|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MAMM GUIDE
|
Facility
|
IP
|
$1,224.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
36100415
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$538.56 |
| Max. Negotiated Rate |
$1,101.60 |
| Rate for Payer: Aetna American Axle |
$795.60
|
| Rate for Payer: Aetna Commercial |
$1,040.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$795.60
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cofinity Advantage |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$1,052.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$979.20
|
| Rate for Payer: Healthscope Commercial |
$1,101.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$856.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$918.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,040.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$918.00
|
| Rate for Payer: PHP Commercial |
$1,040.40
|
| Rate for Payer: Priority Health SBD |
$771.12
|
| Rate for Payer: UMR Bronson Commercial |
$538.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$918.00
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MR GUIDE
|
Facility
|
IP
|
$1,791.10
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
36100421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$788.08 |
| Max. Negotiated Rate |
$1,611.99 |
| Rate for Payer: Aetna American Axle |
$1,164.21
|
| Rate for Payer: Aetna Commercial |
$1,522.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.21
|
| Rate for Payer: Cash Price |
$1,432.88
|
| Rate for Payer: Cofinity Advantage |
$1,253.77
|
| Rate for Payer: Cofinity Commercial |
$1,540.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,432.88
|
| Rate for Payer: Healthscope Commercial |
$1,611.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,253.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,343.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,522.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,343.33
|
| Rate for Payer: PHP Commercial |
$1,522.43
|
| Rate for Payer: Priority Health SBD |
$1,128.39
|
| Rate for Payer: UMR Bronson Commercial |
$788.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,343.33
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MR GUIDE
|
Facility
|
OP
|
$1,791.10
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
36100421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$432.83 |
| Max. Negotiated Rate |
$3,014.63 |
| Rate for Payer: Aetna American Axle |
$1,164.21
|
| Rate for Payer: Aetna Commercial |
$1,522.43
|
| Rate for Payer: Aetna Medicare |
$895.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.21
|
| Rate for Payer: BCBS Complete |
$716.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,014.63
|
| Rate for Payer: BCCCP Commercial |
$432.83
|
| Rate for Payer: BCN Commercial |
$3,014.63
|
| Rate for Payer: Cash Price |
$1,432.88
|
| Rate for Payer: Cash Price |
$1,432.88
|
| Rate for Payer: Cash Price |
$1,432.88
|
| Rate for Payer: Cofinity Advantage |
$1,253.77
|
| Rate for Payer: Cofinity Commercial |
$1,540.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,432.88
|
| Rate for Payer: Healthscope Commercial |
$1,611.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,253.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,343.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,432.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,522.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,343.33
|
| Rate for Payer: PHP Commercial |
$1,522.43
|
| Rate for Payer: Priority Health SBD |
$1,128.39
|
| Rate for Payer: UMR Bronson Commercial |
$662.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,343.33
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION STEREO GUIDE
|
Facility
|
IP
|
$2,149.22
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
36100417
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$945.66 |
| Max. Negotiated Rate |
$1,934.30 |
| Rate for Payer: Aetna American Axle |
$1,396.99
|
| Rate for Payer: Aetna Commercial |
$1,826.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.99
|
| Rate for Payer: Cash Price |
$1,719.38
|
| Rate for Payer: Cofinity Advantage |
$1,504.45
|
| Rate for Payer: Cofinity Commercial |
$1,848.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,719.38
|
| Rate for Payer: Healthscope Commercial |
$1,934.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,504.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,611.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,826.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,611.91
|
| Rate for Payer: PHP Commercial |
$1,826.84
|
| Rate for Payer: Priority Health SBD |
$1,354.01
|
| Rate for Payer: UMR Bronson Commercial |
$945.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,611.91
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION STEREO GUIDE
|
Facility
|
OP
|
$2,149.22
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
36100417
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.66 |
| Max. Negotiated Rate |
$1,934.30 |
| Rate for Payer: Aetna American Axle |
$1,396.99
|
| Rate for Payer: Aetna Commercial |
$1,826.84
|
| Rate for Payer: Aetna Medicare |
$1,074.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.99
|
| Rate for Payer: BCBS Complete |
$859.69
|
| Rate for Payer: BCBS Trust/PPO |
$883.79
|
| Rate for Payer: BCCCP Commercial |
$171.66
|
| Rate for Payer: BCN Commercial |
$883.79
|
| Rate for Payer: Cash Price |
$1,719.38
|
| Rate for Payer: Cash Price |
$1,719.38
|
| Rate for Payer: Cash Price |
$1,719.38
|
| Rate for Payer: Cofinity Advantage |
$1,504.45
|
| Rate for Payer: Cofinity Commercial |
$1,848.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,719.38
|
| Rate for Payer: Healthscope Commercial |
