|
HC COLPOSCOPY VAGINA W/O BIOPSY
|
Facility
|
OP
|
$422.48
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
76100254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.69 |
| Max. Negotiated Rate |
$936.74 |
| Rate for Payer: Aetna American Axle |
$274.61
|
| Rate for Payer: Aetna Commercial |
$359.11
|
| Rate for Payer: Aetna Medicare |
$309.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.55
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS MAPPO |
$298.04
|
| Rate for Payer: BCBS Trust/PPO |
$71.69
|
| Rate for Payer: BCN Commercial |
$71.69
|
| Rate for Payer: BCN Medicare Advantage |
$298.04
|
| Rate for Payer: Cash Price |
$337.98
|
| Rate for Payer: Cash Price |
$337.98
|
| Rate for Payer: Cash Price |
$337.98
|
| Rate for Payer: Cofinity Commercial |
$363.33
|
| Rate for Payer: Cofinity Commercial |
$295.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.04
|
| Rate for Payer: Healthscope Commercial |
$380.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.86
|
| Rate for Payer: Mclaren Medicaid |
$159.75
|
| Rate for Payer: Mclaren Medicare |
$298.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.94
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.11
|
| Rate for Payer: Nomi Health Commercial |
$625.88
|
| Rate for Payer: PACE Medicare |
$283.14
|
| Rate for Payer: PACE SWMI |
$298.04
|
| Rate for Payer: PHP Commercial |
$359.11
|
| Rate for Payer: PHP Medicare Advantage |
$298.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$936.74
|
| Rate for Payer: Priority Health Medicare |
$298.04
|
| Rate for Payer: Priority Health Narrow Network |
$749.39
|
| Rate for Payer: Priority Health SBD |
$266.16
|
| Rate for Payer: Railroad Medicare Medicare |
$298.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.85
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.04
|
| Rate for Payer: UHC Exchange |
$87.14
|
| Rate for Payer: UHC Medicare Advantage |
$298.04
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
| Rate for Payer: UMR Bronson Commercial |
$156.32
|
| Rate for Payer: VA VA |
$298.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.86
|
|
|
HC COLPOSCOPY, VULVA
|
Facility
|
OP
|
$328.77
|
|
|
Service Code
|
CPT 56820
|
| Hospital Charge Code |
76100258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$213.70
|
| Rate for Payer: Aetna Commercial |
$279.45
|
| Rate for Payer: Aetna Medicare |
$204.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$127.27
|
| Rate for Payer: BCN Commercial |
$127.27
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Cash Price |
$263.02
|
| Rate for Payer: Cash Price |
$263.02
|
| Rate for Payer: Cash Price |
$263.02
|
| Rate for Payer: Cofinity Commercial |
$282.74
|
| Rate for Payer: Cofinity Commercial |
$230.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$295.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.58
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.45
|
| Rate for Payer: Nomi Health Commercial |
$413.91
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Commercial |
$279.45
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.50
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$495.60
|
| Rate for Payer: Priority Health SBD |
$207.13
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$81.60
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: UMR Bronson Commercial |
$121.64
|
| Rate for Payer: VA VA |
$197.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.58
|
|
|
HC COLPOSCOPY, VULVA
|
Facility
|
IP
|
$328.77
|
|
|
Service Code
|
CPT 56820
|
| Hospital Charge Code |
76100258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.66 |
| Max. Negotiated Rate |
$295.89 |
| Rate for Payer: Aetna American Axle |
$213.70
|
| Rate for Payer: Aetna Commercial |
$279.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.70
|
| Rate for Payer: Cash Price |
$263.02
|
| Rate for Payer: Cofinity Commercial |
$230.14
|
| Rate for Payer: Cofinity Commercial |
$282.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.02
|
| Rate for Payer: Healthscope Commercial |
$295.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.45
|
| Rate for Payer: PHP Commercial |
$279.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.70
|
| Rate for Payer: Priority Health SBD |
$207.13
|
| Rate for Payer: UMR Bronson Commercial |
$144.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.58
|
|
|
HC COLPOSCOPY VULVA W/BIOPSY
|
Facility
|
IP
|
$854.17
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
76100332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.83 |
| Max. Negotiated Rate |
$768.75 |
| Rate for Payer: Aetna American Axle |
$555.21
|
| Rate for Payer: Aetna Commercial |
$726.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.21
|
| Rate for Payer: Cash Price |
$683.34
|
| Rate for Payer: Cofinity Commercial |
$597.92
|
| Rate for Payer: Cofinity Commercial |
$734.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$597.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.34
|
| Rate for Payer: Healthscope Commercial |
$768.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$640.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.04
