|
HC PLACE BILIARY DRAIN WITH GUIDE EXTERNAL
|
Facility
|
OP
|
$3,181.54
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
36100490
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,177.17 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna American Axle |
$2,068.00
|
| Rate for Payer: Aetna Commercial |
$2,704.31
|
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,068.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Cash Price |
$2,545.23
|
| Rate for Payer: Cash Price |
$2,545.23
|
| Rate for Payer: Cofinity Commercial |
$2,736.12
|
| Rate for Payer: Cofinity Commercial |
$2,227.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,227.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,545.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Healthscope Commercial |
$2,863.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,227.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,386.16
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,704.31
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Commercial |
$2,704.31
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,068.00
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Priority Health SBD |
$2,004.37
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Exchange |
$6,577.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,844.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,177.17
|
| Rate for Payer: VA VA |
$3,441.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,386.16
|
|
|
HC PLACE BILIARY DRAIN WITH GUIDE EXTERNAL
|
Facility
|
IP
|
$3,181.54
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
36100490
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$2,863.39 |
| Rate for Payer: Aetna American Axle |
$2,068.00
|
| Rate for Payer: Aetna Commercial |
$2,704.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,068.00
|
| Rate for Payer: Cash Price |
$2,545.23
|
| Rate for Payer: Cofinity Commercial |
$2,227.08
|
| Rate for Payer: Cofinity Commercial |
$2,736.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,227.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,545.23
|
| Rate for Payer: Healthscope Commercial |
$2,863.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,227.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,386.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,704.31
|
| Rate for Payer: PHP Commercial |
$2,704.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,068.00
|
| Rate for Payer: Priority Health SBD |
$2,004.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,399.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,386.16
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MAMM GUIDE
|
Facility
|
OP
|
$1,165.71
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
36100415
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$431.31 |
| Max. Negotiated Rate |
$1,049.14 |
| Rate for Payer: Aetna American Axle |
$757.71
|
| Rate for Payer: Aetna Commercial |
$990.85
|
| Rate for Payer: Aetna Medicare |
$582.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$757.71
|
| Rate for Payer: BCBS Complete |
$466.28
|
| Rate for Payer: Cash Price |
$932.57
|
| Rate for Payer: Cofinity Commercial |
$1,002.51
|
| Rate for Payer: Cofinity Commercial |
$816.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$816.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$932.57
|
| Rate for Payer: Healthscope Commercial |
$1,049.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$816.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$874.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$990.85
|
| Rate for Payer: PHP Commercial |
$990.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.71
|
| Rate for Payer: Priority Health SBD |
$734.40
|
| Rate for Payer: UMR Bronson Commercial |
$431.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$874.28
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MAMM GUIDE
|
Facility
|
IP
|
$1,165.71
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
36100415
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$512.91 |
| Max. Negotiated Rate |
$1,049.14 |
| Rate for Payer: Aetna American Axle |
$757.71
|
| Rate for Payer: Aetna Commercial |
$990.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$757.71
|
| Rate for Payer: Cash Price |
$932.57
|
| Rate for Payer: Cofinity Commercial |
$1,002.51
|
| Rate for Payer: Cofinity Commercial |
$816.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$816.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$932.57
|
| Rate for Payer: Healthscope Commercial |
$1,049.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$816.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$874.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$990.85
|
| Rate for Payer: PHP Commercial |
$990.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.71
|
| Rate for Payer: Priority Health SBD |
$734.40
|
| Rate for Payer: UMR Bronson Commercial |
$512.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$874.28
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MR GUIDE
|
Facility
|
OP
|
$1,755.98
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
36100421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$649.71 |
| Max. Negotiated Rate |
$1,580.38 |
| Rate for Payer: Aetna American Axle |
$1,141.39
|
| Rate for Payer: Aetna Commercial |
$1,492.58
|
| Rate for Payer: Aetna Medicare |
$877.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,141.39
|
| Rate for Payer: BCBS Complete |
$702.39
|
| Rate for Payer: Cash Price |
$1,404.78
|
| Rate for Payer: Cofinity Commercial |
$1,229.19
|
| Rate for Payer: Cofinity Commercial |
