|
HC FNA BX 1ST LESION US GUIDE
|
Facility
|
OP
|
$1,068.55
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
36100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna American Axle |
$694.56
|
| Rate for Payer: Aetna Commercial |
$908.27
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$694.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$854.84
|
| Rate for Payer: Cash Price |
$854.84
|
| Rate for Payer: Cofinity Commercial |
$918.95
|
| Rate for Payer: Cofinity Commercial |
$747.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$747.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$854.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$961.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$747.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$801.41
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.27
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$908.27
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.56
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$673.19
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: UMR Bronson Commercial |
$395.36
|
| Rate for Payer: VA VA |
$686.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$801.41
|
|
|
HC FNA BX EACH ADDL CT GUIDE
|
Facility
|
OP
|
$150.86
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
36100559
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.82 |
| Max. Negotiated Rate |
$135.77 |
| Rate for Payer: Aetna American Axle |
$98.06
|
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Medicare |
$75.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.06
|
| Rate for Payer: BCBS Complete |
$60.34
|
| Rate for Payer: Cash Price |
$120.69
|
| Rate for Payer: Cofinity Commercial |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$129.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.69
|
| Rate for Payer: Healthscope Commercial |
$135.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.23
|
| Rate for Payer: PHP Commercial |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.06
|
| Rate for Payer: Priority Health SBD |
$95.04
|
| Rate for Payer: UMR Bronson Commercial |
$55.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.14
|
|
|
HC FNA BX EACH ADDL CT GUIDE
|
Facility
|
IP
|
$150.86
|
|
|
Service Code
|
CPT 10010
|
| Hospital Charge Code |
36100559
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$66.38 |
| Max. Negotiated Rate |
$135.77 |
| Rate for Payer: Aetna American Axle |
$98.06
|
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.06
|
| Rate for Payer: Cash Price |
$120.69
|
| Rate for Payer: Cofinity Commercial |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$129.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.69
|
| Rate for Payer: Healthscope Commercial |
$135.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.23
|
| Rate for Payer: PHP Commercial |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.06
|
| Rate for Payer: Priority Health SBD |
$95.04
|
| Rate for Payer: UMR Bronson Commercial |
$66.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.14
|
|
|
HC FNA BX EACH ADDL FLUORO GUIDE
|
Facility
|
IP
|
$165.94
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
36100557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$149.35 |
| Rate for Payer: Aetna American Axle |
$107.86
|
| Rate for Payer: Aetna Commercial |
$141.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.86
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cofinity Commercial |
$116.16
|
| Rate for Payer: Cofinity Commercial |
$142.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.75
|
| Rate for Payer: Healthscope Commercial |
$149.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.05
|
| Rate for Payer: PHP Commercial |
$141.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.86
|
| Rate for Payer: Priority Health SBD |
$104.54
|
| Rate for Payer: UMR Bronson Commercial |
$73.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.45
|
|
|
HC FNA BX EACH ADDL FLUORO GUIDE
|
Facility
|
OP
|
$165.94
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
36100557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.40 |
| Max. Negotiated Rate |
$149.35 |
| Rate for Payer: Aetna American Axle |
$107.86
|
| Rate for Payer: Aetna Commercial |
$141.05
|
| Rate for Payer: Aetna Medicare |
$82.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.86
|
| Rate for Payer: BCBS Complete |
$66.38
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cofinity Commercial |
$116.16
|
| Rate for Payer: Cofinity Commercial |
$142.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.75
|
| Rate for Payer: Healthscope Commercial |
$149.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.05
|
| Rate for Payer: PHP Commercial |
$141.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.86
|
| Rate for Payer: Priority Health SBD |
$104.54
|
| Rate for Payer: UMR Bronson Commercial |
$61.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.45
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
IP
|
$214.75
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.49 |
| Max. Negotiated Rate |
$193.28 |
| Rate for Payer: Aetna American Axle |
$139.59
|
| Rate for Payer: Aetna Commercial |
$182.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.59
