|
HC CATFISH IGE
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna American Axle |
$46.41
|
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UMR Bronson Commercial |
$31.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC CATH ATHRECT ROTATIONAL LVL 5
|
Facility
|
OP
|
$5,593.68
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$5,034.31 |
| Rate for Payer: Aetna American Axle |
$3,635.89
|
| Rate for Payer: Aetna Commercial |
$4,754.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,635.89
|
| Rate for Payer: BCBS Complete |
$2,237.47
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$4,474.94
|
| Rate for Payer: Cash Price |
$4,474.94
|
| Rate for Payer: Cofinity Commercial |
$3,915.58
|
| Rate for Payer: Cofinity Commercial |
$4,810.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,474.94
|
| Rate for Payer: Healthscope Commercial |
$5,034.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,915.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,195.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,754.63
|
| Rate for Payer: PHP Commercial |
$4,754.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,915.58
|
| Rate for Payer: Priority Health SBD |
$3,524.02
|
| Rate for Payer: UMR Bronson Commercial |
$2,069.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,195.26
|
|
|
HC CATH ATHRECT ROTATIONAL LVL 5
|
Facility
|
IP
|
$5,593.68
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,461.22 |
| Max. Negotiated Rate |
$5,034.31 |
| Rate for Payer: Aetna American Axle |
$3,635.89
|
| Rate for Payer: Aetna Commercial |
$4,754.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,635.89
|
| Rate for Payer: Cash Price |
$4,474.94
|
| Rate for Payer: Cofinity Commercial |
$3,915.58
|
| Rate for Payer: Cofinity Commercial |
$4,810.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,474.94
|
| Rate for Payer: Healthscope Commercial |
$5,034.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,915.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,195.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,754.63
|
| Rate for Payer: PHP Commercial |
$4,754.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,915.58
|
| Rate for Payer: Priority Health SBD |
$3,524.02
|
| Rate for Payer: UMR Bronson Commercial |
$2,461.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,195.26
|
|
|
HC CATH BALLOON
|
Facility
|
OP
|
$1,289.14
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,160.23 |
| Rate for Payer: Aetna American Axle |
$837.94
|
| Rate for Payer: Aetna Commercial |
$1,095.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.94
|
| Rate for Payer: BCBS Complete |
$515.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cofinity Commercial |
$1,108.66
|
| Rate for Payer: Cofinity Commercial |
$902.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.31
|
| Rate for Payer: Healthscope Commercial |
$1,160.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,095.77
|
| Rate for Payer: PHP Commercial |
$1,095.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.40
|
| Rate for Payer: Priority Health SBD |
$812.16
|
| Rate for Payer: UMR Bronson Commercial |
$476.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.86
|
|
|
HC CATH BALLOON
|
Facility
|
IP
|
$1,289.14
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$567.22 |
| Max. Negotiated Rate |
$1,160.23 |
| Rate for Payer: Aetna American Axle |
$837.94
|
| Rate for Payer: Aetna Commercial |
$1,095.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.94
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cofinity Commercial |
$902.40
|
| Rate for Payer: Cofinity Commercial |
$1,108.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.31
|
| Rate for Payer: Healthscope Commercial |
$1,160.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,095.77
|
| Rate for Payer: PHP Commercial |
$1,095.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.40
|
| Rate for Payer: Priority Health SBD |
$812.16
|
| Rate for Payer: UMR Bronson Commercial |
$567.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.86
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 1
|
Facility
|
IP
|
$145.26
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.91 |
| Max. Negotiated Rate |
$130.73 |
| Rate for Payer: Aetna American Axle |
$94.42
|
| Rate for Payer: Aetna Commercial |
$123.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.42
|
| Rate for Payer: Cash Price |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$101.68
|
| Rate for Payer: Cofinity Commercial |
$124.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.21
|
| Rate for Payer: Healthscope Commercial |
$130.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.47
