|
HC ENDOPLEGE
|
Facility
|
IP
|
$5,194.83
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,285.73 |
| Max. Negotiated Rate |
$4,675.35 |
| Rate for Payer: Aetna American Axle |
$3,376.64
|
| Rate for Payer: Aetna Commercial |
$4,415.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,376.64
|
| Rate for Payer: Cash Price |
$4,155.86
|
| Rate for Payer: Cofinity Commercial |
$3,636.38
|
| Rate for Payer: Cofinity Commercial |
$4,467.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,155.86
|
| Rate for Payer: Healthscope Commercial |
$4,675.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,636.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,896.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,415.61
|
| Rate for Payer: PHP Commercial |
$4,415.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,636.38
|
| Rate for Payer: Priority Health SBD |
$3,272.74
|
| Rate for Payer: UMR Bronson Commercial |
$2,285.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,896.12
|
|
|
HC ENDOPLEGE
|
Facility
|
OP
|
$5,194.83
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,922.09 |
| Max. Negotiated Rate |
$4,675.35 |
| Rate for Payer: Aetna American Axle |
$3,376.64
|
| Rate for Payer: Aetna Commercial |
$4,415.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,376.64
|
| Rate for Payer: BCBS Complete |
$2,077.93
|
| Rate for Payer: Cash Price |
$4,155.86
|
| Rate for Payer: Cofinity Commercial |
$3,636.38
|
| Rate for Payer: Cofinity Commercial |
$4,467.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,155.86
|
| Rate for Payer: Healthscope Commercial |
$4,675.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,636.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,896.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,415.61
|
| Rate for Payer: PHP Commercial |
$4,415.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,636.38
|
| Rate for Payer: Priority Health SBD |
$3,272.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,922.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,896.12
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
OP
|
$9,288.24
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.85 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna American Axle |
$6,037.36
|
| Rate for Payer: Aetna Commercial |
$7,895.00
|
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,037.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,977.24
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Cash Price |
$7,430.59
|
| Rate for Payer: Cash Price |
$7,430.59
|
| Rate for Payer: Cofinity Commercial |
$6,501.77
|
| Rate for Payer: Cofinity Commercial |
$7,987.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,430.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Healthscope Commercial |
$8,359.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,501.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,966.18
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,895.00
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Commercial |
$7,895.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,501.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Priority Health SBD |
$5,851.59
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$193.85
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: UMR Bronson Commercial |
$3,436.65
|
| Rate for Payer: VA VA |
$3,098.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,966.18
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
IP
|
$9,288.24
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,086.83 |
| Max. Negotiated Rate |
$8,359.42 |
| Rate for Payer: Aetna American Axle |
$6,037.36
|
| Rate for Payer: Aetna Commercial |
$7,895.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,037.36
|
| Rate for Payer: Cash Price |
$7,430.59
|
| Rate for Payer: Cofinity Commercial |
$6,501.77
|
| Rate for Payer: Cofinity Commercial |
$7,987.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,430.59
|
| Rate for Payer: Healthscope Commercial |
$8,359.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,501.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,966.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,895.00
|
| Rate for Payer: PHP Commercial |
$7,895.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,501.77
|
| Rate for Payer: Priority Health SBD |
$5,851.59
|
| Rate for Payer: UMR Bronson Commercial |
$4,086.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,966.18
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.80 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna American Axle |
$321.75
|
| Rate for Payer: Aetna Commercial |
$420.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.75
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$346.50
|
| Rate for Payer: Cofinity Commercial |
$425.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$445.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.75
|
| Rate for Payer: PHP Commercial |
$420.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.50
|
| Rate for Payer: Priority Health SBD |
$311.85
|
| Rate for Payer: UMR Bronson Commercial |
$217.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.25
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna American Axle |
$321.75
|
| Rate for Payer: Aetna Commercial |
$420.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.75
|
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$346.50
|
| Rate for Payer: Cofinity Commercial |
$425.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$445.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$346.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$420.75
|
| Rate for Payer: PHP Commercial |
$420.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.50
|
| Rate for Payer: Priority Health SBD |
$311.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.24
|
| Rate for Payer: UHC Exchange |
$202.95
|
| Rate for Payer: UMR Bronson Commercial |
$183.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.25
|
|
|
HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
32000342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.75 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$151.40
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UMR Bronson Commercial |
$101.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC ENDOSCOPIC CATHJ PANCREATIC DUCTAL SYS
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
32000342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna American Axle |
$178.75
|
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$173.25
|
| Rate for Payer: UMR Bronson Commercial |
