|
HC BALLOONS CATH TRANSLUMINAL LVL 4
|
Facility
|
OP
|
$576.58
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| 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: BCBS Complete |
$230.63
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$461.26
|
| 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 |
$213.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.44
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 5
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$610.20 |
| Rate for Payer: Aetna American Axle |
$440.70
|
| Rate for Payer: Aetna Commercial |
$576.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.70
|
| Rate for Payer: BCBS Complete |
$271.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cofinity Commercial |
$474.60
|
| Rate for Payer: Cofinity Commercial |
$583.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.40
|
| Rate for Payer: Healthscope Commercial |
$610.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$474.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$508.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.30
|
| Rate for Payer: PHP Commercial |
$576.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.60
|
| Rate for Payer: Priority Health SBD |
$427.14
|
| Rate for Payer: UMR Bronson Commercial |
$250.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$508.50
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 5
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.32 |
| Max. Negotiated Rate |
$610.20 |
| Rate for Payer: Aetna American Axle |
$440.70
|
| Rate for Payer: Aetna Commercial |
$576.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.70
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cofinity Commercial |
$474.60
|
| Rate for Payer: Cofinity Commercial |
$583.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$542.40
|
| Rate for Payer: Healthscope Commercial |
$610.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$474.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$508.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$576.30
|
| Rate for Payer: PHP Commercial |
$576.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.60
|
| Rate for Payer: Priority Health SBD |
$427.14
|
| Rate for Payer: UMR Bronson Commercial |
$298.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$508.50
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 6
|
Facility
|
OP
|
$869.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$782.46 |
| Rate for Payer: Aetna American Axle |
$565.11
|
| Rate for Payer: Aetna Commercial |
$738.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.11
|
| Rate for Payer: BCBS Complete |
$347.76
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$695.52
|
| Rate for Payer: Cash Price |
$695.52
|
| Rate for Payer: Cofinity Commercial |
$608.58
|
| Rate for Payer: Cofinity Commercial |
$747.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.52
|
| Rate for Payer: Healthscope Commercial |
$782.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$738.99
|
| Rate for Payer: PHP Commercial |
$738.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.58
|
| Rate for Payer: Priority Health SBD |
$547.72
|
| Rate for Payer: UMR Bronson Commercial |
$321.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.05
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 6
|
Facility
|
IP
|
$869.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.54 |
| Max. Negotiated Rate |
$782.46 |
| Rate for Payer: Aetna American Axle |
$565.11
|
| Rate for Payer: Aetna Commercial |
$738.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.11
|
| Rate for Payer: Cash Price |
$695.52
|
| Rate for Payer: Cofinity Commercial |
$608.58
|
| Rate for Payer: Cofinity Commercial |
$747.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.52
|
| Rate for Payer: Healthscope Commercial |
$782.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$608.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$652.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$738.99
|
| Rate for Payer: PHP Commercial |
$738.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.58
|
| Rate for Payer: Priority Health SBD |
$547.72
|
| Rate for Payer: UMR Bronson Commercial |
$382.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$652.05
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
IP
|
$3,126.70
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,375.75 |
| Max. Negotiated Rate |
$2,814.03 |
| Rate for Payer: Aetna American Axle |
$2,032.36
|
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,032.36
|
| Rate for Payer: Cash Price |
$2,501.36
|
| Rate for Payer: Cofinity Commercial |
$2,188.69
|
| Rate for Payer: Cofinity Commercial |
$2,688.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,501.36
|
| Rate for Payer: Healthscope Commercial |
$2,814.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,188.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,345.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,657.70
|
| Rate for Payer: PHP Commercial |
$2,657.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,188.69
|
| Rate for Payer: Priority Health SBD |
$1,969.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,375.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,345.02
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
OP
|
$3,126.70
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$2,814.03 |
| Rate for Payer: Aetna American Axle |
$2,032.36
|
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,032.36
|
| Rate for Payer: BCBS Complete |
$1,250.68
|
| Rate for Payer: Cash Price |
$2,501.36
|
| Rate for Payer: Cofinity Commercial |
$2,188.69
|
| Rate for Payer: Cofinity Commercial |
$2,688.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,501.36
|
| Rate for Payer: Healthscope Commercial |
$2,814.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,188.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,345.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,657.70
|
| Rate for Payer: PHP Commercial |
$2,657.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,188.69
|
| Rate for Payer: Priority Health SBD |
$1,969.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,345.02
|
|
|
HC BANANA IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC BANANA IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.16
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$5.73
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.21
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
IP
|
$13.42