$1,510.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,229.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,404.78
|
| Rate for Payer: Healthscope Commercial |
$1,580.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,229.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,316.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,492.58
|
| Rate for Payer: PHP Commercial |
$1,492.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.39
|
| Rate for Payer: Priority Health SBD |
$1,106.27
|
| Rate for Payer: UMR Bronson Commercial |
$649.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,316.98
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION MR GUIDE
|
Facility
|
IP
|
$1,755.98
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
36100421
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$772.63 |
| Max. Negotiated Rate |
$1,580.38 |
| Rate for Payer: Aetna American Axle |
$1,141.39
|
| Rate for Payer: Aetna Commercial |
$1,492.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,141.39
|
| Rate for Payer: Cash Price |
$1,404.78
|
| Rate for Payer: Cofinity Commercial |
$1,229.19
|
| Rate for Payer: Cofinity Commercial |
$1,510.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,229.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,404.78
|
| Rate for Payer: Healthscope Commercial |
$1,580.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,229.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,316.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,492.58
|
| Rate for Payer: PHP Commercial |
$1,492.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.39
|
| Rate for Payer: Priority Health SBD |
$1,106.27
|
| Rate for Payer: UMR Bronson Commercial |
$772.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,316.98
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION STEREO GUIDE
|
Facility
|
OP
|
$2,107.08
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
36100417
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$779.62 |
| Max. Negotiated Rate |
$1,896.37 |
| Rate for Payer: Aetna American Axle |
$1,369.60
|
| Rate for Payer: Aetna Commercial |
$1,791.02
|
| Rate for Payer: Aetna Medicare |
$1,053.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,369.60
|
| Rate for Payer: BCBS Complete |
$842.83
|
| Rate for Payer: Cash Price |
$1,685.66
|
| Rate for Payer: Cofinity Commercial |
$1,474.96
|
| Rate for Payer: Cofinity Commercial |
$1,812.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,474.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,685.66
|
| Rate for Payer: Healthscope Commercial |
$1,896.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,474.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,580.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.02
|
| Rate for Payer: PHP Commercial |
$1,791.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.60
|
| Rate for Payer: Priority Health SBD |
$1,327.46
|
| Rate for Payer: UMR Bronson Commercial |
$779.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,580.31
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION STEREO GUIDE
|
Facility
|
IP
|
$2,107.08
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
36100417
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$927.12 |
| Max. Negotiated Rate |
$1,896.37 |
| Rate for Payer: Aetna American Axle |
$1,369.60
|
| Rate for Payer: Aetna Commercial |
$1,791.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,369.60
|
| Rate for Payer: Cash Price |
$1,685.66
|
| Rate for Payer: Cofinity Commercial |
$1,474.96
|
| Rate for Payer: Cofinity Commercial |
$1,812.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,474.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,685.66
|
| Rate for Payer: Healthscope Commercial |
$1,896.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,474.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,580.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.02
|
| Rate for Payer: PHP Commercial |
$1,791.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.60
|
| Rate for Payer: Priority Health SBD |
$1,327.46
|
| Rate for Payer: UMR Bronson Commercial |
$927.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,580.31
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION US GUIDE
|
Facility
|
IP
|
$2,918.68
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
36100419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,284.22 |
| Max. Negotiated Rate |
$2,626.81 |
| Rate for Payer: Aetna American Axle |
$1,897.14
|
| Rate for Payer: Aetna Commercial |
$2,480.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,897.14
|
| Rate for Payer: Cash Price |
$2,334.94
|
| Rate for Payer: Cofinity Commercial |
$2,043.08
|
| Rate for Payer: Cofinity Commercial |
$2,510.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,043.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,334.94
|
| Rate for Payer: Healthscope Commercial |
$2,626.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,043.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,189.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,480.88
|
| Rate for Payer: PHP Commercial |
$2,480.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.14
|
| Rate for Payer: Priority Health SBD |
$1,838.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,284.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,189.01
|
|
|
HC PLACE BREAST LOC DEVICE EACH ADDL LESION US GUIDE
|
Facility
|
OP
|
$2,918.68
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
36100419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,079.91 |
| Max. Negotiated Rate |
$2,626.81 |
| Rate for Payer: Aetna American Axle |
$1,897.14
|
| Rate for Payer: Aetna Commercial |
$2,480.88
|
| Rate for Payer: Aetna Medicare |