|
| Rate for Payer: PHP Commercial |
$726.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.21
|
| Rate for Payer: Priority Health SBD |
$538.13
|
| Rate for Payer: UMR Bronson Commercial |
$375.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$640.63
|
|
|
HC COLPOSCOPY VULVA W/BIOPSY
|
Facility
|
OP
|
$854.17
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
76100332
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.31 |
| Max. Negotiated Rate |
$936.74 |
| Rate for Payer: Aetna American Axle |
$555.21
|
| Rate for Payer: Aetna Commercial |
$726.04
|
| Rate for Payer: Aetna Medicare |
$309.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.55
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS MAPPO |
$298.04
|
| Rate for Payer: BCBS Trust/PPO |
$88.31
|
| Rate for Payer: BCN Commercial |
$88.31
|
| Rate for Payer: BCN Medicare Advantage |
$298.04
|
| Rate for Payer: Cash Price |
$683.34
|
| Rate for Payer: Cash Price |
$683.34
|
| Rate for Payer: Cash Price |
$683.34
|
| Rate for Payer: Cofinity Commercial |
$734.59
|
| Rate for Payer: Cofinity Commercial |
$597.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$597.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$683.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.04
|
| Rate for Payer: Healthscope Commercial |
$768.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$597.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$640.63
|
| Rate for Payer: Mclaren Medicaid |
$159.75
|
| Rate for Payer: Mclaren Medicare |
$298.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.94
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.04
|
| Rate for Payer: Nomi Health Commercial |
$625.88
|
| Rate for Payer: PACE Medicare |
$283.14
|
| Rate for Payer: PACE SWMI |
$298.04
|
| Rate for Payer: PHP Commercial |
$726.04
|
| Rate for Payer: PHP Medicare Advantage |
$298.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$936.74
|
| Rate for Payer: Priority Health Medicare |
$298.04
|
| Rate for Payer: Priority Health Narrow Network |
$749.39
|
| Rate for Payer: Priority Health SBD |
$538.13
|
| Rate for Payer: Railroad Medicare Medicare |
$298.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.44
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.04
|
| Rate for Payer: UHC Exchange |
$110.40
|
| Rate for Payer: UHC Medicare Advantage |
$298.04
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
| Rate for Payer: UMR Bronson Commercial |
$316.04
|
| Rate for Payer: VA VA |
$298.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$640.63
|
|
|
HC COMBI CATH SUPPLY
|
Facility
|
OP
|
$123.46
|
|
| Hospital Charge Code |
27200116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.68 |
| Max. Negotiated Rate |
$111.11 |
| Rate for Payer: Aetna American Axle |
$80.25
|
| Rate for Payer: Aetna Commercial |
$104.94
|
| Rate for Payer: Aetna Medicare |
$61.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.25
|
| Rate for Payer: BCBS Complete |
$49.38
|
| Rate for Payer: Cash Price |
$98.77
|
| Rate for Payer: Cofinity Commercial |
$106.18
|
| Rate for Payer: Cofinity Commercial |
$86.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.77
|
| Rate for Payer: Healthscope Commercial |
$111.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.94
|
| Rate for Payer: PHP Commercial |
$104.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.25
|
| Rate for Payer: Priority Health SBD |
$77.78
|
| Rate for Payer: UMR Bronson Commercial |
$45.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.60
|
|
|
HC COMBI CATH SUPPLY
|
Facility
|
IP
|
$123.46
|
|
| Hospital Charge Code |
27200116
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$111.11 |
| Rate for Payer: Aetna American Axle |
$80.25
|
| Rate for Payer: Aetna Commercial |
$104.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.25
|
| Rate for Payer: Cash Price |
$98.77
|
| Rate for Payer: Cofinity Commercial |
$106.18
|
| Rate for Payer: Cofinity Commercial |
$86.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.77
|
| Rate for Payer: Healthscope Commercial |
$111.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.94
|
| Rate for Payer: PHP Commercial |
$104.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.25
|
| Rate for Payer: Priority Health SBD |
$77.78
|
| Rate for Payer: UMR Bronson Commercial |
$54.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.60
|
|
|
HC COMBINED VACCINE, MMR+VARICELLA, SUBQ
|
Facility
|
OP
|
$213.28
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
63600206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.91 |
| Max. Negotiated Rate |
$723.02 |
| Rate for Payer: Aetna American Axle |
$138.63
|
| Rate for Payer: Aetna Commercial |
$181.29
|
| Rate for Payer: Aetna Medicare |
$106.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.63
|
| Rate for Payer: BCBS Complete |
$85.31
|
| Rate for Payer: BCBS Trust/PPO |
$723.02
|
| Rate for Payer: BCN Commercial |
$723.02
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$149.30
|
| Rate for Payer: Cofinity Commercial |