|
| Rate for Payer: Cash Price |
$171.80
|
| Rate for Payer: Cofinity Commercial |
$150.32
|
| Rate for Payer: Cofinity Commercial |
$184.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.80
|
| Rate for Payer: Healthscope Commercial |
$193.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.54
|
| Rate for Payer: PHP Commercial |
$182.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.59
|
| Rate for Payer: Priority Health SBD |
$135.29
|
| Rate for Payer: UMR Bronson Commercial |
$94.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.06
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
OP
|
$214.75
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.46 |
| Max. Negotiated Rate |
$193.28 |
| Rate for Payer: Aetna American Axle |
$139.59
|
| Rate for Payer: Aetna Commercial |
$182.54
|
| Rate for Payer: Aetna Medicare |
$107.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.59
|
| Rate for Payer: BCBS Complete |
$85.90
|
| Rate for Payer: Cash Price |
$171.80
|
| Rate for Payer: Cofinity Commercial |
$150.32
|
| Rate for Payer: Cofinity Commercial |
$184.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.80
|
| Rate for Payer: Healthscope Commercial |
$193.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.54
|
| Rate for Payer: PHP Commercial |
$182.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.59
|
| Rate for Payer: Priority Health SBD |
$135.29
|
| Rate for Payer: UMR Bronson Commercial |
$79.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.06
|
|
|
HC FNA BX W/O IMG 1ST LESION
|
Facility
|
IP
|
$1,138.32
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
76100423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$500.86 |
| Max. Negotiated Rate |
$1,024.49 |
| Rate for Payer: Aetna American Axle |
$739.91
|
| Rate for Payer: Aetna Commercial |
$967.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.91
|
| Rate for Payer: Cash Price |
$910.66
|
| Rate for Payer: Cofinity Commercial |
$796.82
|
| Rate for Payer: Cofinity Commercial |
$978.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$796.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.66
|
| Rate for Payer: Healthscope Commercial |
$1,024.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$796.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.57
|
| Rate for Payer: PHP Commercial |
$967.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.91
|
| Rate for Payer: Priority Health SBD |
$717.14
|
| Rate for Payer: UMR Bronson Commercial |
$500.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.74
|
|
|
HC FNA BX W/O IMG 1ST LESION
|
Facility
|
OP
|
$1,138.32
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
76100423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna American Axle |
$739.91
|
| Rate for Payer: Aetna Commercial |
$967.57
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$910.66
|
| Rate for Payer: Cash Price |
$910.66
|
| Rate for Payer: Cofinity Commercial |
$978.96
|
| Rate for Payer: Cofinity Commercial |
$796.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$796.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$1,024.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$796.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.74
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.57
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$967.57
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.91
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$717.14
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: UMR Bronson Commercial |
$421.18
|
| Rate for Payer: VA VA |
$389.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.74
|
|
|
HC FNA IMED EVAL
|
Facility
|
OP
|
$74.70
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.64 |
| Max. Negotiated Rate |
$470.43 |
| Rate for Payer: Aetna American Axle |
$48.55
|
| Rate for Payer: Aetna Commercial |
$63.49
|
| Rate for Payer: Aetna Medicare |
$173.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Cofinity Commercial |
$52.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$67.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.02
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.49
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$63.49
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health SBD |
$47.06
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Exchange |
$319.38
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$89.58
|
| Rate for Payer: UMR Bronson Commercial |
$27.64
|
| Rate for Payer: VA VA |
$167.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.02
|
|
|
HC FNA IMED EVAL
|
Facility
|
IP
|
$74.70
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$32.87 |
| Max. Negotiated Rate |
$67.23 |
| Rate for Payer: Aetna American Axle |
$48.55
|
| Rate for Payer: Aetna Commercial |
$63.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.55
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$52.29
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Healthscope Commercial |
$67.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.49
|
| Rate for Payer: PHP Commercial |
$63.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health SBD |
$47.06
|
| Rate for Payer: UMR Bronson Commercial |