$1,934.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,504.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,611.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,719.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,826.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,611.91
|
| Rate for Payer: PHP Commercial |
$1,826.84
|
| Rate for Payer: Priority Health SBD |
$1,354.01
|
| Rate for Payer: UMR Bronson Commercial |
$795.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,611.91
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION US GUIDE
|
Facility
|
IP
|
$2,977.05
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
36100419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,309.90 |
| Max. Negotiated Rate |
$2,679.34 |
| Rate for Payer: Aetna American Axle |
$1,935.08
|
| Rate for Payer: Aetna Commercial |
$2,530.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,935.08
|
| Rate for Payer: Cash Price |
$2,381.64
|
| Rate for Payer: Cofinity Advantage |
$2,083.93
|
| Rate for Payer: Cofinity Commercial |
$2,560.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,381.64
|
| Rate for Payer: Healthscope Commercial |
$2,679.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,083.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,232.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,530.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,232.79
|
| Rate for Payer: PHP Commercial |
$2,530.49
|
| Rate for Payer: Priority Health SBD |
$1,875.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,309.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,232.79
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION US GUIDE
|
Facility
|
OP
|
$2,977.05
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
36100419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$266.26 |
| Max. Negotiated Rate |
$2,679.34 |
| Rate for Payer: Aetna American Axle |
$1,935.08
|
| Rate for Payer: Aetna Commercial |
$2,530.49
|
| Rate for Payer: Aetna Medicare |
$1,488.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,935.08
|
| Rate for Payer: BCBS Complete |
$1,190.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,767.07
|
| Rate for Payer: BCCCP Commercial |
$266.26
|
| Rate for Payer: BCN Commercial |
$1,767.07
|
| Rate for Payer: Cash Price |
$2,381.64
|
| Rate for Payer: Cash Price |
$2,381.64
|
| Rate for Payer: Cash Price |
$2,381.64
|
| Rate for Payer: Cofinity Advantage |
$2,083.93
|
| Rate for Payer: Cofinity Commercial |
$2,560.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,381.64
|
| Rate for Payer: Healthscope Commercial |
$2,679.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,083.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,232.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,381.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,530.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,232.79
|
| Rate for Payer: PHP Commercial |
$2,530.49
|
| Rate for Payer: Priority Health SBD |
$1,875.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,101.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,232.79
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MAMM GUIDE
|
Facility
|
OP
|
$1,477.77
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
36100414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$225.33 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna American Axle |
$960.55
|
| Rate for Payer: Aetna Commercial |
$1,256.10
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$868.77
|
| Rate for Payer: BCCCP Commercial |
$225.33
|
| Rate for Payer: BCN Commercial |
$868.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$1,182.22
|
| Rate for Payer: Cash Price |
$1,182.22
|
| Rate for Payer: Cash Price |
$1,182.22
|
| Rate for Payer: Cofinity Advantage |
$1,034.44
|
| Rate for Payer: Cofinity Commercial |
$1,270.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$1,329.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.33
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.10
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.33
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,256.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$931.00
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: UMR Bronson Commercial |
$546.77
|
| Rate for Payer: VA VA |
$1,645.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.33
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MAMM GUIDE
|
Facility
|
IP
|
$1,477.77
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
36100414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$650.22 |
| Max. Negotiated Rate |
$1,329.99 |
| Rate for Payer: Aetna American Axle |
$960.55
|
| Rate for Payer: Aetna Commercial |
$1,256.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.55
|
| Rate for Payer: Cash Price |
$1,182.22
|
| Rate for Payer: Cofinity Advantage |
$1,034.44
|
| Rate for Payer: Cofinity Commercial |
$1,270.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,182.22
|
| Rate for Payer: Healthscope Commercial |
$1,329.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,034.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,108.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,256.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,108.33
|
| Rate for Payer: PHP Commercial |
$1,256.10
|
| Rate for Payer: Priority Health SBD |
$931.00
|
| Rate for Payer: UMR Bronson Commercial |
$650.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,108.33
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE
|
Facility
|
OP
|
$1,727.59
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
36100420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna American Axle |
$1,122.93
|
| Rate for Payer: Aetna Commercial |
