for Payer: Healthscope Commercial |
$224.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.16
|
| Rate for Payer: PHP Commercial |
$212.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.72
|
| Rate for Payer: Priority Health SBD |
$157.25
|
| Rate for Payer: UMR Bronson Commercial |
$92.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.20
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
OP
|
$281.25
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.06 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$182.81
|
| Rate for Payer: Aetna Commercial |
$239.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.81
|
| Rate for Payer: BCBS Complete |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.00
|
| Rate for Payer: Healthscope Commercial |
$253.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.06
|
| Rate for Payer: PHP Commercial |
$239.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.88
|
| Rate for Payer: Priority Health SBD |
$177.19
|
| Rate for Payer: UMR Bronson Commercial |
$104.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.94
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
IP
|
$281.25
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$253.12 |
| Rate for Payer: Aetna American Axle |
$182.81
|
| Rate for Payer: Aetna Commercial |
$239.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.81
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$196.88
|
| Rate for Payer: Cofinity Commercial |
$241.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.00
|
| Rate for Payer: Healthscope Commercial |
$253.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.06
|
| Rate for Payer: PHP Commercial |
$239.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.88
|
| Rate for Payer: Priority Health SBD |
$177.19
|
| Rate for Payer: UMR Bronson Commercial |
$123.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.94
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
IP
|
$411.39
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$181.01 |
| Max. Negotiated Rate |
$370.25 |
| Rate for Payer: Aetna American Axle |
$267.40
|
| Rate for Payer: Aetna Commercial |
$349.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.40
|
| Rate for Payer: Cash Price |
$329.11
|
| Rate for Payer: Cofinity Commercial |
$287.97
|
| Rate for Payer: Cofinity Commercial |
$353.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.11
|
| Rate for Payer: Healthscope Commercial |
$370.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$349.68
|
| Rate for Payer: PHP Commercial |
$349.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health SBD |
$259.18
|
| Rate for Payer: UMR Bronson Commercial |
$181.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.54
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
OP
|
$411.39
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$152.21 |
| Max. Negotiated Rate |
$416.51 |
| Rate for Payer: Aetna American Axle |
$267.40
|
| Rate for Payer: Aetna Commercial |
$349.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.40
|
| Rate for Payer: BCBS Complete |
$164.56
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$329.11
|
| Rate for Payer: Cash Price |
$329.11
|
| Rate for Payer: Cofinity Commercial |
$287.97
|
| Rate for Payer: Cofinity Commercial |
$353.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.11
|
| Rate for Payer: Healthscope Commercial |
$370.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$349.68
|
| Rate for Payer: PHP Commercial |
$349.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health SBD |
$259.18
|
| Rate for Payer: UMR Bronson Commercial |
$152.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.54
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
IP
|
$528.36
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$232.48 |
| Max. Negotiated Rate |
$475.52 |
| Rate for Payer: Aetna American Axle |
$343.43
|
| Rate for Payer: Aetna Commercial |
$449.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.43
|
| Rate for Payer: Cash Price |
$422.69
|
| Rate for Payer: Cofinity Commercial |
$369.85
|
| Rate for Payer: Cofinity Commercial |
$454.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.69
|
| Rate for Payer: Healthscope Commercial |
$475.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$449.11
|
| Rate for Payer: PHP Commercial |
$449.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.85
|
| Rate for Payer: Priority Health SBD |
$332.87
|
| Rate for Payer: UMR Bronson Commercial |
$232.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.27
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
OP
|
$528.36
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$195.49 |
| Max. Negotiated Rate |
$475.52 |
| Rate for Payer: Aetna American Axle |
$343.43
|
| Rate for Payer: Aetna Commercial |
$449.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.43
|
| Rate for Payer: BCBS Complete |
$211.34
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: Cash Price |
$422.69
|
| Rate for Payer: Cash Price |
$422.69
|
| Rate for Payer: Cofinity Commercial |
$369.85
|
| Rate for Payer: Cofinity Commercial |
$454.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.69
|
| Rate for Payer: Healthscope Commercial |
$475.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$369.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$449.11
|
| Rate for Payer: PHP Commercial |
$449.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.85
|
| Rate for Payer: Priority Health SBD |
$332.87
|
| Rate for Payer: UMR Bronson Commercial |
$195.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.27
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
IP
|
$67.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.88 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna American Axle |
$44.15
|
| Rate for Payer: Aetna Commercial |
$57.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.15
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Healthscope Commercial |
$61.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.73
|
| Rate for Payer: PHP Commercial |
$57.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.54
|
| Rate for Payer: Priority Health SBD |
$42.79
|
| Rate for Payer: UMR Bronson Commercial |
$29.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.94
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
OP
|
$67.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna American Axle |
$44.15
|
| Rate for Payer: Aetna Commercial |
$57.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.15
|
| Rate for Payer: BCBS Complete |
$27.17
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Healthscope Commercial |
$61.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.73
|
| Rate for Payer: PHP Commercial |
$57.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.54
|
| Rate for Payer: Priority Health SBD |
$42.79
|
| Rate for Payer: UMR Bronson Commercial |
$25.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.94
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
IP
|
$11,625.00
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,115.00 |
| Max. Negotiated Rate |
$10,462.50 |
| Rate for Payer: Aetna American Axle |
$7,556.25
|
| Rate for Payer: Aetna Commercial |
$9,881.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,556.25
|
| Rate for Payer: Cash Price |
$9,300.00
|
| Rate for Payer: Cofinity Commercial |
$8,137.50
|
| Rate for Payer: Cofinity Commercial |
$9,997.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,300.00
|
| Rate for Payer: Healthscope Commercial |
$10,462.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,137.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,718.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,881.25
|
| Rate for Payer: PHP Commercial |
$9,881.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,137.50
|
| Rate for Payer: Priority Health SBD |
$7,323.75
|
| Rate for Payer: UMR Bronson Commercial |
$5,115.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,718.75
|
|