$183.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Healthscope Commercial |
$191.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: PHP Commercial |
$181.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health SBD |
$134.37
|
| Rate for Payer: UMR Bronson Commercial |
$78.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.96
|
|
|
HC COMBINED VACCINE, MMR+VARICELLA, SUBQ
|
Facility
|
IP
|
$213.28
|
|
|
Service Code
|
CPT 90710
|
| Hospital Charge Code |
63600206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$191.95 |
| Rate for Payer: Aetna American Axle |
$138.63
|
| Rate for Payer: Aetna Commercial |
$181.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.63
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$149.30
|
| Rate for Payer: Cofinity Commercial |
$183.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Healthscope Commercial |
$191.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: PHP Commercial |
$181.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health SBD |
$134.37
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.96
|
|
|
HC COMMON REED IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200080
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC COMMON REED IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200080
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC COMM WORK REINTEGRATION EA 15 MIN
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$62.98
|
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$48.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: BCBS Complete |
$38.76
|
| Rate for Payer: BCBS Trust/PPO |
$25.69
|
| Rate for Payer: BCN Commercial |
$25.69
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.00
|
| Rate for Payer: Priority Health Narrow Network |
$21.60
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.80
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$29.82
|
| Rate for Payer: UMR Bronson Commercial |
$35.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.68
|
|
|
HC COMM WORK REINTEGRATION EA 15 MIN
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.64 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna American Axle |
$62.98
|
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: UMR Bronson Commercial |
$42.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.68
|
|
|
HC COMPARTMENT PRESSURE CHECK
|
Facility
|
OP
|
$658.62
|
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$243.69 |
| Max. Negotiated Rate |
$592.76 |
| Rate for Payer: Aetna American Axle |
$428.10
|
| Rate for Payer: Aetna Commercial |
$559.83
|
| Rate for Payer: Aetna Medicare |
$329.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.10
|
| Rate for Payer: BCBS Complete |
$263.45
|
| Rate for Payer: Cash Price |
$526.90
|
| Rate for Payer: Cofinity Commercial |
$461.03
|
| Rate for Payer: Cofinity Commercial |
$566.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$461.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.90
|
| Rate for Payer: Healthscope Commercial |
$592.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$461.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.83
|
| Rate for Payer: PHP Commercial |
$559.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.10
|
| Rate for Payer: Priority Health SBD |
$414.93
|
| Rate for Payer: UMR Bronson Commercial |
$243.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.96
|
|
|
HC COMPARTMENT PRESSURE CHECK
|
Facility
|
IP
|
$658.62
|
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$289.79 |
| Max. Negotiated Rate |
$592.76 |
| Rate for Payer: Aetna American Axle |
$428.10
|
| Rate for Payer: Aetna Commercial |
$559.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.10
|
| Rate for Payer: Cash Price |
$526.90
|
| Rate for Payer: Cofinity Commercial |
$461.03
|
| Rate for Payer: Cofinity Commercial |
$566.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$461.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.90
|
| Rate for Payer: Healthscope Commercial |
$592.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$461.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.83
|
| Rate for Payer: PHP Commercial |
$559.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.10
|
| Rate for Payer: Priority Health SBD |
$414.93
|
| Rate for Payer: UMR Bronson Commercial |
$289.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.96
|
|
|
HC COMP BURN GARM 2 LEGS-WAIST
|
Facility
|
IP
|
$238.68
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.02 |
| Max. Negotiated Rate |
$214.81 |
| Rate for Payer: Aetna American Axle |
$155.14
|
| Rate for Payer: Aetna Commercial |
$202.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.14
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cofinity Commercial |
$167.08
|
| Rate for Payer: Cofinity Commercial |
$205.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.94
|
| Rate for Payer: Healthscope Commercial |
$214.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.88
|
| Rate for Payer: PHP Commercial |
$202.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.14