$1,468.45
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,122.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$608.31
|
| Rate for Payer: BCCCP Commercial |
$566.80
|
| Rate for Payer: BCN Commercial |
$608.31
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$1,382.07
|
| Rate for Payer: Cash Price |
$1,382.07
|
| Rate for Payer: Cash Price |
$1,382.07
|
| Rate for Payer: Cofinity Advantage |
$1,209.31
|
| Rate for Payer: Cofinity Commercial |
$1,485.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,382.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$1,554.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,209.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,295.69
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,468.45
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,295.69
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$1,468.45
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$1,088.38
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: UMR Bronson Commercial |
$639.21
|
| Rate for Payer: VA VA |
$705.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,295.69
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE
|
Facility
|
IP
|
$1,727.59
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
36100420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$760.14 |
| Max. Negotiated Rate |
$1,554.83 |
| Rate for Payer: Aetna American Axle |
$1,122.93
|
| Rate for Payer: Aetna Commercial |
$1,468.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,122.93
|
| Rate for Payer: Cash Price |
$1,382.07
|
| Rate for Payer: Cofinity Advantage |
$1,209.31
|
| Rate for Payer: Cofinity Commercial |
$1,485.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,382.07
|
| Rate for Payer: Healthscope Commercial |
$1,554.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,209.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,295.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,468.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,295.69
|
| Rate for Payer: PHP Commercial |
$1,468.45
|
| Rate for Payer: Priority Health SBD |
$1,088.38
|
| Rate for Payer: UMR Bronson Commercial |
$760.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,295.69
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE
|
Facility
|
OP
|
$2,438.02
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
36100416
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna American Axle |
$1,584.71
|
| Rate for Payer: Aetna Commercial |
$2,072.32
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,584.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$608.31
|
| Rate for Payer: BCCCP Commercial |
$240.24
|
| Rate for Payer: BCN Commercial |
$608.31
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$1,950.42
|
| Rate for Payer: Cash Price |
$1,950.42
|
| Rate for Payer: Cash Price |
$1,950.42
|
| Rate for Payer: Cofinity Advantage |
$1,706.61
|
| Rate for Payer: Cofinity Commercial |
$2,096.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,950.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$2,194.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,706.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,828.52
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,072.32
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,828.52
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$2,072.32
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$1,535.95
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: UMR Bronson Commercial |
$902.07
|
| Rate for Payer: VA VA |
$705.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,828.52
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE
|
Facility
|
IP
|
$2,438.02
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
36100416
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,072.73 |
| Max. Negotiated Rate |
$2,194.22 |
| Rate for Payer: Aetna American Axle |
$1,584.71
|
| Rate for Payer: Aetna Commercial |
$2,072.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,584.71
|
| Rate for Payer: Cash Price |
$1,950.42
|
| Rate for Payer: Cofinity Advantage |
$1,706.61
|
| Rate for Payer: Cofinity Commercial |
$2,096.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,950.42
|
| Rate for Payer: Healthscope Commercial |
$2,194.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,706.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,828.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,072.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,828.52
|
| Rate for Payer: PHP Commercial |
$2,072.32
|
| Rate for Payer: Priority Health SBD |
$1,535.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,072.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,828.52
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE
|
Facility
|
IP
|
$2,002.24
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
36100418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$880.99 |
| Max. Negotiated Rate |
$1,802.02 |
| Rate for Payer: Aetna American Axle |
$1,301.46
|
| Rate for Payer: Aetna Commercial |
$1,701.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,301.46
|
| Rate for Payer: Cash Price |
$1,601.79
|
| Rate for Payer: Cofinity Advantage |
$1,401.57
|
| Rate for Payer: Cofinity Commercial |
$1,721.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,601.79
|
| Rate for Payer: Healthscope Commercial |
$1,802.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,401.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,501.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,701.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,501.68
|
| Rate for Payer: PHP Commercial |
$1,701.90
|
| Rate for Payer: Priority Health SBD |
$1,261.41
|
| Rate for Payer: UMR Bronson Commercial |