|
| Rate for Payer: PHP Commercial |
$123.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.68
|
| Rate for Payer: Priority Health SBD |
$91.51
|
| Rate for Payer: UMR Bronson Commercial |
$63.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.94
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 1
|
Facility
|
OP
|
$145.26
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$130.73 |
| Rate for Payer: Aetna American Axle |
$94.42
|
| Rate for Payer: Aetna Commercial |
$123.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.42
|
| Rate for Payer: BCBS Complete |
$58.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$116.21
|
| Rate for Payer: Cash Price |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$101.68
|
| Rate for Payer: Cofinity Commercial |
$124.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.21
|
| Rate for Payer: Healthscope Commercial |
$130.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.47
|
| Rate for Payer: PHP Commercial |
$123.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.68
|
| Rate for Payer: Priority Health SBD |
$91.51
|
| Rate for Payer: UMR Bronson Commercial |
$53.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.94
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 7
|
Facility
|
OP
|
$792.81
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$713.53 |
| Rate for Payer: Aetna American Axle |
$515.33
|
| Rate for Payer: Aetna Commercial |
$673.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.33
|
| Rate for Payer: BCBS Complete |
$317.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$634.25
|
| Rate for Payer: Cash Price |
$634.25
|
| Rate for Payer: Cofinity Commercial |
$554.97
|
| Rate for Payer: Cofinity Commercial |
$681.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.25
|
| Rate for Payer: Healthscope Commercial |
$713.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$554.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$673.89
|
| Rate for Payer: PHP Commercial |
$673.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.97
|
| Rate for Payer: Priority Health SBD |
$499.47
|
| Rate for Payer: UMR Bronson Commercial |
$293.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.61
|
|
|
HC CATHETER BALLOON DILAT NON VASC LVL 7
|
Facility
|
IP
|
$792.81
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$348.84 |
| Max. Negotiated Rate |
$713.53 |
| Rate for Payer: Aetna American Axle |
$515.33
|
| Rate for Payer: Aetna Commercial |
$673.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.33
|
| Rate for Payer: Cash Price |
$634.25
|
| Rate for Payer: Cofinity Commercial |
$554.97
|
| Rate for Payer: Cofinity Commercial |
$681.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.25
|
| Rate for Payer: Healthscope Commercial |
$713.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$554.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$673.89
|
| Rate for Payer: PHP Commercial |
$673.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.97
|
| Rate for Payer: Priority Health SBD |
$499.47
|
| Rate for Payer: UMR Bronson Commercial |
$348.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.61
|
|
|
HC CATHETER INTRADISCAL
|
Facility
|
IP
|
$1,502.05
|
|
|
Service Code
|
CPT C1754
|
| Hospital Charge Code |
27200357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$660.90 |
| Max. Negotiated Rate |
$1,351.84 |
| Rate for Payer: Aetna American Axle |
$976.33
|
| Rate for Payer: Aetna Commercial |
$1,276.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$976.33
|
| Rate for Payer: Cash Price |
$1,201.64
|
| Rate for Payer: Cofinity Commercial |
$1,051.44
|
| Rate for Payer: Cofinity Commercial |
$1,291.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.64
|
| Rate for Payer: Healthscope Commercial |
$1,351.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,051.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,126.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,276.74
|
| Rate for Payer: PHP Commercial |
$1,276.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.44
|
| Rate for Payer: Priority Health SBD |
$946.29
|
| Rate for Payer: UMR Bronson Commercial |
$660.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,126.54
|
|
|
HC CATHETER INTRADISCAL
|
Facility
|
OP
|
$1,502.05
|
|
|
Service Code
|
CPT C1754
|
| Hospital Charge Code |
27200357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.76 |
| Max. Negotiated Rate |
$1,351.84 |
| Rate for Payer: Aetna American Axle |
$976.33
|
| Rate for Payer: Aetna Commercial |
$1,276.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$976.33
|
| Rate for Payer: BCBS Complete |
$600.82
|
| Rate for Payer: Cash Price |
$1,201.64
|