|
| Rate for Payer: Priority Health SBD |
$150.37
|
| Rate for Payer: UMR Bronson Commercial |
$105.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.01
|
|
|
HC COMP BURN GARM 2 LEGS-WAIST
|
Facility
|
OP
|
$238.68
|
|
|
Service Code
|
HCPCS A6511
|
| Hospital Charge Code |
98300142
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.31 |
| Max. Negotiated Rate |
$285.81 |
| Rate for Payer: Aetna American Axle |
$155.14
|
| Rate for Payer: Aetna Commercial |
$202.88
|
| Rate for Payer: Aetna Medicare |
$119.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.14
|
| Rate for Payer: BCBS Complete |
$95.47
|
| Rate for Payer: BCBS Trust/PPO |
$285.81
|
| Rate for Payer: BCN Commercial |
$285.81
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cash Price |
$190.94
|
| Rate for Payer: Cofinity Commercial |
$167.08
|
| Rate for Payer: Cofinity Commercial |
$205.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.94
|
| Rate for Payer: Healthscope Commercial |
$214.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.88
|
| Rate for Payer: PHP Commercial |
$202.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.14
|
| Rate for Payer: Priority Health SBD |
$150.37
|
| Rate for Payer: UMR Bronson Commercial |
$88.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.01
|
|
|
HC COMP BURN GARM 2 OR MORE FAB/C
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC COMP BURN GARM 2 OR MORE FAB/C
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300143
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna American Axle |
$7.96
|
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC COMP BURN GARM ABD REINFOR DBL
|
Facility
|
IP
|
$16.32
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna American Axle |
$10.61
|
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health SBD |
$10.28
|
| Rate for Payer: UMR Bronson Commercial |
$7.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
|
|
HC COMP BURN GARM ABD REINFOR DBL
|
Facility
|
OP
|
$16.32
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300144
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$10.61
|
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health SBD |
$10.28
|
| Rate for Payer: UMR Bronson Commercial |
$6.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
|
|
HC COMP BURN GARM ANKLET
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna American Axle |
$41.11
|
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$44.27
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health SBD |
$39.84
|
| Rate for Payer: UMR Bronson Commercial |
$27.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC COMP BURN GARM ANKLET
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
HCPCS A6512
|
| Hospital Charge Code |
98300145
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$414.43 |
| Rate for Payer: Aetna American Axle |
$41.11
|
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS Trust/PPO |
$414.43
|
| Rate for Payer: BCN Commercial |
$414.43
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$44.27
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health SBD |
$39.84
|
| Rate for Payer: UMR Bronson Commercial |
$23.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC COMP BURN GARM BDY BRF SLVD LE
|
Facility
|
IP
|
$338.64
|
|
|
Service Code
|
HCPCS A6510
|
| Hospital Charge Code |
98300146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$304.78 |
| Rate for Payer: Aetna American Axle |
$220.12
|
| Rate for Payer: Aetna Commercial |
$287.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.12
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$237.05
|
| Rate for Payer: Cofinity Commercial |
$291.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Healthscope Commercial |
$304.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.84
|
| Rate for Payer: PHP Commercial |
$287.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: Priority Health SBD |
$213.34
|
| Rate for Payer: UMR Bronson Commercial |
$149.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.98
|
|
|
HC COMP BURN GARM BDY BRF SLVD LE
|
Facility
|
OP
|
$338.64
|
|
|
Service Code
|
HCPCS A6510
|
| Hospital Charge Code |
98300146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$125.30 |
| Max. Negotiated Rate |
$523.99 |
| Rate for Payer: Aetna American Axle |
$220.12
|
| Rate for Payer: Aetna Commercial |
$287.84
|
| Rate for Payer: Aetna Medicare |
$169.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.12
|
| Rate for Payer: BCBS Complete |
$135.46
|
| Rate for Payer: BCBS Trust/PPO |
$523.99
|
| Rate for Payer: BCN Commercial |
$523.99
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$237.05
|
| Rate for Payer: Cofinity Commercial |
$291.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Healthscope Commercial |
$304.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.84
|
| Rate for Payer: PHP Commercial |
$287.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: Priority Health SBD |
$213.34
|
| Rate for Payer: UMR Bronson Commercial |
$125.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.98
|
|
