|
HC ELECTROPHYSIOLOGY PACK
|
Facility
|
IP
|
$266.93
|
|
| Hospital Charge Code |
62200002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$117.45 |
| Max. Negotiated Rate |
$240.24 |
| Rate for Payer: Aetna American Axle |
$173.50
|
| Rate for Payer: Aetna Commercial |
$226.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.50
|
| Rate for Payer: Cash Price |
$213.54
|
| Rate for Payer: Cofinity Commercial |
$186.85
|
| Rate for Payer: Cofinity Commercial |
$229.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$186.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.54
|
| Rate for Payer: Healthscope Commercial |
$240.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$186.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.89
|
| Rate for Payer: PHP Commercial |
$226.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.50
|
| Rate for Payer: Priority Health SBD |
$168.17
|
| Rate for Payer: UMR Bronson Commercial |
$117.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.20
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
OP
|
$27,014.28
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,966.68 |
| Max. Negotiated Rate |
$24,312.85 |
| Rate for Payer: Aetna American Axle |
$17,559.28
|
| Rate for Payer: Aetna Commercial |
$22,962.14
|
| Rate for Payer: Aetna Medicare |
$7,696.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,559.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,250.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,250.65
|
| Rate for Payer: BCBS Complete |
$4,165.01
|
| Rate for Payer: BCBS MAPPO |
$7,400.52
|
| Rate for Payer: BCN Medicare Advantage |
$7,400.52
|
| Rate for Payer: Cash Price |
$21,611.42
|
| Rate for Payer: Cash Price |
$21,611.42
|
| Rate for Payer: Cofinity Commercial |
$23,232.28
|
| Rate for Payer: Cofinity Commercial |
$18,910.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,910.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,611.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,400.52
|
| Rate for Payer: Healthscope Commercial |
$24,312.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,910.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,260.71
|
| Rate for Payer: Mclaren Medicaid |
$3,966.68
|
| Rate for Payer: Mclaren Medicare |
$7,400.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,770.55
|
| Rate for Payer: Meridian Medicaid |
$4,165.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,510.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,962.14
|
| Rate for Payer: PACE Medicare |
$7,030.49
|
| Rate for Payer: PACE SWMI |
$7,400.52
|
| Rate for Payer: PHP Commercial |
$22,962.14
|
| Rate for Payer: PHP Medicare Advantage |
$7,400.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,966.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,559.28
|
| Rate for Payer: Priority Health Medicare |
$7,400.52
|
| Rate for Payer: Priority Health SBD |
$17,019.00
|
| Rate for Payer: Railroad Medicare Medicare |
$7,400.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,831.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,400.52
|
| Rate for Payer: UHC Exchange |
$14,143.13
|
| Rate for Payer: UHC Medicare Advantage |
$7,400.52
|
| Rate for Payer: UHCCP Medicaid |
$3,966.68
|
| Rate for Payer: UMR Bronson Commercial |
$9,995.28
|
| Rate for Payer: VA VA |
$7,400.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,260.71
|
|
|
HC ELECTROPHYSIOLOGY STUDY
|
Facility
|
IP
|
$27,014.28
|
|
|
Service Code
|
CPT 93620
|
| Hospital Charge Code |
48100037
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,886.28 |
| Max. Negotiated Rate |
$24,312.85 |
| Rate for Payer: Aetna American Axle |
$17,559.28
|
| Rate for Payer: Aetna Commercial |
$22,962.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,559.28
|
| Rate for Payer: Cash Price |
$21,611.42
|
| Rate for Payer: Cofinity Commercial |
$18,910.00
|
| Rate for Payer: Cofinity Commercial |
$23,232.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,910.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,611.42
|
| Rate for Payer: Healthscope Commercial |
$24,312.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,910.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,260.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,962.14
|
| Rate for Payer: PHP Commercial |
$22,962.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,559.28
|
| Rate for Payer: Priority Health SBD |
$17,019.00
|
| Rate for Payer: UMR Bronson Commercial |
$11,886.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,260.71
|
|
|
HC ELM IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
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 |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| 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: 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 Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$9.98
|
| 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 ELM IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200042
|
|
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 ELVAREX CHAP STYLE ONE LEG
|
Facility
|
IP
|
$584.55
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$257.20 |
| Max. Negotiated Rate |
$526.10 |
| Rate for Payer: Aetna American Axle |
$379.96
|
| Rate for Payer: Aetna Commercial |
$496.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.96
|
| Rate for Payer: Cash Price |
$467.64
|
| Rate for Payer: Cofinity Commercial |
$409.19
|
| Rate for Payer: Cofinity Commercial |
