|
HC BACITRACIN 1 OZ
|
Facility
|
OP
|
$7.97
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Aetna American Axle |
$5.18
|
| Rate for Payer: Aetna Commercial |
$6.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.18
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$5.58
|
| Rate for Payer: Cofinity Commercial |
$6.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$7.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.77
|
| Rate for Payer: PHP Commercial |
$6.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.58
|
| Rate for Payer: Priority Health SBD |
$5.02
|
| Rate for Payer: UMR Bronson Commercial |
$2.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.98
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
IP
|
$7.97
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Aetna American Axle |
$5.18
|
| Rate for Payer: Aetna Commercial |
$6.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.18
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$5.58
|
| Rate for Payer: Cofinity Commercial |
$6.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$7.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.77
|
| Rate for Payer: PHP Commercial |
$6.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.58
|
| Rate for Payer: Priority Health SBD |
$5.02
|
| Rate for Payer: UMR Bronson Commercial |
$3.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.98
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
OP
|
$30.37
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Aetna American Axle |
$19.74
|
| Rate for Payer: Aetna Commercial |
$25.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.74
|
| Rate for Payer: BCBS Complete |
$12.15
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$26.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.30
|
| Rate for Payer: Healthscope Commercial |
$27.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.81
|
| Rate for Payer: PHP Commercial |
$25.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.26
|
| Rate for Payer: Priority Health SBD |
$19.13
|
| Rate for Payer: UMR Bronson Commercial |
$11.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.78
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
IP
|
$30.37
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$27.33 |
| Rate for Payer: Aetna American Axle |
$19.74
|
| Rate for Payer: Aetna Commercial |
$25.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.74
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$26.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.30
|
| Rate for Payer: Healthscope Commercial |
$27.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.81
|
| Rate for Payer: PHP Commercial |
$25.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.26
|
| Rate for Payer: Priority Health SBD |
$19.13
|
| Rate for Payer: UMR Bronson Commercial |
$13.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.78
|
|
|
HC BACK SCREEN
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC BACK SCREEN
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
OP
|
$68.34
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.29 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$44.42
|
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.42
|
| Rate for Payer: BCBS Complete |
$27.34
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Cofinity Commercial |
$47.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.09
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.84
|
| Rate for Payer: Priority Health SBD |
$43.05
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$25.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.26
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
IP
|
$68.34
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Aetna American Axle |
$44.42
|
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.42
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Cofinity Commercial |
$47.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.09
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.84
|
| Rate for Payer: Priority Health SBD |
$43.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.26
|
|
|
HC BACTERIAL VAGINOSIS PANEL
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
30600337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna American Axle |
$97.50
|
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health SBD |
$94.50
|
| Rate for Payer: UMR Bronson Commercial |
$66.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC BACTERIAL VAGINOSIS PANEL
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
30600337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$178.29 |
| Rate for Payer: Aetna American Axle |
$97.50
|
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: BCBS Complete |
$81.93
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Mclaren Medicaid |
$78.02
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Medicaid |
$81.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.63
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health Narrow Network |
$114.10
|
| Rate for Payer: Priority Health SBD |
$94.50
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.16
|
| Rate for Payer: UHC Core |
$171.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Exchange |
$142.63
|
| Rate for Payer: UHC Medicare Advantage |
$146.91
|
| Rate for Payer: UMR Bronson Commercial |
$55.50
|
| Rate for Payer: VA VA |
$142.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC BAG BLOOD TRANSFER
|
Facility
|
IP
|
$8.70
|
|
| Hospital Charge Code |
27000161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Aetna American Axle |
$5.66
|
| Rate for Payer: Aetna Commercial |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.66
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cofinity Commercial |
$6.09
|
| Rate for Payer: Cofinity Commercial |
$7.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$7.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.40
|
| Rate for Payer: PHP Commercial |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.09
|
| Rate for Payer: Priority Health SBD |
$5.48
|
| Rate for Payer: UMR Bronson Commercial |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.52
