|
HC BOOT STATIC AIR W/STAB Z-FLEX
|
Facility
|
IP
|
$47.84
|
|
| Hospital Charge Code |
27000631
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.27
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.66
|
| Rate for Payer: PHP Commercial |
$40.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.49
|
| Rate for Payer: Priority Health SBD |
$30.14
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.88
|
|
|
HC BOOT STATIC AIR W/STAB Z-FLEX
|
Facility
|
OP
|
$47.84
|
|
| Hospital Charge Code |
27000631
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna Commercial |
$40.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.27
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.66
|
| Rate for Payer: PHP Commercial |
$40.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.49
|
| Rate for Payer: Priority Health SBD |
$30.14
|
| Rate for Payer: UMR Bronson Commercial |
$17.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.88
|
|
|
HC BOSTON SCI CRT ICD
|
Facility
|
OP
|
$25,806.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$23,225.40 |
| Rate for Payer: Aetna American Axle |
$16,773.90
|
| Rate for Payer: Aetna Commercial |
$21,935.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,773.90
|
| Rate for Payer: BCBS Complete |
$10,322.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$20,644.80
|
| Rate for Payer: Cash Price |
$20,644.80
|
| Rate for Payer: Cofinity Commercial |
$22,193.16
|
| Rate for Payer: Cofinity Commercial |
$18,064.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,644.80
|
| Rate for Payer: Healthscope Commercial |
$23,225.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,064.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,354.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,935.10
|
| Rate for Payer: PHP Commercial |
$21,935.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,064.20
|
| Rate for Payer: Priority Health SBD |
$16,257.78
|
| Rate for Payer: UMR Bronson Commercial |
$9,548.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,354.50
|
|
|
HC BOSTON SCI CRT ICD
|
Facility
|
IP
|
$25,806.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$11,354.64 |
| Max. Negotiated Rate |
$23,225.40 |
| Rate for Payer: Aetna American Axle |
$16,773.90
|
| Rate for Payer: Aetna Commercial |
$21,935.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,773.90
|
| Rate for Payer: Cash Price |
$20,644.80
|
| Rate for Payer: Cofinity Commercial |
$18,064.20
|
| Rate for Payer: Cofinity Commercial |
$22,193.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,644.80
|
| Rate for Payer: Healthscope Commercial |
$23,225.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,064.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,354.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,935.10
|
| Rate for Payer: PHP Commercial |
$21,935.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,064.20
|
| Rate for Payer: Priority Health SBD |
$16,257.78
|
| Rate for Payer: UMR Bronson Commercial |
$11,354.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,354.50
|
|
|
HC BOSTON SCI CRT LEAD
|
Facility
|
OP
|
$6,751.77
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$6,076.59 |
| Rate for Payer: Aetna American Axle |
$4,388.65
|
| Rate for Payer: Aetna Commercial |
$5,739.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,388.65
|
| Rate for Payer: BCBS Complete |
$2,700.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$5,401.42
|
| Rate for Payer: Cash Price |
$5,401.42
|
| Rate for Payer: Cofinity Commercial |
$4,726.24
|
| Rate for Payer: Cofinity Commercial |
$5,806.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,401.42
|
| Rate for Payer: Healthscope Commercial |
$6,076.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,726.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,063.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,739.00
|
| Rate for Payer: PHP Commercial |
$5,739.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,726.24
|
| Rate for Payer: Priority Health SBD |
$4,253.62
|
| Rate for Payer: UMR Bronson Commercial |
$2,498.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,063.83
|
|
|
HC BOSTON SCI CRT LEAD
|
Facility
|
IP
|
$6,751.77
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,970.78 |
| Max. Negotiated Rate |
$6,076.59 |
| Rate for Payer: Aetna American Axle |
$4,388.65
|
| Rate for Payer: Aetna Commercial |
$5,739.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,388.65
|
| Rate for Payer: Cash Price |
$5,401.42
|
| Rate for Payer: Cofinity Commercial |
$4,726.24
|
| Rate for Payer: Cofinity Commercial |
$5,806.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,401.42
|
| Rate for Payer: Healthscope Commercial |
$6,076.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,726.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,063.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,739.00
|
| Rate for Payer: PHP Commercial |
$5,739.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,726.24
|
| Rate for Payer: Priority Health SBD |
$4,253.62
|
| Rate for Payer: UMR Bronson Commercial |
$2,970.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,063.83
|
|
|
HC BOSTON SCI DUAL PACEMAKER
|
Facility
|
IP
|
$8,404.80
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,698.11 |
| Max. Negotiated Rate |
$7,564.32 |
| Rate for Payer: Aetna American Axle |
$5,463.12
|
| Rate for Payer: Aetna Commercial |
$7,144.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,463.12
|
| Rate for Payer: Cash Price |
$6,723.84
|
| Rate for Payer: Cofinity Commercial |
$5,883.36
|
| Rate for Payer: Cofinity Commercial |
$7,228.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,723.84
