|
HC MASTECTOMY SLEEVE EA $375
|
Facility
|
OP
|
$382.50
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Aetna American Axle |
$248.62
|
| Rate for Payer: Aetna Commercial |
$325.12
|
| Rate for Payer: Aetna Medicare |
$191.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.62
|
| Rate for Payer: BCBS Complete |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cofinity Commercial |
$267.75
|
| Rate for Payer: Cofinity Commercial |
$328.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.00
|
| Rate for Payer: Healthscope Commercial |
$344.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.12
|
| Rate for Payer: PHP Commercial |
$325.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.62
|
| Rate for Payer: Priority Health SBD |
$240.98
|
| Rate for Payer: UMR Bronson Commercial |
$141.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.88
|
|
|
HC MASTECTOMY SLEEVE EA $375
|
Facility
|
IP
|
$382.50
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$168.30 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Aetna American Axle |
$248.62
|
| Rate for Payer: Aetna Commercial |
$325.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.62
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cofinity Commercial |
$267.75
|
| Rate for Payer: Cofinity Commercial |
$328.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$267.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.00
|
| Rate for Payer: Healthscope Commercial |
$344.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$267.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.12
|
| Rate for Payer: PHP Commercial |
$325.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.62
|
| Rate for Payer: Priority Health SBD |
$240.98
|
| Rate for Payer: UMR Bronson Commercial |
$168.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.88
|
|
|
HC MASTECTOMY SLEEVE EA $40
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$134.97 |
| Rate for Payer: Aetna American Axle |
$26.52
|
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: BCBS Complete |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: UMR Bronson Commercial |
$15.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC MASTECTOMY SLEEVE EA $40
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna American Axle |
$26.52
|
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.52
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: UMR Bronson Commercial |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC MASTECTOMY SLEEVE EA $400
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$179.52 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna American Axle |
$265.20
|
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.80
|
| Rate for Payer: PHP Commercial |
$346.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health SBD |
$257.04
|
| Rate for Payer: UMR Bronson Commercial |
$179.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.00
|
|
|
HC MASTECTOMY SLEEVE EA $400
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000017
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna American Axle |
$265.20
|
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.20
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$285.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.80
|
| Rate for Payer: PHP Commercial |
$346.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health SBD |
$257.04
|
| Rate for Payer: UMR Bronson Commercial |
$150.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.00
|
|
|
HC MASTECTOMY SLEEVE EA $425
|
Facility
|
OP
|
$433.50
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Aetna American Axle |
$281.78
|
| Rate for Payer: Aetna Commercial |
$368.48
|
| Rate for Payer: Aetna Medicare |
$216.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.78
|
| Rate for Payer: BCBS Complete |
$173.40
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cofinity Commercial |
$303.45
|
| Rate for Payer: Cofinity Commercial |
$372.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.80
|
| Rate for Payer: Healthscope Commercial |
$390.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.48
|
| Rate for Payer: PHP Commercial |
$368.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.78
|
| Rate for Payer: Priority Health SBD |
$273.10
|
| Rate for Payer: UMR Bronson Commercial |
$160.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.12
|
|
|
HC MASTECTOMY SLEEVE EA $425
|
Facility
|
IP
|
$433.50
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000018
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$390.15 |
| Rate for Payer: Aetna American Axle |
$281.78
|
| Rate for Payer: Aetna Commercial |
$368.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.78
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cofinity Commercial |
$303.45
|
| Rate for Payer: Cofinity Commercial |
$372.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$303.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$346.80
|
| Rate for Payer: Healthscope Commercial |
$390.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.48
|
| Rate for Payer: PHP Commercial |
$368.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.78
|
| Rate for Payer: Priority Health SBD |
$273.10
|
| Rate for Payer: UMR Bronson Commercial |
$190.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.12
|
|
|
HC MASTECTOMY SLEEVE EA $450
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna American Axle |
$298.35
|
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$321.30
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health SBD |
$289.17
|
| Rate for Payer: UMR Bronson Commercial |
$169.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC MASTECTOMY SLEEVE EA $450
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$201.96 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna American Axle |
$298.35
|
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$321.30
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health SBD |
$289.17
|
| Rate for Payer: UMR Bronson Commercial |
$201.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC MASTECTOMY SLEEVE EA $50
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC MASTECTOMY SLEEVE EA $50
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$134.97 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC MASTECTOMY SLEEVE EA $60
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.64 |
| Max. Negotiated Rate |
