|
PR CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP
|
Professional
|
Both
|
$4,528.00
|
|
|
Service Code
|
HCPCS 33310
|
| Min. Negotiated Rate |
$733.15 |
| Max. Negotiated Rate |
$3,169.60 |
| Rate for Payer: Aetna Commercial |
$1,565.46
|
| Rate for Payer: BCBS Complete |
$769.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,038.64
|
| Rate for Payer: Cash Price |
$3,622.40
|
| Rate for Payer: Cash Price |
$3,622.40
|
| Rate for Payer: Meridian Medicaid |
$769.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$733.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,169.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,827.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,827.28
|
| Rate for Payer: Priority Health SBD |
$1,827.28
|
| Rate for Payer: UMR Bronson Commercial |
$2,082.88
|
|
|
PR CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
HCPCS 93660
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$3,564.97 |
| Rate for Payer: Aetna Commercial |
$205.18
|
| Rate for Payer: BCBS Complete |
$224.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,564.97
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.30
|
| Rate for Payer: Priority Health Narrow Network |
$99.30
|
| Rate for Payer: Priority Health SBD |
$226.03
|
| Rate for Payer: UMR Bronson Commercial |
$258.52
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
92960
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$216.04 |
| Max. Negotiated Rate |
$441.90 |
| Rate for Payer: Aetna American Axle |
$319.15
|
| Rate for Payer: Aetna Commercial |
$417.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.15
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$343.70
|
| Rate for Payer: Cofinity Commercial |
$422.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.80
|
| Rate for Payer: Healthscope Commercial |
$441.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$417.35
|
| Rate for Payer: PHP Commercial |
$417.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.70
|
| Rate for Payer: Priority Health SBD |
$309.33
|
| Rate for Payer: UMR Bronson Commercial |
$216.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.25
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 92960
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$343.70 |
| Rate for Payer: Aetna Commercial |
$144.47
|
| Rate for Payer: BCBS Complete |
$71.12
|
| Rate for Payer: BCBS Trust/PPO |
$237.21
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Meridian Medicaid |
$71.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.84
|
| Rate for Payer: Priority Health Narrow Network |
$150.84
|
| Rate for Payer: Priority Health SBD |
$150.84
|
| Rate for Payer: UMR Bronson Commercial |
$225.86
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
92960
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$343.70 |
| Rate for Payer: Aetna Commercial |
$144.47
|
| Rate for Payer: BCBS Complete |
$71.12
|
| Rate for Payer: BCBS Trust/PPO |
$237.21
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Meridian Medicaid |
$71.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.84
|
| Rate for Payer: Priority Health Narrow Network |
$150.84
|
| Rate for Payer: Priority Health SBD |
$150.84
|
| Rate for Payer: UMR Bronson Commercial |
$225.86
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
92960
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$104.13 |
| Max. Negotiated Rate |
$1,821.15 |
| Rate for Payer: Aetna American Axle |
$319.15
|
| Rate for Payer: Aetna Commercial |
$417.35
|
| Rate for Payer: Aetna Medicare |
$601.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$723.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$723.12
|
| Rate for Payer: BCBS Complete |
$332.29
|
| Rate for Payer: BCBS MAPPO |
$578.50
|
| Rate for Payer: BCBS Trust/PPO |
$597.69
|
| Rate for Payer: BCN Medicare Advantage |
$578.50
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$343.70
|
| Rate for Payer: Cofinity Commercial |
$422.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$578.50
|
| Rate for Payer: Healthscope Commercial |
$441.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.25
|
| Rate for Payer: Mclaren Medicaid |
$316.44
|
| Rate for Payer: Mclaren Medicare |
$578.50
|
| Rate for Payer: Meridian Medicaid |
$332.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$607.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$665.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$417.35
|
| Rate for Payer: PACE Medicare |
$549.58
|
| Rate for Payer: PACE SWMI |
$578.50
|
| Rate for Payer: PHP Commercial |
$417.35
|
| Rate for Payer: PHP Medicare Advantage |
$578.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,821.15
|
| Rate for Payer: Priority Health Medicare |
$578.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,456.92
|
| Rate for Payer: Priority Health SBD |
$309.33
|
| Rate for Payer: Railroad Medicare Medicare |
$578.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$578.50
|
| Rate for Payer: UHC Exchange |
$104.13
|
| Rate for Payer: UHC Medicare Advantage |
$595.86
|
| Rate for Payer: UMR Bronson Commercial |
$181.67
|
| Rate for Payer: VA VA |
$578.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.25
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 92961