|
| Rate for Payer: Healthscope Commercial |
$7,564.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,883.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,303.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,144.08
|
| Rate for Payer: PHP Commercial |
$7,144.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,883.36
|
| Rate for Payer: Priority Health SBD |
$5,295.02
|
| Rate for Payer: UMR Bronson Commercial |
$3,698.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,303.60
|
|
|
HC BOSTON SCI DUAL PACEMAKER
|
Facility
|
OP
|
$8,404.80
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500004
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,109.78 |
| Max. Negotiated Rate |
$7,564.32 |
| Rate for Payer: Aetna American Axle |
$5,463.12
|
| Rate for Payer: Aetna Commercial |
$7,144.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,463.12
|
| Rate for Payer: BCBS Complete |
$3,361.92
|
| Rate for Payer: Cash Price |
$6,723.84
|
| Rate for Payer: Cofinity Commercial |
$5,883.36
|
| Rate for Payer: Cofinity Commercial |
$7,228.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,723.84
|
| Rate for Payer: Healthscope Commercial |
$7,564.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,883.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,303.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,144.08
|
| Rate for Payer: PHP Commercial |
$7,144.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,883.36
|
| Rate for Payer: Priority Health SBD |
$5,295.02
|
| Rate for Payer: UMR Bronson Commercial |
$3,109.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,303.60
|
|
|
HC BOSTON SCI ICD DUAL
|
Facility
|
OP
|
$18,156.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,717.72 |
| Max. Negotiated Rate |
$16,340.40 |
| Rate for Payer: Aetna American Axle |
$11,801.40
|
| Rate for Payer: Aetna Commercial |
$15,432.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,801.40
|
| Rate for Payer: BCBS Complete |
$7,262.40
|
| Rate for Payer: Cash Price |
$14,524.80
|
| Rate for Payer: Cofinity Commercial |
$12,709.20
|
| Rate for Payer: Cofinity Commercial |
$15,614.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,524.80
|
| Rate for Payer: Healthscope Commercial |
$16,340.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,709.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,617.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,432.60
|
| Rate for Payer: PHP Commercial |
$15,432.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,709.20
|
| Rate for Payer: Priority Health SBD |
$11,438.28
|
| Rate for Payer: UMR Bronson Commercial |
$6,717.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,617.00
|
|
|
HC BOSTON SCI ICD DUAL
|
Facility
|
IP
|
$18,156.00
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27800002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,988.64 |
| Max. Negotiated Rate |
$16,340.40 |
| Rate for Payer: Aetna American Axle |
$11,801.40
|
| Rate for Payer: Aetna Commercial |
$15,432.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,801.40
|
| Rate for Payer: Cash Price |
$14,524.80
|
| Rate for Payer: Cofinity Commercial |
$12,709.20
|
| Rate for Payer: Cofinity Commercial |
$15,614.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,524.80
|
| Rate for Payer: Healthscope Commercial |
$16,340.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,709.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,617.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,432.60
|
| Rate for Payer: PHP Commercial |
$15,432.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,709.20
|
| Rate for Payer: Priority Health SBD |
$11,438.28
|
| Rate for Payer: UMR Bronson Commercial |
$7,988.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,617.00
|
|
|
HC BOSTON SCI ICD SINGLE
|
Facility
|
OP
|
$21,624.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,000.88 |
| Max. Negotiated Rate |
$19,461.60 |
| Rate for Payer: Aetna American Axle |
$14,055.60
|
| Rate for Payer: Aetna Commercial |
$18,380.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,055.60
|
| Rate for Payer: BCBS Complete |
$8,649.60
|
| Rate for Payer: Cash Price |
$17,299.20
|
| Rate for Payer: Cofinity Commercial |
$15,136.80
|
| Rate for Payer: Cofinity Commercial |
$18,596.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,299.20
|
| Rate for Payer: Healthscope Commercial |
$19,461.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,136.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,218.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18,380.40
|
| Rate for Payer: PHP Commercial |
$18,380.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,136.80
|
| Rate for Payer: Priority Health SBD |
$13,623.12
|
| Rate for Payer: UMR Bronson Commercial |
$8,000.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,218.00
|
|
|
HC BOSTON SCI ICD SINGLE
|
Facility
|
IP
|
$21,624.00
|
|
|
Service Code
|
HCPCS C1722
|
| Hospital Charge Code |
27800003
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,514.56 |
| Max. Negotiated Rate |
$19,461.60 |
| Rate for Payer: Aetna American Axle |
$14,055.60
|
| Rate for Payer: Aetna Commercial |
$18,380.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,055.60
|
| Rate for Payer: Cash Price |
$17,299.20
|
| Rate for Payer: Cofinity Commercial |
$15,136.80
|
| Rate for Payer: Cofinity Commercial |
$18,596.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,299.20
|
| Rate for Payer: Healthscope Commercial |
$19,461.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,136.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,218.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18,380.40