$134.97 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UMR Bronson Commercial |
$22.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC MASTECTOMY SLEEVE EA $60
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UMR Bronson Commercial |
$26.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC MASTECTOMY SLEEVE EA $70
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UMR Bronson Commercial |
$31.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC MASTECTOMY SLEEVE EA $70
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$134.97 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UMR Bronson Commercial |
$26.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC MASTECTOMY SLEEVE EA $80
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna American Axle |
$53.04
|
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: UMR Bronson Commercial |
$35.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC MASTECTOMY SLEEVE EA $80
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$134.97 |
| Rate for Payer: Aetna American Axle |
$53.04
|
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$40.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: BCBS Complete |
$32.64
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: UMR Bronson Commercial |
$30.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC MASTECTOMY SLEEVE EA $90
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$134.97 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Trust/PPO |
$134.97
|
| Rate for Payer: BCN Commercial |
$134.97
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UMR Bronson Commercial |
$33.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC MASTECTOMY SLEEVE EA $90
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.39 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: UMR Bronson Commercial |
$40.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
IP
|
$2,142.08
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$942.52 |
| Max. Negotiated Rate |
$1,927.87 |
| Rate for Payer: Aetna American Axle |
$1,392.35
|
| Rate for Payer: Aetna Commercial |
$1,820.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,392.35
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cofinity Commercial |
$1,499.46
|
| Rate for Payer: Cofinity Commercial |
$1,842.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,499.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,713.66
|
| Rate for Payer: Healthscope Commercial |
$1,927.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,499.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,606.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,820.77
|
| Rate for Payer: PHP Commercial |
$1,820.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.35
|
| Rate for Payer: Priority Health SBD |
$1,349.51
|
| Rate for Payer: UMR Bronson Commercial |
$942.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,606.56
|
|
|
HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
OP
|
$2,142.08
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.12 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna American Axle |
$1,392.35
|
| Rate for Payer: Aetna Commercial |
$1,820.77
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,392.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,334.61
|
| Rate for Payer: BCN Commercial |
$2,334.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cofinity Commercial |
$1,842.19
|
| Rate for Payer: Cofinity Commercial |
$1,499.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,499.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,713.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$1,927.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,499.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,606.56
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,820.77
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$1,820.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$1,349.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.43
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$303.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: UMR Bronson Commercial |
$792.57
|
| Rate for Payer: VA VA |
$1,587.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,606.56
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 1
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna American Axle |
$72.93
|
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.93
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$78.54
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health SBD |
$70.69
|
| Rate for Payer: UMR Bronson Commercial |
$49.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 1
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna American Axle |
$72.93
|
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$14.50
|
| Rate for Payer: BCN Commercial |
$14.50
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Cofinity Commercial |
$78.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Mclaren Medicaid |
$8.07
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$22.58
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.05
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$12.04
|
| Rate for Payer: Priority Health SBD |
$70.69
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.05
|
| Rate for Payer: UHC Exchange |
$15.05
|
| Rate for Payer: UHC Medicare Advantage |
$15.05
|
| Rate for Payer: UHCCP Medicaid |
$8.07
|
| Rate for Payer: UMR Bronson Commercial |
$41.51
|
| Rate for Payer: VA VA |
$15.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 2
|
Facility
|
IP
|
$242.35
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.63 |
| Max. Negotiated Rate |
$218.12 |
| Rate for Payer: Aetna American Axle |
$157.53
|
| Rate for Payer: Aetna Commercial |
$206.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.53
|
| Rate for Payer: Cash Price |
$193.88
|
| Rate for Payer: Cofinity Commercial |
$169.64
|
| Rate for Payer: Cofinity Commercial |
$208.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.88
|
| Rate for Payer: Healthscope Commercial |
$218.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.00
|
| Rate for Payer: PHP Commercial |
$206.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.53
|
| Rate for Payer: Priority Health SBD |
$152.68
|
| Rate for Payer: UMR Bronson Commercial |
$106.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.76
|
|