|
|
|
HC BAG BLOOD TRANSFER
|
Facility
|
OP
|
$8.70
|
|
| Hospital Charge Code |
27000161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$7.83 |
| Rate for Payer: Aetna American Axle |
$5.66
|
| Rate for Payer: Aetna Commercial |
$7.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.66
|
| Rate for Payer: BCBS Complete |
$3.48
|
| Rate for Payer: Cash Price |
$6.96
|
| Rate for Payer: Cofinity Commercial |
$6.09
|
| Rate for Payer: Cofinity Commercial |
$7.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$7.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.40
|
| Rate for Payer: PHP Commercial |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.09
|
| Rate for Payer: Priority Health SBD |
$5.48
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.52
|
|
|
HC BAG WASTE
|
Facility
|
IP
|
$63.00
|
|
| Hospital Charge Code |
27000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna American Axle |
$40.95
|
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.95
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$44.10
|
| Rate for Payer: Cofinity Commercial |
$54.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.40
|
| Rate for Payer: Healthscope Commercial |
$56.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.55
|
| Rate for Payer: PHP Commercial |
$53.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.10
|
| Rate for Payer: Priority Health SBD |
$39.69
|
| Rate for Payer: UMR Bronson Commercial |
$27.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.25
|
|
|
HC BAG WASTE
|
Facility
|
OP
|
$63.00
|
|
| Hospital Charge Code |
27000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.31 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna American Axle |
$40.95
|
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.95
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$44.10
|
| Rate for Payer: Cofinity Commercial |
$54.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.40
|
| Rate for Payer: Healthscope Commercial |
$56.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.55
|
| Rate for Payer: PHP Commercial |
$53.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.10
|
| Rate for Payer: Priority Health SBD |
$39.69
|
| Rate for Payer: UMR Bronson Commercial |
$23.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.25
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
IP
|
$733.86
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.90 |
| Max. Negotiated Rate |
$660.47 |
| Rate for Payer: Aetna American Axle |
$477.01
|
| Rate for Payer: Aetna Commercial |
$623.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.01
|
| Rate for Payer: Cash Price |
$587.09
|
| Rate for Payer: Cofinity Commercial |
$513.70
|
| Rate for Payer: Cofinity Commercial |
$631.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.09
|
| Rate for Payer: Healthscope Commercial |
$660.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.78
|
| Rate for Payer: PHP Commercial |
$623.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.70
|
| Rate for Payer: Priority Health SBD |
$462.33
|
| Rate for Payer: UMR Bronson Commercial |
$322.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.40
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
OP
|
$733.86
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.91 |
| Max. Negotiated Rate |
$2,936.60 |
| Rate for Payer: Aetna American Axle |
$477.01
|
| Rate for Payer: Aetna Commercial |
$623.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.01
|
| Rate for Payer: BCBS Complete |
$293.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,936.60
|
| Rate for Payer: Cash Price |
$587.09
|
| Rate for Payer: Cash Price |
$587.09
|
| Rate for Payer: Cofinity Commercial |
$513.70
|
| Rate for Payer: Cofinity Commercial |
$631.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.09
|
| Rate for Payer: Healthscope Commercial |
$660.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.78
|
| Rate for Payer: PHP Commercial |
$623.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.70
|
| Rate for Payer: Priority Health SBD |
$462.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.10
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$171.91
|
| Rate for Payer: UMR Bronson Commercial |
$271.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.40
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
OP
|
$1,887.28
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$698.29 |
| Max. Negotiated Rate |
$1,698.55 |
| Rate for Payer: Aetna American Axle |
$1,226.73
|
| Rate for Payer: Aetna Commercial |
$1,604.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,226.73
|
| Rate for Payer: BCBS Complete |
$754.91
|
| Rate for Payer: Cash Price |
$1,509.82
|
| Rate for Payer: Cofinity Commercial |
$1,321.10
|
| Rate for Payer: Cofinity Commercial |
$1,623.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.82
|
| Rate for Payer: Healthscope Commercial |
$1,698.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,321.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,415.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,604.19
|
| Rate for Payer: PHP Commercial |
$1,604.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.10
|
| Rate for Payer: Priority Health SBD |
$1,188.99
|
| Rate for Payer: UMR Bronson Commercial |
$698.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,415.46
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
IP
|
$1,887.28
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$830.40 |
| Max. Negotiated Rate |
$1,698.55 |
| Rate for Payer: Aetna American Axle |
$1,226.73
|
| Rate for Payer: Aetna Commercial |
$1,604.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,226.73
|
| Rate for Payer: Cash Price |
$1,509.82
|
| Rate for Payer: Cofinity Commercial |
$1,321.10
|
| Rate for Payer: Cofinity Commercial |
$1,623.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.82
|
| Rate for Payer: Healthscope Commercial |
$1,698.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,321.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,415.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,604.19
|
| Rate for Payer: PHP Commercial |
$1,604.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.10