|
| Min. Negotiated Rate |
$101.96 |
| Max. Negotiated Rate |
$344.40 |
| Rate for Payer: Aetna Commercial |
$330.21
|
| Rate for Payer: BCBS Complete |
$160.14
|
| Rate for Payer: BCBS Trust/PPO |
$101.96
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Meridian Medicaid |
$160.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.57
|
| Rate for Payer: Priority Health Narrow Network |
$338.57
|
| Rate for Payer: Priority Health SBD |
$338.57
|
| Rate for Payer: UMR Bronson Commercial |
$226.32
|
|
|
PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 96161
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$179.62 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$179.62
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.43
|
| Rate for Payer: Priority Health Narrow Network |
$5.43
|
| Rate for Payer: Priority Health SBD |
$5.43
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
|
|
PR CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 99484
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$594.87 |
| Rate for Payer: Aetna Commercial |
$30.26
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS Trust/PPO |
$594.87
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.26
|
| Rate for Payer: Priority Health Narrow Network |
$37.26
|
| Rate for Payer: Priority Health SBD |
$37.26
|
| Rate for Payer: UMR Bronson Commercial |
$40.94
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
OP
|
$1,668.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$495.75 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna American Axle |
$1,084.20
|
| Rate for Payer: Aetna Commercial |
$1,417.80
|
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cofinity Commercial |
$1,167.60
|
| Rate for Payer: Cofinity Commercial |
$1,434.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$1,501.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,167.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.00
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,417.80
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$1,417.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Priority Health SBD |
$1,050.84
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.32
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$495.75
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: UMR Bronson Commercial |
$617.16
|
| Rate for Payer: VA VA |
$2,877.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.00
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 25210
|
| Min. Negotiated Rate |
$322.48 |
| Max. Negotiated Rate |
$1,167.60 |
| Rate for Payer: Aetna Commercial |
$654.43
|
| Rate for Payer: BCBS Complete |
$338.60
|
| Rate for Payer: BCBS Trust/PPO |
$637.66
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Meridian Medicaid |
$338.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$764.44
|
| Rate for Payer: Priority Health Narrow Network |
$764.44
|
| Rate for Payer: Priority Health SBD |
$764.44
|
| Rate for Payer: UMR Bronson Commercial |
$767.28
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 25210
|
| Hospital Charge Code |
25210
|
| Min. Negotiated Rate |
$322.48 |
| Max. Negotiated Rate |
$1,167.60 |
| Rate for Payer: Aetna Commercial |
$654.43
|
| Rate for Payer: BCBS Complete |
$338.60
|
| Rate for Payer: BCBS Trust/PPO |
$637.66
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Meridian Medicaid |
$338.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$764.44
|
| Rate for Payer: Priority Health Narrow Network |
$764.44
|
| Rate for Payer: Priority Health SBD |
$764.44
|
| Rate for Payer: UMR Bronson Commercial |
$767.28
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
IP
|
$1,668.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$733.92 |
| Max. Negotiated Rate |
$1,501.20 |
| Rate for Payer: Aetna American Axle |
$1,084.20
|
| Rate for Payer: Aetna Commercial |
$1,417.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.20
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cofinity Commercial |
$1,434.48
|
| Rate for Payer: Cofinity Commercial |
$1,167.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.40
|
| Rate for Payer: Healthscope Commercial |
$1,501.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,167.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,251.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,417.80
|
| Rate for Payer: PHP Commercial |
$1,417.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: Priority Health SBD |
$1,050.84
|
| Rate for Payer: UMR Bronson Commercial |
$733.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,251.00
|
|
|
PR CARPECTOMY ALL BONES PROXIMAL ROW
|
Professional
|
Both
|
$2,244.00
|
|
|
Service Code
|
HCPCS 25215
|
| Min. Negotiated Rate |
$403.21 |
| Max. Negotiated Rate |
$1,570.80 |
| Rate for Payer: Aetna Commercial |
$824.12
|
| Rate for Payer: BCBS Complete |
$423.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,436.98
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Meridian Medicaid |
$423.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,570.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$957.48
|
| Rate for Payer: Priority Health Narrow Network |
$957.48
|
| Rate for Payer: Priority Health SBD |