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna American Axle |
$8.72
|
| Rate for Payer: Aetna Commercial |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.72
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$12.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.41
|
| Rate for Payer: PHP Commercial |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health SBD |
$8.45
|
| Rate for Payer: UMR Bronson Commercial |
$5.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.06
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
OP
|
$13.42
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$12.08 |
| Rate for Payer: Aetna American Axle |
$8.72
|
| Rate for Payer: Aetna Commercial |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.72
|
| Rate for Payer: BCBS Complete |
$5.37
|
| Rate for Payer: Cash Price |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$12.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.41
|
| Rate for Payer: PHP Commercial |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.39
|
| Rate for Payer: Priority Health SBD |
$8.45
|
| Rate for Payer: UMR Bronson Commercial |
$4.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.06
|
|
|
HC BANDING
|
Facility
|
IP
|
$946.71
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$416.55 |
| Max. Negotiated Rate |
$852.04 |
| Rate for Payer: Aetna American Axle |
$615.36
|
| Rate for Payer: Aetna Commercial |
$804.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.36
|
| Rate for Payer: Cash Price |
$757.37
|
| Rate for Payer: Cofinity Commercial |
$662.70
|
| Rate for Payer: Cofinity Commercial |
$814.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.37
|
| Rate for Payer: Healthscope Commercial |
$852.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$662.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$710.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$804.70
|
| Rate for Payer: PHP Commercial |
$804.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.70
|
| Rate for Payer: Priority Health SBD |
$596.43
|
| Rate for Payer: UMR Bronson Commercial |
$416.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$710.03
|
|
|
HC BANDING
|
Facility
|
OP
|
$946.71
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$350.28 |
| Max. Negotiated Rate |
$852.04 |
| Rate for Payer: Aetna American Axle |
$615.36
|
| Rate for Payer: Aetna Commercial |
$804.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.36
|
| Rate for Payer: BCBS Complete |
$378.68
|
| Rate for Payer: Cash Price |
$757.37
|
| Rate for Payer: Cofinity Commercial |
$662.70
|
| Rate for Payer: Cofinity Commercial |
$814.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$757.37
|
| Rate for Payer: Healthscope Commercial |
$852.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$662.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$710.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$804.70
|
| Rate for Payer: PHP Commercial |
$804.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$662.70
|
| Rate for Payer: Priority Health SBD |
$596.43
|
| Rate for Payer: UMR Bronson Commercial |
$350.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$710.03
|
|
|
HC BARBITURATE URIN
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna American Axle |
$62.01
|
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$55.89
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.55
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.58
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$38.86
|
| Rate for Payer: Priority Health SBD |
$60.10
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: UMR Bronson Commercial |
$35.30
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.55
|
|
|
HC BARBITURATE URIN
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$85.86 |
| Rate for Payer: Aetna American Axle |
$62.01
|
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.01
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health SBD |
$60.10
|
| Rate for Payer: UMR Bronson Commercial |
$41.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.55
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.28 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna American Axle |
$40.30
|
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.30
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health SBD |
$39.06
|
| Rate for Payer: UMR Bronson Commercial |
$27.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna American Axle |
$40.30
|
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.30
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health SBD |
$39.06
|
| Rate for Payer: UHC Core |
$18.70
|
| Rate for Payer: UMR Bronson Commercial |
$22.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC BARRIER ADHESION
|
Facility
|
IP
|
$578.39
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
27000463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$254.49 |
| Max. Negotiated Rate |
$520.55 |
| Rate for Payer: Aetna American Axle |
$375.95
|
| Rate for Payer: Aetna Commercial |
$491.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.95
|
| Rate for Payer: Cash Price |
$462.71
|
| Rate for Payer: Cofinity Commercial |
$404.87
|
| Rate for Payer: Cofinity Commercial |
$497.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.71
|
| Rate for Payer: Healthscope Commercial |
$520.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$491.63
|
| Rate for Payer: PHP Commercial |
$491.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.87
|
| Rate for Payer: Priority Health SBD |
$364.39
|
| Rate for Payer: UMR Bronson Commercial |
$254.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.79
|
|
|
HC BARRIER ADHESION
|
Facility
|
OP
|
$578.39
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
27000463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$214.00 |
| Max. Negotiated Rate |
$520.55 |
| Rate for Payer: Aetna American Axle |
$375.95
|
| Rate for Payer: Aetna Commercial |
$491.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.95
|
| Rate for Payer: BCBS Complete |
$231.36
|
| Rate for Payer: Cash Price |
$462.71
|
| Rate for Payer: Cofinity Commercial |
$404.87
|
| Rate for Payer: Cofinity Commercial |
$497.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.71
|
| Rate for Payer: Healthscope Commercial |
$520.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$404.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$491.63
|
| Rate for Payer: PHP Commercial |
$491.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.87
|
| Rate for Payer: Priority Health SBD |
$364.39
|