$502.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$409.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.64
|
| Rate for Payer: Healthscope Commercial |
$526.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$409.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.87
|
| Rate for Payer: PHP Commercial |
$496.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.96
|
| Rate for Payer: Priority Health SBD |
$368.27
|
| Rate for Payer: UMR Bronson Commercial |
$257.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.41
|
|
|
HC ELVAREX CHAP STYLE ONE LEG
|
Facility
|
OP
|
$584.55
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000368
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$216.28 |
| Max. Negotiated Rate |
$526.10 |
| Rate for Payer: Aetna American Axle |
$379.96
|
| Rate for Payer: Aetna Commercial |
$496.87
|
| Rate for Payer: Aetna Medicare |
$292.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.96
|
| Rate for Payer: BCBS Complete |
$233.82
|
| Rate for Payer: Cash Price |
$467.64
|
| Rate for Payer: Cofinity Commercial |
$409.19
|
| Rate for Payer: Cofinity Commercial |
$502.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$409.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.64
|
| Rate for Payer: Healthscope Commercial |
$526.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$409.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.87
|
| Rate for Payer: PHP Commercial |
$496.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.96
|
| Rate for Payer: Priority Health SBD |
$368.27
|
| Rate for Payer: UMR Bronson Commercial |
$216.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.41
|
|
|
HC ELVAREX CHAP STYLE TWO LEG
|
Facility
|
OP
|
$1,169.07
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$432.56 |
| Max. Negotiated Rate |
$1,052.16 |
| Rate for Payer: Aetna American Axle |
$759.90
|
| Rate for Payer: Aetna Commercial |
$993.71
|
| Rate for Payer: Aetna Medicare |
$584.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.90
|
| Rate for Payer: BCBS Complete |
$467.63
|
| Rate for Payer: Cash Price |
$935.26
|
| Rate for Payer: Cofinity Commercial |
$1,005.40
|
| Rate for Payer: Cofinity Commercial |
$818.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$818.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.26
|
| Rate for Payer: Healthscope Commercial |
$1,052.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$818.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$876.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.71
|
| Rate for Payer: PHP Commercial |
$993.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.90
|
| Rate for Payer: Priority Health SBD |
$736.51
|
| Rate for Payer: UMR Bronson Commercial |
$432.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$876.80
|
|
|
HC ELVAREX CHAP STYLE TWO LEG
|
Facility
|
IP
|
$1,169.07
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000369
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$514.39 |
| Max. Negotiated Rate |
$1,052.16 |
| Rate for Payer: Aetna American Axle |
$759.90
|
| Rate for Payer: Aetna Commercial |
$993.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.90
|
| Rate for Payer: Cash Price |
$935.26
|
| Rate for Payer: Cofinity Commercial |
$1,005.40
|
| Rate for Payer: Cofinity Commercial |
$818.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$818.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$935.26
|
| Rate for Payer: Healthscope Commercial |
$1,052.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$818.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$876.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$993.71
|
| Rate for Payer: PHP Commercial |
$993.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.90
|
| Rate for Payer: Priority Health SBD |
$736.51
|
| Rate for Payer: UMR Bronson Commercial |
$514.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$876.80
|
|
|
HC ELVAREX KNEE SLANT OPEN TOE
|
Facility
|
OP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.15 |
| Max. Negotiated Rate |
$258.19 |
| Rate for Payer: Aetna American Axle |
$186.47
|
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna Medicare |
$143.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.47
|
| Rate for Payer: BCBS Complete |
$114.75
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health SBD |
$180.73
|
| Rate for Payer: UMR Bronson Commercial |
$106.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.16
|
|
|
HC ELVAREX KNEE SLANT OPEN TOE
|
Facility
|
IP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000366
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.23 |
| Max. Negotiated Rate |
$258.19 |
| Rate for Payer: Aetna American Axle |
$186.47
|
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.47
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health SBD |
$180.73
|
| Rate for Payer: UMR Bronson Commercial |
$126.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.16
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
OP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Aetna American Axle |
$165.48
|
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.48
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$178.21
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health SBD |
$160.39
|
| Rate for Payer: UMR Bronson Commercial |
$94.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.94
|
|
|
HC ELVAREX SLEEVE
|
Facility
|
IP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000365
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.02 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Aetna American Axle |