| Rate for Payer: Cofinity Commercial |
$1,051.44
|
| Rate for Payer: Cofinity Commercial |
$1,291.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.64
|
| Rate for Payer: Healthscope Commercial |
$1,351.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,051.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,126.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,276.74
|
| Rate for Payer: PHP Commercial |
$1,276.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.44
|
| Rate for Payer: Priority Health SBD |
$946.29
|
| Rate for Payer: UMR Bronson Commercial |
$555.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,126.54
|
|
|
HC CATHETERIZATION FOR COLLECTION OF SPECIMEN
|
Facility
|
OP
|
$29.58
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
30000114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$26.62 |
| Rate for Payer: Aetna American Axle |
$19.23
|
| Rate for Payer: Aetna Commercial |
$25.14
|
| Rate for Payer: Aetna Medicare |
$8.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.71
|
| Rate for Payer: BCBS Complete |
$4.92
|
| Rate for Payer: BCBS MAPPO |
$8.57
|
| Rate for Payer: BCN Medicare Advantage |
$8.57
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$20.71
|
| Rate for Payer: Cofinity Commercial |
$25.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.57
|
| Rate for Payer: Healthscope Commercial |
$26.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.18
|
| Rate for Payer: Mclaren Medicaid |
$4.69
|
| Rate for Payer: Mclaren Medicare |
$8.57
|
| Rate for Payer: Meridian Medicaid |
$4.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.14
|
| Rate for Payer: PACE Medicare |
$8.14
|
| Rate for Payer: PACE SWMI |
$8.57
|
| Rate for Payer: PHP Commercial |
$25.14
|
| Rate for Payer: PHP Medicare Advantage |
$8.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.00
|
| Rate for Payer: Priority Health Medicare |
$8.57
|
| Rate for Payer: Priority Health Narrow Network |
$2.40
|
| Rate for Payer: Priority Health SBD |
$18.64
|
| Rate for Payer: Railroad Medicare Medicare |
$8.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.60
|
| Rate for Payer: UHC Core |
$3.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.57
|
| Rate for Payer: UHC Exchange |
$8.83
|
| Rate for Payer: UHC Medicare Advantage |
$8.83
|
| Rate for Payer: UMR Bronson Commercial |
$10.94
|
| Rate for Payer: VA VA |
$8.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.18
|
|
|
HC CATHETERIZATION FOR COLLECTION OF SPECIMEN
|
Facility
|
IP
|
$29.58
|
|
|
Service Code
|
CPT P9612
|
| Hospital Charge Code |
30000114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$26.62 |
| Rate for Payer: Aetna American Axle |
$19.23
|
| Rate for Payer: Aetna Commercial |
$25.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.23
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$20.71
|
| Rate for Payer: Cofinity Commercial |
$25.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.66
|
| Rate for Payer: Healthscope Commercial |
$26.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.14
|
| Rate for Payer: PHP Commercial |
$25.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.71
|
| Rate for Payer: Priority Health SBD |
$18.64
|
| Rate for Payer: UMR Bronson Commercial |
$13.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.18
|
|
|
HC CATHETER NOS LVL 1
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna American Axle |
$42.90
|
| Rate for Payer: Aetna Commercial |
$56.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.90
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$46.20
|
| Rate for Payer: Cofinity Commercial |
$56.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.80
|
| Rate for Payer: Healthscope Commercial |
$59.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.10
|
| Rate for Payer: PHP Commercial |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: Priority Health SBD |
$41.58
|
| Rate for Payer: UMR Bronson Commercial |
$29.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.50
|
|
|
HC CATHETER NOS LVL 1
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna American Axle |
$42.90
|
| Rate for Payer: Aetna Commercial |
$56.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.90
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$56.76
|
| Rate for Payer: Cofinity Commercial |
$46.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.80
|
| Rate for Payer: Healthscope Commercial |
$59.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.10
|
| Rate for Payer: PHP Commercial |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: Priority Health SBD |
$41.58
|
| Rate for Payer: UMR Bronson Commercial |
$24.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.50