$32.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.02
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$8.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna American Axle |
$14.88
|
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
HC FNA INTERPRETATION & REPORT
|
Facility
|
IP
|
$221.80
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
31100007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$97.59 |
| Max. Negotiated Rate |
$199.62 |
| Rate for Payer: Aetna American Axle |
$144.17
|
| Rate for Payer: Aetna Commercial |
$188.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.17
|
| Rate for Payer: Cash Price |
$177.44
|
| Rate for Payer: Cofinity Commercial |
$155.26
|
| Rate for Payer: Cofinity Commercial |
$190.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.44
|
| Rate for Payer: Healthscope Commercial |
$199.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.53
|
| Rate for Payer: PHP Commercial |
$188.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.17
|
| Rate for Payer: Priority Health SBD |
$139.73
|
| Rate for Payer: UMR Bronson Commercial |
$97.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.35
|
|
|
HC FNA INTERPRETATION & REPORT
|
Facility
|
OP
|
$221.80
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
31100007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$199.62 |
| Rate for Payer: Aetna American Axle |
$144.17
|
| Rate for Payer: Aetna Commercial |
$188.53
|
| Rate for Payer: Aetna Medicare |
$54.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.14
|
| Rate for Payer: BCBS Complete |
$29.33
|
| Rate for Payer: BCBS MAPPO |
$52.11
|
| Rate for Payer: BCN Medicare Advantage |
$52.11
|
| Rate for Payer: Cash Price |
$177.44
|
| Rate for Payer: Cash Price |
$177.44
|
| Rate for Payer: Cofinity Commercial |
$190.75
|
| Rate for Payer: Cofinity Commercial |
$155.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.11
|
| Rate for Payer: Healthscope Commercial |
$199.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.35
|
| Rate for Payer: Mclaren Medicaid |
$27.93
|
| Rate for Payer: Mclaren Medicare |
$52.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.72
|
| Rate for Payer: Meridian Medicaid |
$29.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.53
|
| Rate for Payer: PACE Medicare |
$49.50
|
| Rate for Payer: PACE SWMI |
$52.11
|
| Rate for Payer: PHP Commercial |
$188.53
|
| Rate for Payer: PHP Medicare Advantage |
$52.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.17
|
| Rate for Payer: Priority Health Medicare |
$52.11
|
| Rate for Payer: Priority Health SBD |
$139.73
|
| Rate for Payer: Railroad Medicare Medicare |
$52.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.11
|
| Rate for Payer: UHC Exchange |
$99.59
|
| Rate for Payer: UHC Medicare Advantage |
$52.11
|
| Rate for Payer: UHCCP Medicaid |
$27.93
|
| Rate for Payer: UMR Bronson Commercial |
$82.07
|
| Rate for Payer: VA VA |
$52.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.35
|
|
|
HC FOLATE SERUM
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
30100204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$15.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.38
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.70
|
| Rate for Payer: BCN Medicare Advantage |
$14.70
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.70
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$14.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.44
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PACE Medicare |
$13.96
|
| Rate for Payer: PACE SWMI |
$14.70
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$14.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health Medicare |
$14.70
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$14.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.70
|
| Rate for Payer: UHC Exchange |
$28.09
|
| Rate for Payer: UHC Medicare Advantage |
$14.70
|
| Rate for Payer: UHCCP Medicaid |
$7.88
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: VA VA |
$14.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC FOLATE SERUM
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
30100204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UMR Bronson Commercial |
$27.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC FOLEY INSERT BY PHYSICIAN
|
Facility
|
OP
|
$500.32
|
|
| Hospital Charge Code |
45000041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.12 |
| Max. Negotiated Rate |
$450.29 |
| Rate for Payer: Aetna American Axle |
$325.21
|
| Rate for Payer: Aetna Commercial |
$425.27
|
| Rate for Payer: Aetna Medicare |
$250.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.21
|
| Rate for Payer: BCBS Complete |
$200.13
|
| Rate for Payer: Cash Price |
$400.26
|
| Rate for Payer: Cofinity Commercial |
$350.22
|
| Rate for Payer: Cofinity Commercial |
$430.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.26
|
| Rate for Payer: Healthscope Commercial |
$450.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.27
|
| Rate for Payer: PHP Commercial |
$425.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.21
|
| Rate for Payer: Priority Health SBD |
$315.20
|
| Rate for Payer: UMR Bronson Commercial |