$1,459.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,897.14
|
| Rate for Payer: BCBS Complete |
$1,167.47
|
| Rate for Payer: Cash Price |
$2,334.94
|
| Rate for Payer: Cofinity Commercial |
$2,043.08
|
| Rate for Payer: Cofinity Commercial |
$2,510.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,043.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,334.94
|
| Rate for Payer: Healthscope Commercial |
$2,626.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,043.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,189.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,480.88
|
| Rate for Payer: PHP Commercial |
$2,480.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.14
|
| Rate for Payer: Priority Health SBD |
$1,838.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,079.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,189.01
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MAMM GUIDE
|
Facility
|
OP
|
$1,448.79
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
36100414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$536.05 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna American Axle |
$941.71
|
| Rate for Payer: Aetna Commercial |
$1,231.47
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$1,159.03
|
| Rate for Payer: Cash Price |
$1,159.03
|
| Rate for Payer: Cofinity Commercial |
$1,245.96
|
| Rate for Payer: Cofinity Commercial |
$1,014.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,014.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$1,303.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,014.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.59
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.47
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,231.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.71
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$912.74
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$3,019.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: UMR Bronson Commercial |
$536.05
|
| Rate for Payer: VA VA |
$1,580.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.59
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MAMM GUIDE
|
Facility
|
IP
|
$1,448.79
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
36100414
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$637.47 |
| Max. Negotiated Rate |
$1,303.91 |
| Rate for Payer: Aetna American Axle |
$941.71
|
| Rate for Payer: Aetna Commercial |
$1,231.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.71
|
| Rate for Payer: Cash Price |
$1,159.03
|
| Rate for Payer: Cofinity Commercial |
$1,014.15
|
| Rate for Payer: Cofinity Commercial |
$1,245.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,014.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.03
|
| Rate for Payer: Healthscope Commercial |
$1,303.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,014.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.47
|
| Rate for Payer: PHP Commercial |
$1,231.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.71
|
| Rate for Payer: Priority Health SBD |
$912.74
|
| Rate for Payer: UMR Bronson Commercial |
$637.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.59
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE
|
Facility
|
OP
|
$1,693.72
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
36100420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna American Axle |
$1,100.92
|
| Rate for Payer: Aetna Commercial |
$1,439.66
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,100.92
|
| 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 |
$1,354.98
|
| Rate for Payer: Cash Price |
$1,354.98
|
| Rate for Payer: Cofinity Commercial |
$1,456.60
|
| Rate for Payer: Cofinity Commercial |
$1,185.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,185.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,354.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$1,524.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,185.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,270.29
|
| 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 |
$1,439.66
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$1,439.66
|
| 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 |
$1,100.92
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$1,067.04
|
| 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 |
$626.68
|
| Rate for Payer: VA VA |
$686.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,270.29
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION MR GUIDE
|
Facility
|
IP
|
$1,693.72
|
|
|
Service Code
|
CPT 19287
|
| Hospital Charge Code |
36100420
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$745.24 |
| Max. Negotiated Rate |
$1,524.35 |
| Rate for Payer: Aetna American Axle |
$1,100.92
|
| Rate for Payer: Aetna Commercial |
$1,439.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,100.92
|
| Rate for Payer: Cash Price |
$1,354.98
|
| Rate for Payer: Cofinity Commercial |
$1,185.60
|
| Rate for Payer: Cofinity Commercial |
$1,456.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,185.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,354.98
|
| Rate for Payer: Healthscope Commercial |
$1,524.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,185.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,270.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,439.66
|
| Rate for Payer: PHP Commercial |
$1,439.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.92
|
| Rate for Payer: Priority Health SBD |
$1,067.04
|
| Rate for Payer: UMR Bronson Commercial |
$745.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,270.29
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE
|
Facility
|
OP
|
$2,390.22
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
36100416
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$2,151.20 |
| Rate for Payer: Aetna American Axle |
$1,553.64
|
| Rate for Payer: Aetna Commercial |
$2,031.69
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,553.64
|
| 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 |
$1,912.18
|
| Rate for Payer: Cash Price |
$1,912.18
|
| Rate for Payer: Cofinity Commercial |
$2,055.59
|
| Rate for Payer: Cofinity Commercial |
$1,673.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,673.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,912.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$2,151.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,673.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,792.66
|
| 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 |
$2,031.69
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$2,031.69
|
| 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 |
$1,553.64
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$1,505.84
|
| 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 |
$884.38
|
| Rate for Payer: VA VA |
$686.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,792.66
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION STEREO GUIDE
|
Facility
|
IP
|
$2,390.22
|
|
|
Service Code
|
CPT 19283
|
| Hospital Charge Code |
36100416
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,051.70 |
| Max. Negotiated Rate |
$2,151.20 |
| Rate for Payer: Aetna American Axle |
$1,553.64
|
| Rate for Payer: Aetna Commercial |
$2,031.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,553.64
|
| Rate for Payer: Cash Price |
$1,912.18
|
| Rate for Payer: Cofinity Commercial |
$1,673.15
|
| Rate for Payer: Cofinity Commercial |
$2,055.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,673.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,912.18
|
| Rate for Payer: Healthscope Commercial |
$2,151.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,673.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,792.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,031.69
|
| Rate for Payer: PHP Commercial |
$2,031.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,553.64
|
| Rate for Payer: Priority Health SBD |
$1,505.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,051.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,792.66
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE
|
Facility
|
IP
|
$1,962.98
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
36100418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$863.71 |
| Max. Negotiated Rate |
$1,766.68 |
| Rate for Payer: Aetna American Axle |
$1,275.94
|
| Rate for Payer: Aetna Commercial |
$1,668.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.94
|
| Rate for Payer: Cash Price |
$1,570.38
|
| Rate for Payer: Cofinity Commercial |
$1,374.09
|
| Rate for Payer: Cofinity Commercial |
$1,688.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,374.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.38
|
| Rate for Payer: Healthscope Commercial |
$1,766.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,374.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,472.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.53
|
| Rate for Payer: PHP Commercial |
$1,668.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.94
|
| Rate for Payer: Priority Health SBD |
$1,236.68
|
| Rate for Payer: UMR Bronson Commercial |
$863.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,472.23
|
|
|
HC PLACE BREAST LOC DEVICE FIRST LESION US GUIDE
|
Facility
|
OP
|
$1,962.98
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
36100418
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna American Axle |
$1,275.94
|
| Rate for Payer: Aetna Commercial |
$1,668.53
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.94
|
| 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 |
$1,570.38
|
| Rate for Payer: Cash Price |
$1,570.38
|
| Rate for Payer: Cofinity Commercial |
$1,688.16
|
| Rate for Payer: Cofinity Commercial |
$1,374.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,374.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$1,766.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,374.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,472.23
|
| 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 |
$1,668.53
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$1,668.53
|
| 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 |
$1,275.94
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$1,236.68
|
| 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 |
$726.30
|
| Rate for Payer: VA VA |
$686.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,472.23
|
|
|
HC PLACEMENT FIDUCIAL MARKERS
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
36000120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$471.24 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna American Axle |
$696.15
|
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$749.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$749.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health SBD |
$674.73
|
| Rate for Payer: UMR Bronson Commercial |
$471.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
HC PLACEMENT FIDUCIAL MARKERS
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
36000120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$396.27 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna American Axle |
$696.15
|
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna Medicare |
$535.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: BCBS Complete |