$957.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,032.24
|
|
|
PR CARTILAGE GRAFT COSTOCHONDRAL
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 20910
|
| Min. Negotiated Rate |
$309.92 |
| Max. Negotiated Rate |
$8,557.53 |
| Rate for Payer: Aetna Commercial |
$625.78
|
| Rate for Payer: BCBS Complete |
$325.42
|
| Rate for Payer: BCBS Trust/PPO |
$8,557.53
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Meridian Medicaid |
$325.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$309.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$732.78
|
| Rate for Payer: Priority Health Narrow Network |
$732.78
|
| Rate for Payer: Priority Health SBD |
$732.78
|
| Rate for Payer: UMR Bronson Commercial |
$423.66
|
|
|
PR CARTILAGE GRAFT NASAL SEPTUM
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 20912
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$739.43 |
| Rate for Payer: Aetna Commercial |
$630.42
|
| Rate for Payer: BCBS Complete |
$326.98
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Meridian Medicaid |
$326.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$311.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$739.43
|
| Rate for Payer: Priority Health Narrow Network |
$739.43
|
| Rate for Payer: Priority Health SBD |
$739.43
|
| Rate for Payer: UMR Bronson Commercial |
$476.10
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Aetna American Axle |
$261.30
|
| Rate for Payer: Aetna Commercial |
$341.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.30
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$345.72
|
| Rate for Payer: Cofinity Commercial |
$281.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.60
|
| Rate for Payer: Healthscope Commercial |
$361.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.70
|
| Rate for Payer: PHP Commercial |
$341.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health SBD |
$253.26
|
| Rate for Payer: UMR Bronson Commercial |
$176.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.50
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$2,557.47 |
| Rate for Payer: Aetna American Axle |
$261.30
|
| Rate for Payer: Aetna Commercial |
$341.70
|
| Rate for Payer: Aetna Medicare |
$844.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$888.71
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cofinity Commercial |
$281.40
|
| Rate for Payer: Cofinity Commercial |
$345.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Healthscope Commercial |
$361.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.50
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.70
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Commercial |
$341.70
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,557.47
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.98
|
| Rate for Payer: Priority Health SBD |
$253.26
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.40
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: UMR Bronson Commercial |
$148.74
|
| Rate for Payer: VA VA |
$812.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.50
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS G0104
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$1,681.05 |
| Rate for Payer: Aetna Commercial |
$54.91
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,681.05
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.01
|
| Rate for Payer: Priority Health Narrow Network |
$97.01
|
| Rate for Payer: Priority Health SBD |
$97.01
|
| Rate for Payer: UMR Bronson Commercial |
$184.92
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$1,681.05 |
| Rate for Payer: Aetna Commercial |
$54.91
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,681.05
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.01
|
| Rate for Payer: Priority Health Narrow Network |
$97.01
|
| Rate for Payer: Priority Health SBD |
$97.01
|
| Rate for Payer: UMR Bronson Commercial |
$184.92
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS G0101
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$1,696.90 |
| Rate for Payer: Aetna Commercial |
$27.24
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,696.90
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.13
|
| Rate for Payer: Priority Health Narrow Network |
$35.13
|
| Rate for Payer: Priority Health SBD |
$35.13
|
| Rate for Payer: UMR Bronson Commercial |
$30.82
|
|
|
PR CAST SUP GAUNTLET FIBERGLASS
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS Q4014
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna Commercial |
$22.26
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: UMR Bronson Commercial |
$25.30
|
|
|
PR CAST SUP LNG ARM SPLINT FBRG
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$12.17
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: UMR Bronson Commercial |
$11.50
|
|
|
PR CAST SUP LNG ARM SPLNT PED F
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS Q4020
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna Commercial |
$6.10
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
|
|
PR CAST SUP LNG LEG CYLINDER FB
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS Q4034
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$68.60 |
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: UMR Bronson Commercial |
$45.08
|
|