|
| Rate for Payer: PHP Commercial |
$18,380.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,136.80
|
| Rate for Payer: Priority Health SBD |
$13,623.12
|
| Rate for Payer: UMR Bronson Commercial |
$9,514.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,218.00
|
|
|
HC BOSTON SCI PACEMAKER LEAD
|
Facility
|
IP
|
$2,213.49
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.94 |
| Max. Negotiated Rate |
$1,992.14 |
| Rate for Payer: Aetna American Axle |
$1,438.77
|
| Rate for Payer: Aetna Commercial |
$1,881.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,438.77
|
| Rate for Payer: Cash Price |
$1,770.79
|
| Rate for Payer: Cofinity Commercial |
$1,549.44
|
| Rate for Payer: Cofinity Commercial |
$1,903.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,770.79
|
| Rate for Payer: Healthscope Commercial |
$1,992.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,549.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,660.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,881.47
|
| Rate for Payer: PHP Commercial |
$1,881.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,549.44
|
| Rate for Payer: Priority Health SBD |
$1,394.50
|
| Rate for Payer: UMR Bronson Commercial |
$973.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,660.12
|
|
|
HC BOSTON SCI PACEMAKER LEAD
|
Facility
|
OP
|
$2,213.49
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27800074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$818.99 |
| Max. Negotiated Rate |
$1,992.14 |
| Rate for Payer: Aetna American Axle |
$1,438.77
|
| Rate for Payer: Aetna Commercial |
$1,881.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,438.77
|
| Rate for Payer: BCBS Complete |
$885.40
|
| Rate for Payer: Cash Price |
$1,770.79
|
| Rate for Payer: Cofinity Commercial |
$1,549.44
|
| Rate for Payer: Cofinity Commercial |
$1,903.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,770.79
|
| Rate for Payer: Healthscope Commercial |
$1,992.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,549.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,660.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,881.47
|
| Rate for Payer: PHP Commercial |
$1,881.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,549.44
|
| Rate for Payer: Priority Health SBD |
$1,394.50
|
| Rate for Payer: UMR Bronson Commercial |
$818.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,660.12
|
|
|
HC BOSTON SCI PERIPHERAL STENT
|
Facility
|
OP
|
$2,626.53
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.82 |
| Max. Negotiated Rate |
$2,363.88 |
| Rate for Payer: Aetna American Axle |
$1,707.24
|
| Rate for Payer: Aetna Commercial |
$2,232.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,707.24
|
| Rate for Payer: BCBS Complete |
$1,050.61
|
| Rate for Payer: Cash Price |
$2,101.22
|
| Rate for Payer: Cofinity Commercial |
$1,838.57
|
| Rate for Payer: Cofinity Commercial |
$2,258.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,101.22
|
| Rate for Payer: Healthscope Commercial |
$2,363.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,838.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,969.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,232.55
|
| Rate for Payer: PHP Commercial |
$2,232.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,838.57
|
| Rate for Payer: Priority Health SBD |
$1,654.71
|
| Rate for Payer: UMR Bronson Commercial |
$971.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,969.90
|
|
|
HC BOSTON SCI PERIPHERAL STENT
|
Facility
|
IP
|
$2,626.53
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800004
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.67 |
| Max. Negotiated Rate |
$2,363.88 |
| Rate for Payer: Aetna American Axle |
$1,707.24
|
| Rate for Payer: Aetna Commercial |
$2,232.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,707.24
|
| Rate for Payer: Cash Price |
$2,101.22
|
| Rate for Payer: Cofinity Commercial |
$1,838.57
|
| Rate for Payer: Cofinity Commercial |
$2,258.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,101.22
|
| Rate for Payer: Healthscope Commercial |
$2,363.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,838.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,969.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,232.55
|
| Rate for Payer: PHP Commercial |
$2,232.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,838.57
|
| Rate for Payer: Priority Health SBD |
$1,654.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,155.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,969.90
|
|
|
HC BOSTON SCI SINGLE PACEMAKER
|
Facility
|
IP
|
$13,947.49
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500005
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,136.90 |
| Max. Negotiated Rate |
$12,552.74 |
| Rate for Payer: Aetna American Axle |
$9,065.87
|
| Rate for Payer: Aetna Commercial |
$11,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,065.87
|
| Rate for Payer: Cash Price |
$11,157.99
|
| Rate for Payer: Cofinity Commercial |
$11,994.84
|
| Rate for Payer: Cofinity Commercial |
$9,763.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,157.99
|
| Rate for Payer: Healthscope Commercial |
$12,552.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,763.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,460.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,855.37
|
| Rate for Payer: PHP Commercial |
$11,855.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,763.24
|
| Rate for Payer: Priority Health SBD |
$8,786.92
|
| Rate for Payer: UMR Bronson Commercial |
$6,136.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,460.62
|
|
|
HC BOSTON SCI SINGLE PACEMAKER
|
Facility