| Rate for Payer: UMR Bronson Commercial |
$214.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.79
|
|
|
HC BARRX 360 EXPRESS CATH BALLOON
|
Facility
|
OP
|
$5,608.69
|
|
| Hospital Charge Code |
27200286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,075.22 |
| Max. Negotiated Rate |
$5,047.82 |
| Rate for Payer: Aetna American Axle |
$3,645.65
|
| Rate for Payer: Aetna Commercial |
$4,767.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,645.65
|
| Rate for Payer: BCBS Complete |
$2,243.48
|
| Rate for Payer: Cash Price |
$4,486.95
|
| Rate for Payer: Cofinity Commercial |
$3,926.08
|
| Rate for Payer: Cofinity Commercial |
$4,823.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,486.95
|
| Rate for Payer: Healthscope Commercial |
$5,047.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,926.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,206.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,767.39
|
| Rate for Payer: PHP Commercial |
$4,767.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,926.08
|
| Rate for Payer: Priority Health SBD |
$3,533.47
|
| Rate for Payer: UMR Bronson Commercial |
$2,075.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,206.52
|
|
|
HC BARRX 360 EXPRESS CATH BALLOON
|
Facility
|
IP
|
$5,608.69
|
|
| Hospital Charge Code |
27200286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,467.82 |
| Max. Negotiated Rate |
$5,047.82 |
| Rate for Payer: Aetna American Axle |
$3,645.65
|
| Rate for Payer: Aetna Commercial |
$4,767.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,645.65
|
| Rate for Payer: Cash Price |
$4,486.95
|
| Rate for Payer: Cofinity Commercial |
$3,926.08
|
| Rate for Payer: Cofinity Commercial |
$4,823.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,486.95
|
| Rate for Payer: Healthscope Commercial |
$5,047.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,926.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,206.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,767.39
|
| Rate for Payer: PHP Commercial |
$4,767.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,926.08
|
| Rate for Payer: Priority Health SBD |
$3,533.47
|
| Rate for Payer: UMR Bronson Commercial |
$2,467.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,206.52
|
|
|
HC BARRX 90 RFA FOCAL CATHETER
|
Facility
|
IP
|
$4,265.57
|
|
| Hospital Charge Code |
27200287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,876.85 |
| Max. Negotiated Rate |
$3,839.01 |
| Rate for Payer: Aetna American Axle |
$2,772.62
|
| Rate for Payer: Aetna Commercial |
$3,625.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,772.62
|
| Rate for Payer: Cash Price |
$3,412.46
|
| Rate for Payer: Cofinity Commercial |
$2,985.90
|
| Rate for Payer: Cofinity Commercial |
$3,668.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,412.46
|
| Rate for Payer: Healthscope Commercial |
$3,839.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,985.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,199.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,625.73
|
| Rate for Payer: PHP Commercial |
$3,625.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,985.90
|
| Rate for Payer: Priority Health SBD |
$2,687.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,876.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,199.18
|
|
|
HC BARRX 90 RFA FOCAL CATHETER
|
Facility
|
OP
|
$4,265.57
|
|
| Hospital Charge Code |
27200287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,578.26 |
| Max. Negotiated Rate |
$3,839.01 |
| Rate for Payer: Aetna American Axle |
$2,772.62
|
| Rate for Payer: Aetna Commercial |
$3,625.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,772.62
|
| Rate for Payer: BCBS Complete |
$1,706.23
|
| Rate for Payer: Cash Price |
$3,412.46
|
| Rate for Payer: Cofinity Commercial |
$2,985.90
|
| Rate for Payer: Cofinity Commercial |
$3,668.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,412.46
|
| Rate for Payer: Healthscope Commercial |
$3,839.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,985.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,199.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,625.73
|
| Rate for Payer: PHP Commercial |
$3,625.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,985.90
|
| Rate for Payer: Priority Health SBD |
$2,687.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,578.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,199.18
|
|
|
HC BARRX RFA
|
Facility
|
IP
|
$2,004.30
|
|
| Hospital Charge Code |
36000101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$881.89 |
| Max. Negotiated Rate |
$1,803.87 |
| Rate for Payer: Aetna American Axle |
$1,302.80
|
| Rate for Payer: Aetna Commercial |
$1,703.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.80
|
| Rate for Payer: Cash Price |
$1,603.44
|
| Rate for Payer: Cofinity Commercial |
$1,403.01
|
| Rate for Payer: Cofinity Commercial |
$1,723.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.44
|
| Rate for Payer: Healthscope Commercial |
$1,803.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,403.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,503.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,703.66
|
| Rate for Payer: PHP Commercial |
$1,703.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,403.01
|
| Rate for Payer: Priority Health SBD |
$1,262.71
|
| Rate for Payer: UMR Bronson Commercial |
$881.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,503.22
|
|
|
HC BARRX RFA
|
Facility
|
OP
|
$2,004.30
|
|
| Hospital Charge Code |
36000101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$741.59 |
| Max. Negotiated Rate |
$1,803.87 |
| Rate for Payer: Aetna American Axle |
$1,302.80
|
| Rate for Payer: Aetna Commercial |
$1,703.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.80
|
| Rate for Payer: BCBS Complete |
$801.72
|
| Rate for Payer: Cash Price |
$1,603.44
|
| Rate for Payer: Cofinity Commercial |
$1,403.01
|
| Rate for Payer: Cofinity Commercial |
$1,723.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.44
|
| Rate for Payer: Healthscope Commercial |
$1,803.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,403.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,503.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,703.66
|
| Rate for Payer: PHP Commercial |
$1,703.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,403.01
|
| Rate for Payer: Priority Health SBD |
$1,262.71
|
| Rate for Payer: UMR Bronson Commercial |
$741.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,503.22
|
|