$165.48
|
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.48
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$178.21
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health SBD |
$160.39
|
| Rate for Payer: UMR Bronson Commercial |
$112.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.94
|
|
|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
IP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.02 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Aetna American Axle |
$165.48
|
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.48
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$178.21
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health SBD |
$160.39
|
| Rate for Payer: UMR Bronson Commercial |
$112.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.94
|
|
|
HC ELVAREX SOFT ARMSLEEVE
|
Facility
|
OP
|
$254.59
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000372
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.20 |
| Max. Negotiated Rate |
$229.13 |
| Rate for Payer: Aetna American Axle |
$165.48
|
| Rate for Payer: Aetna Commercial |
$216.40
|
| Rate for Payer: Aetna Medicare |
$127.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.48
|
| Rate for Payer: BCBS Complete |
$101.84
|
| Rate for Payer: Cash Price |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$178.21
|
| Rate for Payer: Cofinity Commercial |
$218.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.67
|
| Rate for Payer: Healthscope Commercial |
$229.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.40
|
| Rate for Payer: PHP Commercial |
$216.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.48
|
| Rate for Payer: Priority Health SBD |
$160.39
|
| Rate for Payer: UMR Bronson Commercial |
$94.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.94
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
OP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$106.15 |
| Max. Negotiated Rate |
$258.19 |
| Rate for Payer: Aetna American Axle |
$186.47
|
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna Medicare |
$143.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.47
|
| Rate for Payer: BCBS Complete |
$114.75
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health SBD |
$180.73
|
| Rate for Payer: UMR Bronson Commercial |
$106.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.16
|
|
|
HC ELVAREX SOFT KNEE CLOSED T
|
Facility
|
IP
|
$286.88
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.23 |
| Max. Negotiated Rate |
$258.19 |
| Rate for Payer: Aetna American Axle |
$186.47
|
| Rate for Payer: Aetna Commercial |
$243.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.47
|
| Rate for Payer: Cash Price |
$229.50
|
| Rate for Payer: Cofinity Commercial |
$200.82
|
| Rate for Payer: Cofinity Commercial |
$246.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$258.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.85
|
| Rate for Payer: PHP Commercial |
$243.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.47
|
| Rate for Payer: Priority Health SBD |
$180.73
|
| Rate for Payer: UMR Bronson Commercial |
$126.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.16
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
OP
|
$419.62
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$155.26 |
| Max. Negotiated Rate |
$377.66 |
| Rate for Payer: Aetna American Axle |
$272.75
|
| Rate for Payer: Aetna Commercial |
$356.68
|
| Rate for Payer: Aetna Medicare |
$209.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.75
|
| Rate for Payer: BCBS Complete |
$167.85
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cofinity Commercial |
$293.73
|
| Rate for Payer: Cofinity Commercial |
$360.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.70
|
| Rate for Payer: Healthscope Commercial |
$377.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.68
|
| Rate for Payer: PHP Commercial |
$356.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.75
|
| Rate for Payer: Priority Health SBD |
$264.36
|
| Rate for Payer: UMR Bronson Commercial |
$155.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.71
|
|
|
HC ELVAREX THIGH SLANT OPEN TOE
|
Facility
|
IP
|
$419.62
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$184.63 |
| Max. Negotiated Rate |
$377.66 |
| Rate for Payer: Aetna American Axle |
$272.75
|
| Rate for Payer: Aetna Commercial |
$356.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.75
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cofinity Commercial |
$293.73
|
| Rate for Payer: Cofinity Commercial |
$360.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.70
|
| Rate for Payer: Healthscope Commercial |
$377.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.68
|
| Rate for Payer: PHP Commercial |
$356.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.75
|
| Rate for Payer: Priority Health SBD |
$264.36
|
| Rate for Payer: UMR Bronson Commercial |
$184.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.71
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
IP
|
$538.93
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$237.13 |
| Max. Negotiated Rate |
$485.04 |
| Rate for Payer: Aetna American Axle |
$350.30
|
| Rate for Payer: Aetna Commercial |
$458.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.30
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$377.25
|
| Rate for Payer: Cofinity Commercial |
$463.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$377.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.14
|
| Rate for Payer: Healthscope Commercial |
