|
HC MASTECTOMY SLEEVE EA $150
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna American Axle |
$97.50
|
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health SBD |
$94.50
|
| Rate for Payer: UMR Bronson Commercial |
$66.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC MASTECTOMY SLEEVE EA $175
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna American Axle |
$113.75
|
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: UMR Bronson Commercial |
$77.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
HC MASTECTOMY SLEEVE EA $175
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000007
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$161.76 |
| Rate for Payer: Aetna American Axle |
$113.75
|
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: UMR Bronson Commercial |
$64.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
HC MASTECTOMY SLEEVE EA $200
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna American Axle |
$130.00
|
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: UMR Bronson Commercial |
$74.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
HC MASTECTOMY SLEEVE EA $200
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000008
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna American Axle |
$130.00
|
| Rate for Payer: Aetna Commercial |
$170.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$172.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$180.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.00
|
| Rate for Payer: PHP Commercial |
$170.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health SBD |
$126.00
|
| Rate for Payer: UMR Bronson Commercial |
$88.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.00
|
|
|
HC MASTECTOMY SLEEVE EA $225
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000009
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.00 |
| 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: 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 |
$99.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
|
HC MASTECTOMY SLEEVE EA $225
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000009
|
|
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: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$180.00
|
| 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 MASTECTOMY SLEEVE EA $250
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna American Axle |
$162.50
|
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$175.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health SBD |
$157.50
|
| Rate for Payer: UMR Bronson Commercial |
$110.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC MASTECTOMY SLEEVE EA $250
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna American Axle |
$162.50
|
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.50
|
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$175.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health SBD |
$157.50
|
| Rate for Payer: UMR Bronson Commercial |
$92.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC MASTECTOMY SLEEVE EA $275
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UMR Bronson Commercial |
$121.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC MASTECTOMY SLEEVE EA $275
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$101.75 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UMR Bronson Commercial |
$101.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC MASTECTOMY SLEEVE EA $300
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000012
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UMR Bronson Commercial |
$111.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC MASTECTOMY SLEEVE EA $300
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000012
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UMR Bronson Commercial |
$132.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC MASTECTOMY SLEEVE EA $325
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000013
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna American Axle |
$211.25
|
| Rate for Payer: Aetna Commercial |
$276.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.25
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$227.50
|
| Rate for Payer: Cofinity Commercial |
$279.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Healthscope Commercial |
$292.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.25
|
| Rate for Payer: PHP Commercial |
$276.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health SBD |
$204.75
|
| Rate for Payer: UMR Bronson Commercial |
$120.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.75
|
|
|
HC MASTECTOMY SLEEVE EA $325
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000013
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna American Axle |
$211.25
|
| Rate for Payer: Aetna Commercial |
$276.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.25
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$227.50
|
| Rate for Payer: Cofinity Commercial |
$279.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Healthscope Commercial |
$292.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.25
|
| Rate for Payer: PHP Commercial |
$276.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health SBD |
$204.75
|
| Rate for Payer: UMR Bronson Commercial |
$143.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.75
|
|
|
HC MASTECTOMY SLEEVE EA $350
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000014
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna American Axle |
$227.50
|
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.50
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health SBD |
$220.50
|
| Rate for Payer: UMR Bronson Commercial |
$154.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
|
HC MASTECTOMY SLEEVE EA $350
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000014
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$129.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna American Axle |
$227.50
|
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.50
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health SBD |
$220.50
|
| Rate for Payer: UMR Bronson Commercial |
$129.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
|
HC MASTECTOMY SLEEVE EA $375
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna American Axle |
$243.75
|
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health SBD |
$236.25
|
| Rate for Payer: UMR Bronson Commercial |
$165.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
|
|
HC MASTECTOMY SLEEVE EA $375
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna American Axle |
$243.75
|
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: BCBS Complete |
$150.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health SBD |
$236.25
|
| Rate for Payer: UMR Bronson Commercial |
$138.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
|
|
HC MASTECTOMY SLEEVE EA $40
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$161.76 |
| Rate for Payer: Aetna American Axle |
$26.00
|
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health SBD |
$25.20
|
| Rate for Payer: UMR Bronson Commercial |
$14.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC MASTECTOMY SLEEVE EA $40
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna American Axle |
$26.00
|
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health SBD |
$25.20
|
| Rate for Payer: UMR Bronson Commercial |
$17.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC MASTECTOMY SLEEVE EA $400
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna American Axle |
$260.00
|
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.00
|
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health SBD |
$252.00
|
| Rate for Payer: UMR Bronson Commercial |
$148.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
HC MASTECTOMY SLEEVE EA $400
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna American Axle |
$260.00
|
| Rate for Payer: Aetna Commercial |
$340.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$344.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.00
|
| Rate for Payer: PHP Commercial |
$340.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health SBD |
$252.00
|
| Rate for Payer: UMR Bronson Commercial |
$176.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.00
|
|
|
HC MASTECTOMY SLEEVE EA $425
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$187.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna American Axle |
$276.25
|
| Rate for Payer: Aetna Commercial |
$361.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.25
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$297.50
|
| Rate for Payer: Cofinity Commercial |
$365.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.00
|
| Rate for Payer: Healthscope Commercial |
$382.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.25
|
| Rate for Payer: PHP Commercial |
$361.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.50
|
| Rate for Payer: Priority Health SBD |
$267.75
|
| Rate for Payer: UMR Bronson Commercial |
$187.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.75
|
|
|
HC MASTECTOMY SLEEVE EA $425
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Aetna American Axle |
$276.25
|
| Rate for Payer: Aetna Commercial |
$361.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.25
|
| Rate for Payer: BCBS Complete |
$170.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.76
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cofinity Commercial |
$297.50
|
| Rate for Payer: Cofinity Commercial |
$365.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.00
|
| Rate for Payer: Healthscope Commercial |
$382.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.25
|
| Rate for Payer: PHP Commercial |
$361.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.50
|
| Rate for Payer: Priority Health SBD |
$267.75
|
| Rate for Payer: UMR Bronson Commercial |
$157.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.75
|
|