$428.40
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$749.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$749.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health SBD |
$674.73
|
| Rate for Payer: UMR Bronson Commercial |
$396.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER
|
Facility
|
OP
|
$7,265.88
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
36100106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,688.38 |
| Max. Negotiated Rate |
$6,539.29 |
| Rate for Payer: Aetna American Axle |
$4,722.82
|
| Rate for Payer: Aetna Commercial |
$6,176.00
|
| Rate for Payer: Aetna Medicare |
$3,632.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,722.82
|
| Rate for Payer: BCBS Complete |
$2,906.35
|
| Rate for Payer: Cash Price |
$5,812.70
|
| Rate for Payer: Cofinity Commercial |
$5,086.12
|
| Rate for Payer: Cofinity Commercial |
$6,248.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,086.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,812.70
|
| Rate for Payer: Healthscope Commercial |
$6,539.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,086.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,449.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,176.00
|
| Rate for Payer: PHP Commercial |
$6,176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,722.82
|
| Rate for Payer: Priority Health SBD |
$4,577.50
|
| Rate for Payer: UMR Bronson Commercial |
$2,688.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,449.41
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 1ST ORDER
|
Facility
|
IP
|
$7,265.88
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
36100106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,196.99 |
| Max. Negotiated Rate |
$6,539.29 |
| Rate for Payer: Aetna American Axle |
$4,722.82
|
| Rate for Payer: Aetna Commercial |
$6,176.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,722.82
|
| Rate for Payer: Cash Price |
$5,812.70
|
| Rate for Payer: Cofinity Commercial |
$5,086.12
|
| Rate for Payer: Cofinity Commercial |
$6,248.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,086.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,812.70
|
| Rate for Payer: Healthscope Commercial |
$6,539.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,086.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,449.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,176.00
|
| Rate for Payer: PHP Commercial |
$6,176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,722.82
|
| Rate for Payer: Priority Health SBD |
$4,577.50
|
| Rate for Payer: UMR Bronson Commercial |
$3,196.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,449.41
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
36100107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$448.80 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Aetna American Axle |
$663.00
|
| Rate for Payer: Aetna Commercial |
$867.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cofinity Commercial |
$714.00
|
| Rate for Payer: Cofinity Commercial |
$877.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.00
|
| Rate for Payer: Healthscope Commercial |
$918.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$714.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.00
|
| Rate for Payer: PHP Commercial |
$867.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: Priority Health SBD |
$642.60
|
| Rate for Payer: UMR Bronson Commercial |
$448.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.00
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 2ND ORDER
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
36100107
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$377.40 |
| Max. Negotiated Rate |
$918.00 |
| Rate for Payer: Aetna American Axle |
$663.00
|
| Rate for Payer: Aetna Commercial |
$867.00
|
| Rate for Payer: Aetna Medicare |
$510.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.00
|
| Rate for Payer: BCBS Complete |
$408.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cofinity Commercial |
$714.00
|
| Rate for Payer: Cofinity Commercial |
$877.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.00
|
| Rate for Payer: Healthscope Commercial |
$918.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$714.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.00
|
| Rate for Payer: PHP Commercial |
$867.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: Priority Health SBD |
$642.60
|
| Rate for Payer: UMR Bronson Commercial |
$377.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.00
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER
|
Facility
|
OP
|
$845.54
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
36100108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$312.85 |
| Max. Negotiated Rate |
$760.99 |
| Rate for Payer: Aetna American Axle |
$549.60
|
| Rate for Payer: Aetna Commercial |
$718.71
|
| Rate for Payer: Aetna Medicare |
$422.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.60
|
| Rate for Payer: BCBS Complete |
$338.22
|
| Rate for Payer: Cash Price |
$676.43
|
| Rate for Payer: Cofinity Commercial |
$591.88
|
| Rate for Payer: Cofinity Commercial |
$727.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$591.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.43
|
| Rate for Payer: Healthscope Commercial |
$760.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$591.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.71
|
| Rate for Payer: PHP Commercial |
$718.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.60
|
| Rate for Payer: Priority Health SBD |
$532.69
|
| Rate for Payer: UMR Bronson Commercial |
$312.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.15
|
|