$880.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,501.68
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE
|
Facility
|
OP
|
$2,002.24
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
36100418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$330.02 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna American Axle |
$1,301.46
|
| Rate for Payer: Aetna Commercial |
$1,701.90
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,301.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,163.99
|
| Rate for Payer: BCCCP Commercial |
$330.02
|
| Rate for Payer: BCN Commercial |
$1,163.99
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$1,601.79
|
| Rate for Payer: Cash Price |
$1,601.79
|
| Rate for Payer: Cash Price |
$1,601.79
|
| Rate for Payer: Cofinity Advantage |
$1,401.57
|
| Rate for Payer: Cofinity Commercial |
$1,721.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,601.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$1,802.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,401.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,501.68
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,701.90
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,501.68
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$1,701.90
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$1,261.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: UMR Bronson Commercial |
$740.83
|
| Rate for Payer: VA VA |
$705.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,501.68
|
|
|
HC PLACEMENT FIDUCIAL MARKERS
|
Facility
|
OP
|
$1,092.42
|
|
| Hospital Charge Code |
36000120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$404.20 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna American Axle |
$710.07
|
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$546.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: BCBS Complete |
$436.97
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Advantage |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$764.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$873.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$819.32
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health SBD |
$688.22
|
| Rate for Payer: UMR Bronson Commercial |
$404.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC PLACEMENT FIDUCIAL MARKERS
|
Facility
|
IP
|
$1,092.42
|
|
| Hospital Charge Code |
36000120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$480.66 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna American Axle |
$710.07
|
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.07
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Advantage |
$764.69
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$764.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$819.32
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health SBD |
$688.22
|
| Rate for Payer: UMR Bronson Commercial |
$480.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC PLACEMENT OF BAKRI BALLOON
|
Facility
|
IP
|
$510.33
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
72000013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$224.55 |
| Max. Negotiated Rate |
$459.30 |
| Rate for Payer: Aetna American Axle |
$331.71
|
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.71
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Advantage |
$357.23
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: Priority Health SBD |
$321.51
|
| Rate for Payer: UMR Bronson Commercial |
$224.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.75
|
|
|
HC PLACEMENT OF BAKRI BALLOON
|
Facility
|
OP
|
$510.33
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
72000013
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$651.46 |
| Rate for Payer: Aetna American Axle |
$331.71
|
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$171.73
|
| Rate for Payer: BCN Commercial |
$171.73
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Advantage |
$357.23
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.75
|
| Rate for Payer: Mclaren Medicaid |
$201.44
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health SBD |
$321.51
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.71
|
| Rate for Payer: UHC Core |
$265.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Exchange |
$200.56
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: UMR Bronson Commercial |
$188.82
|
| Rate for Payer: VA VA |
$201.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.75
|
|
|
HC PLACEMENT OF JADA SYSTEM
|
Facility
|
OP
|
$8,104.44
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
72000012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna American Axle |
$5,267.89
|
| Rate for Payer: Aetna Commercial |
$6,888.77
|
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,267.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$171.73
|
| Rate for Payer: BCN Commercial |
$171.73
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Advantage |
$5,673.11
|
| Rate for Payer: Cofinity Commercial |
$6,969.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$7,294.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,673.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,078.33
|
| Rate for Payer: Mclaren Medicaid |
$201.44
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$6,888.77
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health SBD |
$5,105.80
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,267.89
|
| Rate for Payer: UHC Core |
$4,222.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Exchange |
$3,185.04
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: UMR Bronson Commercial |
$2,998.64
|
| Rate for Payer: VA VA |
$201.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,078.33