$485.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$377.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$404.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.09
|
| Rate for Payer: PHP Commercial |
$458.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.30
|
| Rate for Payer: Priority Health SBD |
$339.53
|
| Rate for Payer: UMR Bronson Commercial |
$237.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$404.20
|
|
|
HC ELVAREX WAIST HIGH PRESSURE
|
Facility
|
OP
|
$538.93
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
27000370
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$199.40 |
| Max. Negotiated Rate |
$485.04 |
| Rate for Payer: Aetna American Axle |
$350.30
|
| Rate for Payer: Aetna Commercial |
$458.09
|
| Rate for Payer: Aetna Medicare |
$269.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.30
|
| Rate for Payer: BCBS Complete |
$215.57
|
| Rate for Payer: Cash Price |
$431.14
|
| Rate for Payer: Cofinity Commercial |
$377.25
|
| Rate for Payer: Cofinity Commercial |
$463.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$377.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.14
|
| Rate for Payer: Healthscope Commercial |
$485.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$377.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$404.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.09
|
| Rate for Payer: PHP Commercial |
$458.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.30
|
| Rate for Payer: Priority Health SBD |
$339.53
|
| Rate for Payer: UMR Bronson Commercial |
$199.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$404.20
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
OP
|
$69.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Aetna American Axle |
$45.03
|
| Rate for Payer: Aetna Commercial |
$58.89
|
| Rate for Payer: Aetna Medicare |
$34.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.03
|
| Rate for Payer: BCBS Complete |
$27.71
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$59.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.42
|
| Rate for Payer: Healthscope Commercial |
$62.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.89
|
| Rate for Payer: PHP Commercial |
$58.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.03
|
| Rate for Payer: Priority Health SBD |
$43.65
|
| Rate for Payer: UMR Bronson Commercial |
$25.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.96
|
|
|
HC ELVAREX ZIPPER
|
Facility
|
IP
|
$69.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000371
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Aetna American Axle |
$45.03
|
| Rate for Payer: Aetna Commercial |
$58.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.03
|
| Rate for Payer: Cash Price |
$55.42
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Cofinity Commercial |
$59.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.42
|
| Rate for Payer: Healthscope Commercial |
$62.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.89
|
| Rate for Payer: PHP Commercial |
$58.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.03
|
| Rate for Payer: Priority Health SBD |
$43.65
|
| Rate for Payer: UMR Bronson Commercial |
$30.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.96
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
OP
|
$11,857.50
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,387.27 |
| Max. Negotiated Rate |
$10,671.75 |
| Rate for Payer: Aetna American Axle |
$7,707.38
|
| Rate for Payer: Aetna Commercial |
$10,078.88
|
| Rate for Payer: Aetna Medicare |
$5,928.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,707.38
|
| Rate for Payer: BCBS Complete |
$4,743.00
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cofinity Commercial |
$10,197.45
|
| Rate for Payer: Cofinity Commercial |
$8,300.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,300.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,486.00
|
| Rate for Payer: Healthscope Commercial |
$10,671.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,300.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,893.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,078.88
|
| Rate for Payer: PHP Commercial |
$10,078.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,707.38
|
| Rate for Payer: Priority Health SBD |
$7,470.23
|
| Rate for Payer: UMR Bronson Commercial |
$4,387.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,893.12
|
|
|
HC EMBOLIC GLUE LVL
|
Facility
|
IP
|
$11,857.50
|
|
| Hospital Charge Code |
27800128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,217.30 |
| Max. Negotiated Rate |
$10,671.75 |
| Rate for Payer: Aetna American Axle |
$7,707.38
|
| Rate for Payer: Aetna Commercial |
$10,078.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,707.38
|
| Rate for Payer: Cash Price |
$9,486.00
|
| Rate for Payer: Cofinity Commercial |
$10,197.45
|
| Rate for Payer: Cofinity Commercial |
$8,300.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,300.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,486.00
|
| Rate for Payer: Healthscope Commercial |
$10,671.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,300.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,893.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,078.88
|
| Rate for Payer: PHP Commercial |
$10,078.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,707.38
|
| Rate for Payer: Priority Health SBD |
$7,470.23
|
| Rate for Payer: UMR Bronson Commercial |
$5,217.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,893.12
|
|