|
|
|
HC CATHETER NOS LVL 2
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna American Axle |
$227.50
|
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.50
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health SBD |
$220.50
|
| Rate for Payer: UMR Bronson Commercial |
$129.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
|
HC CATHETER NOS LVL 2
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna American Axle |
$227.50
|
| Rate for Payer: Aetna Commercial |
$297.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.50
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.00
|
| Rate for Payer: Healthscope Commercial |
$315.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.50
|
| Rate for Payer: PHP Commercial |
$297.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health SBD |
$220.50
|
| Rate for Payer: UMR Bronson Commercial |
$154.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.50
|
|
|
HC CATHETER PRESSURE GENERATING ONE WAY INTERMED OCCLUSIVE
|
Facility
|
IP
|
$11,625.00
|
|
|
Service Code
|
CPT C1982
|
| Hospital Charge Code |
27800147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,115.00 |
| Max. Negotiated Rate |
$10,462.50 |
| Rate for Payer: Aetna American Axle |
$7,556.25
|
| Rate for Payer: Aetna Commercial |
$9,881.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,556.25
|
| Rate for Payer: Cash Price |
$9,300.00
|
| Rate for Payer: Cofinity Commercial |
$8,137.50
|
| Rate for Payer: Cofinity Commercial |
$9,997.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,300.00
|
| Rate for Payer: Healthscope Commercial |
$10,462.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,137.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,718.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,881.25
|
| Rate for Payer: PHP Commercial |
$9,881.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,137.50
|
| Rate for Payer: Priority Health SBD |
$7,323.75
|
| Rate for Payer: UMR Bronson Commercial |
$5,115.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,718.75
|
|
|
HC CATHETER PRESSURE GENERATING ONE WAY INTERMED OCCLUSIVE
|
Facility
|
OP
|
$11,625.00
|
|
|
Service Code
|
CPT C1982
|
| Hospital Charge Code |
27800147
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,092.00 |
| Max. Negotiated Rate |
$10,462.50 |
| Rate for Payer: Aetna American Axle |
$7,556.25
|
| Rate for Payer: Aetna Commercial |
$9,881.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,556.25
|
| Rate for Payer: BCBS Complete |
$4,650.00
|
| Rate for Payer: Cash Price |
$9,300.00
|
| Rate for Payer: Cofinity Commercial |
$8,137.50
|
| Rate for Payer: Cofinity Commercial |
$9,997.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,300.00
|
| Rate for Payer: Healthscope Commercial |
$10,462.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,137.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,718.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,881.25
|
| Rate for Payer: PHP Commercial |
$9,881.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,137.50
|
| Rate for Payer: Priority Health SBD |
$7,323.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,092.00
|
| Rate for Payer: UHC Exchange |
$4,766.25
|
| Rate for Payer: UMR Bronson Commercial |
$4,301.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,718.75
|
|
|
HC CATHETER SINGLE
|
Facility
|
OP
|
$186.82
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.12 |
| Max. Negotiated Rate |
$168.14 |
| Rate for Payer: Aetna American Axle |
$121.43
|
| Rate for Payer: Aetna Commercial |
$158.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.43
|
| Rate for Payer: BCBS Complete |
$74.73
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$130.77
|
| Rate for Payer: Cofinity Commercial |
$160.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Healthscope Commercial |
$168.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.80
|
| Rate for Payer: PHP Commercial |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.77
|
| Rate for Payer: Priority Health SBD |
$117.70
|
| Rate for Payer: UMR Bronson Commercial |
$69.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.12
|
|
|
HC CATHETER SINGLE
|
Facility
|
IP
|
$186.82
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$168.14 |
| Rate for Payer: Aetna American Axle |
$121.43
|
| Rate for Payer: Aetna Commercial |
$158.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.43
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$130.77
|
| Rate for Payer: Cofinity Commercial |
$160.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Healthscope Commercial |
$168.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.80
|