|
|
|
HC PLACEMENT OF JADA SYSTEM
|
Facility
|
IP
|
$8,104.44
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
72000012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$3,565.95 |
| Max. Negotiated Rate |
$7,294.00 |
| Rate for Payer: Aetna American Axle |
$5,267.89
|
| Rate for Payer: Aetna Commercial |
$6,888.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,267.89
|
| Rate for Payer: Cash Price |
$6,483.55
|
| Rate for Payer: Cofinity Advantage |
$5,673.11
|
| Rate for Payer: Cofinity Commercial |
$6,969.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,483.55
|
| Rate for Payer: Healthscope Commercial |
$7,294.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,673.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,078.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,888.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,078.33
|
| Rate for Payer: PHP Commercial |
$6,888.77
|
| Rate for Payer: Priority Health SBD |
$5,105.80
|
| Rate for Payer: UMR Bronson Commercial |
$3,565.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,078.33
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER
|
Facility
|
OP
|
$7,411.20
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
36100106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,742.14 |
| Max. Negotiated Rate |
$6,670.08 |
| Rate for Payer: Aetna American Axle |
$4,817.28
|
| Rate for Payer: Aetna Commercial |
$6,299.52
|
| Rate for Payer: Aetna Medicare |
$3,705.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,817.28
|
| Rate for Payer: BCBS Complete |
$2,964.48
|
| Rate for Payer: BCBS Trust/PPO |
$4,860.07
|
| Rate for Payer: BCN Commercial |
$4,860.07
|
| Rate for Payer: Cash Price |
$5,928.96
|
| Rate for Payer: Cash Price |
$5,928.96
|
| Rate for Payer: Cash Price |
$5,928.96
|
| Rate for Payer: Cofinity Advantage |
$5,187.84
|
| Rate for Payer: Cofinity Commercial |
$6,373.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,928.96
|
| Rate for Payer: Healthscope Commercial |
$6,670.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,187.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,558.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,928.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,299.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,558.40
|
| Rate for Payer: PHP Commercial |
$6,299.52
|
| Rate for Payer: Priority Health SBD |
$4,669.06
|
| Rate for Payer: UMR Bronson Commercial |
$2,742.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,558.40
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER
|
Facility
|
IP
|
$7,411.20
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
36100106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,260.93 |
| Max. Negotiated Rate |
$6,670.08 |
| Rate for Payer: Aetna American Axle |
$4,817.28
|
| Rate for Payer: Aetna Commercial |
$6,299.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,817.28
|
| Rate for Payer: Cash Price |
$5,928.96
|
| Rate for Payer: Cofinity Advantage |
$5,187.84
|
| Rate for Payer: Cofinity Commercial |
$6,373.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,928.96
|
| Rate for Payer: Healthscope Commercial |
$6,670.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,187.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,558.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,299.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,558.40
|
| Rate for Payer: PHP Commercial |
$6,299.52
|
| Rate for Payer: Priority Health SBD |
$4,669.06
|
| Rate for Payer: UMR Bronson Commercial |
$3,260.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,558.40
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER
|
Facility
|
IP
|
$1,040.40
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
36100107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$457.78 |
| Max. Negotiated Rate |
$936.36 |
| Rate for Payer: Aetna American Axle |
$676.26
|
| Rate for Payer: Aetna Commercial |
$884.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.26
|
| Rate for Payer: Cash Price |
$832.32
|
| Rate for Payer: Cofinity Advantage |
$728.28
|
| Rate for Payer: Cofinity Commercial |
$894.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.32
|
| Rate for Payer: Healthscope Commercial |
$936.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.30
|
| Rate for Payer: PHP Commercial |
$884.34
|
| Rate for Payer: Priority Health SBD |
$655.45
|
| Rate for Payer: UMR Bronson Commercial |
$457.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.30
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER
|
Facility
|
OP
|
$1,040.40
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
36100107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$384.95 |
| Max. Negotiated Rate |
$5,024.88 |
| Rate for Payer: Aetna American Axle |
$676.26
|
| Rate for Payer: Aetna Commercial |
$884.34
|
| Rate for Payer: Aetna Medicare |
$520.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.26
|
| Rate for Payer: BCBS Complete |
$416.16
|
| Rate for Payer: BCBS Trust/PPO |
$5,024.88
|
| Rate for Payer: BCN Commercial |
$5,024.88
|
| Rate for Payer: Cash Price |
$832.32
|
| Rate for Payer: Cash Price |
$832.32
|
| Rate for Payer: Cash Price |
$832.32
|
| Rate for Payer: Cofinity Advantage |
$728.28
|
| Rate for Payer: Cofinity Commercial |
$894.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.32
|
| Rate for Payer: Healthscope Commercial |
$936.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$832.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.30
|
| Rate for Payer: PHP Commercial |
$884.34
|
| Rate for Payer: Priority Health SBD |
$655.45
|
| Rate for Payer: UMR Bronson Commercial |
$384.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.30
|
|