|
OP
|
$13,947.49
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500005
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,160.57 |
| Max. Negotiated Rate |
$12,552.74 |
| Rate for Payer: Aetna American Axle |
$9,065.87
|
| Rate for Payer: Aetna Commercial |
$11,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,065.87
|
| Rate for Payer: BCBS Complete |
$5,579.00
|
| Rate for Payer: Cash Price |
$11,157.99
|
| Rate for Payer: Cofinity Commercial |
$11,994.84
|
| Rate for Payer: Cofinity Commercial |
$9,763.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,157.99
|
| Rate for Payer: Healthscope Commercial |
$12,552.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,763.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,460.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,855.37
|
| Rate for Payer: PHP Commercial |
$11,855.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,763.24
|
| Rate for Payer: Priority Health SBD |
$8,786.92
|
| Rate for Payer: UMR Bronson Commercial |
$5,160.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,460.62
|
|
|
HC BOSTON SCI TACHY (ICD) LEAD
|
Facility
|
OP
|
$8,600.98
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,182.36 |
| Max. Negotiated Rate |
$7,740.88 |
| Rate for Payer: Aetna American Axle |
$5,590.64
|
| Rate for Payer: Aetna Commercial |
$7,310.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,590.64
|
| Rate for Payer: BCBS Complete |
$3,440.39
|
| Rate for Payer: Cash Price |
$6,880.78
|
| Rate for Payer: Cofinity Commercial |
$6,020.69
|
| Rate for Payer: Cofinity Commercial |
$7,396.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,880.78
|
| Rate for Payer: Healthscope Commercial |
$7,740.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,020.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,450.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,310.83
|
| Rate for Payer: PHP Commercial |
$7,310.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,020.69
|
| Rate for Payer: Priority Health SBD |
$5,418.62
|
| Rate for Payer: UMR Bronson Commercial |
$3,182.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,450.74
|
|
|
HC BOSTON SCI TACHY (ICD) LEAD
|
Facility
|
IP
|
$8,600.98
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,784.43 |
| Max. Negotiated Rate |
$7,740.88 |
| Rate for Payer: Aetna American Axle |
$5,590.64
|
| Rate for Payer: Aetna Commercial |
$7,310.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,590.64
|
| Rate for Payer: Cash Price |
$6,880.78
|
| Rate for Payer: Cofinity Commercial |
$6,020.69
|
| Rate for Payer: Cofinity Commercial |
$7,396.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,880.78
|
| Rate for Payer: Healthscope Commercial |
$7,740.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,020.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,450.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,310.83
|
| Rate for Payer: PHP Commercial |
$7,310.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,020.69
|
| Rate for Payer: Priority Health SBD |
$5,418.62
|
| Rate for Payer: UMR Bronson Commercial |
$3,784.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,450.74
|
|
|
HC BOTRYTIS CINEREA IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200075
|
|
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 |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| 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 BOTRYTIS CINEREA IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200075
|
|
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 |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| 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 BOTTLE A/B CDI 500
|
Facility
|
IP
|
$198.00
|
|
| Hospital Charge Code |
27000684
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna American Axle |
$128.70
|
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.70
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$170.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.40
|
| Rate for Payer: Healthscope Commercial |
$178.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.30
|
| Rate for Payer: PHP Commercial |
$168.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.60
|
| Rate for Payer: Priority Health SBD |
$124.74
|
| Rate for Payer: UMR Bronson Commercial |
$87.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.50
|
|
|
HC BOTTLE A/B CDI 500
|
Facility
|
OP
|
$198.00
|
|
| Hospital Charge Code |
27000684
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.26 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna American Axle |
$128.70
|
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.70
|
| Rate for Payer: BCBS Complete |
$79.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$170.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.40
|
| Rate for Payer: Healthscope Commercial |
$178.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.30
|
| Rate for Payer: PHP Commercial |
$168.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.60
|
| Rate for Payer: Priority Health SBD |
$124.74
|
| Rate for Payer: UMR Bronson Commercial |
$73.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.50
|
|
|
HC BOWL
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
27000091
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.00 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna American Axle |
$146.25
|
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.25
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$157.50
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health SBD |
$141.75
|
| Rate for Payer: UMR Bronson Commercial |
$99.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