| Rate for Payer: PHP Commercial |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.77
|
| Rate for Payer: Priority Health SBD |
$117.70
|
| Rate for Payer: UMR Bronson Commercial |
$82.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.12
|
|
|
HC CATHETER TLA DRUG COATED NON LASER
|
Facility
|
IP
|
$1,606.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27200302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$706.86 |
| Max. Negotiated Rate |
$1,445.85 |
| Rate for Payer: Aetna American Axle |
$1,044.22
|
| Rate for Payer: Aetna Commercial |
$1,365.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.22
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cofinity Commercial |
$1,124.55
|
| Rate for Payer: Cofinity Commercial |
$1,381.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.20
|
| Rate for Payer: Healthscope Commercial |
$1,445.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,124.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,204.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,365.52
|
| Rate for Payer: PHP Commercial |
$1,365.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,124.55
|
| Rate for Payer: Priority Health SBD |
$1,012.10
|
| Rate for Payer: UMR Bronson Commercial |
$706.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,204.88
|
|
|
HC CATHETER TLA DRUG COATED NON LASER
|
Facility
|
OP
|
$1,606.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27200302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$594.40 |
| Max. Negotiated Rate |
$1,445.85 |
| Rate for Payer: Aetna American Axle |
$1,044.22
|
| Rate for Payer: Aetna Commercial |
$1,365.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.22
|
| Rate for Payer: BCBS Complete |
$642.60
|
| Rate for Payer: Cash Price |
$1,285.20
|
| Rate for Payer: Cofinity Commercial |
$1,381.59
|
| Rate for Payer: Cofinity Commercial |
$1,124.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,285.20
|
| Rate for Payer: Healthscope Commercial |
$1,445.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,124.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,204.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,365.52
|
| Rate for Payer: PHP Commercial |
$1,365.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,124.55
|
| Rate for Payer: Priority Health SBD |
$1,012.10
|
| Rate for Payer: UMR Bronson Commercial |
$594.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,204.88
|
|
|
HC CATHETER TRANSLUM ATHERECT DIRECTIONAL
|
Facility
|
OP
|
$7,545.17
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27200294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$6,790.65 |
| Rate for Payer: Aetna American Axle |
$4,904.36
|
| Rate for Payer: Aetna Commercial |
$6,413.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,904.36
|
| Rate for Payer: BCBS Complete |
$3,018.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$6,036.14
|
| Rate for Payer: Cash Price |
$6,036.14
|
| Rate for Payer: Cofinity Commercial |
$5,281.62
|
| Rate for Payer: Cofinity Commercial |
$6,488.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,036.14
|
| Rate for Payer: Healthscope Commercial |
$6,790.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,281.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,658.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,413.39
|
| Rate for Payer: PHP Commercial |
$6,413.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,281.62
|
| Rate for Payer: Priority Health SBD |
$4,753.46
|
| Rate for Payer: UMR Bronson Commercial |
$2,791.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,658.88
|
|
|
HC CATHETER TRANSLUM ATHERECT DIRECTIONAL
|
Facility
|
IP
|
$7,545.17
|
|
|
Service Code
|
HCPCS C1714
|
| Hospital Charge Code |
27200294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,319.87 |
| Max. Negotiated Rate |
$6,790.65 |
| Rate for Payer: Aetna American Axle |
$4,904.36
|
| Rate for Payer: Aetna Commercial |
$6,413.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,904.36
|
| Rate for Payer: Cash Price |
$6,036.14
|
| Rate for Payer: Cofinity Commercial |
$5,281.62
|
| Rate for Payer: Cofinity Commercial |
$6,488.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,036.14
|
| Rate for Payer: Healthscope Commercial |
$6,790.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,281.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,658.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,413.39
|
| Rate for Payer: PHP Commercial |
$6,413.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,281.62
|
| Rate for Payer: Priority Health SBD |
$4,753.46
|
| Rate for Payer: UMR Bronson Commercial |
$3,319.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,658.88
|
|