|
| Rate for Payer: Priority Health SBD |
$1,188.99
|
| Rate for Payer: UMR Bronson Commercial |
$830.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,415.46
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
IP
|
$80.85
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$72.76 |
| Rate for Payer: Aetna American Axle |
$52.55
|
| Rate for Payer: Aetna Commercial |
$68.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.55
|
| Rate for Payer: Cash Price |
$64.68
|
| Rate for Payer: Cofinity Commercial |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$69.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.68
|
| Rate for Payer: Healthscope Commercial |
$72.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.72
|
| Rate for Payer: PHP Commercial |
$68.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.60
|
| Rate for Payer: Priority Health SBD |
$50.94
|
| Rate for Payer: UMR Bronson Commercial |
$35.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.64
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
OP
|
$80.85
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$72.76 |
| Rate for Payer: Aetna American Axle |
$52.55
|
| Rate for Payer: Aetna Commercial |
$68.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.55
|
| Rate for Payer: BCBS Complete |
$32.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$64.68
|
| Rate for Payer: Cash Price |
$64.68
|
| Rate for Payer: Cofinity Commercial |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$69.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.68
|
| Rate for Payer: Healthscope Commercial |
$72.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.72
|
| Rate for Payer: PHP Commercial |
$68.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.60
|
| Rate for Payer: Priority Health SBD |
$50.94
|
| Rate for Payer: UMR Bronson Commercial |
$29.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.64
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
IP
|
$244.19
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna American Axle |
$158.72
|
| Rate for Payer: Aetna Commercial |
$207.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.72
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Commercial |
$170.93
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Healthscope Commercial |
$219.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.56
|
| Rate for Payer: PHP Commercial |
$207.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.93
|
| Rate for Payer: Priority Health SBD |
$153.84
|
| Rate for Payer: UMR Bronson Commercial |
$107.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.14
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
OP
|
$244.19
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna American Axle |
$158.72
|
| Rate for Payer: Aetna Commercial |
$207.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.72
|
| Rate for Payer: BCBS Complete |
$97.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cash Price |
$195.35
|
| Rate for Payer: Cofinity Commercial |
$170.93
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.35
|
| Rate for Payer: Healthscope Commercial |
$219.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.56
|
| Rate for Payer: PHP Commercial |
$207.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.93
|
| Rate for Payer: Priority Health SBD |
$153.84
|
| Rate for Payer: UMR Bronson Commercial |
$90.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.14
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 3
|
Facility
|
OP
|
$412.78
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$371.50 |
| Rate for Payer: Aetna American Axle |
$268.31
|
| Rate for Payer: Aetna Commercial |
$350.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.31
|
| Rate for Payer: BCBS Complete |
$165.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cofinity Commercial |
$288.95
|
| Rate for Payer: Cofinity Commercial |
$354.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.22
|
| Rate for Payer: Healthscope Commercial |
$371.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.86
|
| Rate for Payer: PHP Commercial |
$350.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.95
|
| Rate for Payer: Priority Health SBD |
$260.05
|
| Rate for Payer: UMR Bronson Commercial |
$152.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.58
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 3
|
Facility
|
IP
|
$412.78
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$181.62 |
| Max. Negotiated Rate |
$371.50 |
| Rate for Payer: Aetna American Axle |
$268.31
|
| Rate for Payer: Aetna Commercial |
$350.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.31
|
| Rate for Payer: Cash Price |
$330.22
|
| Rate for Payer: Cofinity Commercial |
$288.95
|
| Rate for Payer: Cofinity Commercial |
$354.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.22
|
| Rate for Payer: Healthscope Commercial |
$371.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$288.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$350.86
|
| Rate for Payer: PHP Commercial |
$350.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.95
|
| Rate for Payer: Priority Health SBD |
$260.05
|
| Rate for Payer: UMR Bronson Commercial |
$181.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.58
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 4
|
Facility
|
IP
|
$576.58
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.70 |
| Max. Negotiated Rate |
$518.92 |
| Rate for Payer: Aetna American Axle |
$374.78
|
| Rate for Payer: Aetna Commercial |
$490.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.78
|
| Rate for Payer: Cash Price |
$461.26
|
| Rate for Payer: Cofinity Commercial |
$403.61
|
| Rate for Payer: Cofinity Commercial |
$495.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.26
|
| Rate for Payer: Healthscope Commercial |
$518.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$490.09
|
| Rate for Payer: PHP Commercial |
$490.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.61
|
| Rate for Payer: Priority Health SBD |
$363.25
|
| Rate for Payer: UMR Bronson Commercial |
$253.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.44
|
|