$185.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.24
|
|
|
HC FOLEY INSERT BY PHYSICIAN
|
Facility
|
IP
|
$500.32
|
|
| Hospital Charge Code |
45000041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$220.14 |
| Max. Negotiated Rate |
$450.29 |
| Rate for Payer: Aetna American Axle |
$325.21
|
| Rate for Payer: Aetna Commercial |
$425.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.21
|
| Rate for Payer: Cash Price |
$400.26
|
| Rate for Payer: Cofinity Commercial |
$350.22
|
| Rate for Payer: Cofinity Commercial |
$430.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$350.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.26
|
| Rate for Payer: Healthscope Commercial |
$450.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.27
|
| Rate for Payer: PHP Commercial |
$425.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.21
|
| Rate for Payer: Priority Health SBD |
$315.20
|
| Rate for Payer: UMR Bronson Commercial |
$220.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.24
|
|
|
HC FOLLICLE STIM HORMONE (FSH)
|
Facility
|
IP
|
$65.55
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
30100230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$58.99 |
| Rate for Payer: Aetna American Axle |
$42.61
|
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.61
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$45.88
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Healthscope Commercial |
$58.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: PHP Commercial |
$55.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health SBD |
$41.30
|
| Rate for Payer: UMR Bronson Commercial |
$28.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.16
|
|
|
HC FOLLICLE STIM HORMONE (FSH)
|
Facility
|
OP
|
$65.55
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
30100230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$58.99 |
| Rate for Payer: Aetna American Axle |
$42.61
|
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.23
|
| Rate for Payer: BCBS Complete |
$10.46
|
| Rate for Payer: BCBS MAPPO |
$18.58
|
| Rate for Payer: BCN Medicare Advantage |
$18.58
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Cofinity Commercial |
$45.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$58.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.16
|
| Rate for Payer: Mclaren Medicaid |
$9.96
|
| Rate for Payer: Mclaren Medicare |
$18.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.51
|
| Rate for Payer: Meridian Medicaid |
$10.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: PACE Medicare |
$17.65
|
| Rate for Payer: PACE SWMI |
$18.58
|
| Rate for Payer: PHP Commercial |
$55.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health Medicare |
$18.58
|
| Rate for Payer: Priority Health SBD |
$41.30
|
| Rate for Payer: Railroad Medicare Medicare |
$18.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.58
|
| Rate for Payer: UHC Exchange |
$35.51
|
| Rate for Payer: UHC Medicare Advantage |
$18.58
|
| Rate for Payer: UHCCP Medicaid |
$9.96
|
| Rate for Payer: UMR Bronson Commercial |
$24.25
|
| Rate for Payer: VA VA |
$18.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.16
|
|
|
HC FOOD ALLERGY PROFILE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
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 FOOD ALLERGY PROFILE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
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 FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
IP
|
$650.25
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.11 |
| Max. Negotiated Rate |
$585.23 |
| Rate for Payer: Aetna American Axle |
$422.66
|
| Rate for Payer: Aetna Commercial |
$552.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.66
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cofinity Commercial |
$455.18
|
| Rate for Payer: Cofinity Commercial |
$559.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.20
|
| Rate for Payer: Healthscope Commercial |
$585.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.71
|
| Rate for Payer: PHP Commercial |
$552.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.66
|
| Rate for Payer: Priority Health SBD |
$409.66
|
| Rate for Payer: UMR Bronson Commercial |
$286.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.69
|
|
|
HC FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
OP
|
$650.25
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.59 |
| Max. Negotiated Rate |
$585.23 |
| Rate for Payer: Aetna American Axle |
$422.66
|
| Rate for Payer: Aetna Commercial |
$552.71
|
| Rate for Payer: Aetna Medicare |
$325.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.66
|
| Rate for Payer: BCBS Complete |
$260.10
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cofinity Commercial |
$455.18
|
| Rate for Payer: Cofinity Commercial |
$559.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.20
|
| Rate for Payer: Healthscope Commercial |
$585.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.71
|
| Rate for Payer: PHP Commercial |
$552.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.66
|
| Rate for Payer: Priority Health SBD |
$409.66
|
| Rate for Payer: UMR Bronson Commercial |
$240.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.69
|
|