$121.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
IP
|
$2,717.00
|
|
| Hospital Charge Code |
36000118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,195.48 |
| Max. Negotiated Rate |
$2,445.30 |
| Rate for Payer: Aetna American Axle |
$1,766.05
|
| Rate for Payer: Aetna Commercial |
$2,309.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,766.05
|
| Rate for Payer: Cash Price |
$2,173.60
|
| Rate for Payer: Cofinity Commercial |
$1,901.90
|
| Rate for Payer: Cofinity Commercial |
$2,336.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,173.60
|
| Rate for Payer: Healthscope Commercial |
$2,445.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,901.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,037.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,309.45
|
| Rate for Payer: PHP Commercial |
$2,309.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,901.90
|
| Rate for Payer: Priority Health SBD |
$1,711.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,195.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,037.75
|
|
|
HC ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$2,717.00
|
|
| Hospital Charge Code |
36000118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,005.29 |
| Max. Negotiated Rate |
$2,445.30 |
| Rate for Payer: Aetna American Axle |
$1,766.05
|
| Rate for Payer: Aetna Commercial |
$2,309.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,766.05
|
| Rate for Payer: BCBS Complete |
$1,086.80
|
| Rate for Payer: Cash Price |
$2,173.60
|
| Rate for Payer: Cofinity Commercial |
$1,901.90
|
| Rate for Payer: Cofinity Commercial |
$2,336.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,173.60
|
| Rate for Payer: Healthscope Commercial |
$2,445.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,901.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,037.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,309.45
|
| Rate for Payer: PHP Commercial |
$2,309.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,901.90
|
| Rate for Payer: Priority Health SBD |
$1,711.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,005.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,037.75
|
|
|
HC ENDOSCOPIC SUBMUCOSAL DISSECTION
|
Facility
|
IP
|
$5,002.00
|
|
| Hospital Charge Code |
36000119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,200.88 |
| Max. Negotiated Rate |
$4,501.80 |
| Rate for Payer: Aetna American Axle |
$3,251.30
|
| Rate for Payer: Aetna Commercial |
$4,251.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,251.30
|
| Rate for Payer: Cash Price |
$4,001.60
|
| Rate for Payer: Cofinity Commercial |
$3,501.40
|
| Rate for Payer: Cofinity Commercial |
$4,301.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,001.60
|
| Rate for Payer: Healthscope Commercial |
$4,501.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,501.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,751.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,251.70
|
| Rate for Payer: PHP Commercial |
$4,251.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,501.40
|
| Rate for Payer: Priority Health SBD |
$3,151.26
|
| Rate for Payer: UMR Bronson Commercial |
$2,200.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,751.50
|
|
|
HC ENDOSCOPIC SUBMUCOSAL DISSECTION
|
Facility
|
OP
|
$5,002.00
|
|
| Hospital Charge Code |
36000119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,850.74 |
| Max. Negotiated Rate |
$4,501.80 |
| Rate for Payer: Aetna American Axle |
$3,251.30
|
| Rate for Payer: Aetna Commercial |
$4,251.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,251.30
|
| Rate for Payer: BCBS Complete |
$2,000.80
|
| Rate for Payer: Cash Price |
$4,001.60
|
| Rate for Payer: Cofinity Commercial |
$3,501.40
|
| Rate for Payer: Cofinity Commercial |
$4,301.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,001.60
|
| Rate for Payer: Healthscope Commercial |
$4,501.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,501.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,751.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,251.70
|
| Rate for Payer: PHP Commercial |
$4,251.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,501.40
|
| Rate for Payer: Priority Health SBD |
$3,151.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,850.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,751.50
|
|
|
HC ENDO STENT PLACEMENT
|
Facility
|
OP
|
$773.00
|
|
| Hospital Charge Code |
36000114
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$286.01 |
| Max. Negotiated Rate |
$695.70 |
| Rate for Payer: Aetna American Axle |
$502.45
|
| Rate for Payer: Aetna Commercial |
$657.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.45
|
| Rate for Payer: BCBS Complete |
$309.20
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$541.10
|
| Rate for Payer: Cofinity Commercial |
$664.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.40
|
| Rate for Payer: Healthscope Commercial |
$695.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$541.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.05
|
| Rate for Payer: PHP Commercial |
$657.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: Priority Health SBD |
$486.99
|
| Rate for Payer: UMR Bronson Commercial |
$286.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.75
|
|
|
HC ENDO STENT PLACEMENT
|
Facility
|
IP
|
$773.00
|
|
| Hospital Charge Code |
36000114
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.12 |
| Max. Negotiated Rate |
$695.70 |
| Rate for Payer: Aetna American Axle |
$502.45
|
| Rate for Payer: Aetna Commercial |
$657.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.45
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$541.10
|
| Rate for Payer: Cofinity Commercial |
$664.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.40
|
| Rate for Payer: Healthscope Commercial |
$695.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$541.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$579.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$657.05
|
| Rate for Payer: PHP Commercial |
$657.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.10
|
| Rate for Payer: Priority Health SBD |
$486.99
|
| Rate for Payer: UMR Bronson Commercial |
$340.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$579.75
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS
|
Facility
|
IP
|
$2,938.00
|
|
|
Service Code
|
CPT 36479
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,292.72 |
| Max. Negotiated Rate |
$2,644.20 |
| Rate for Payer: Aetna American Axle |
$1,909.70
|
| Rate for Payer: Aetna Commercial |
$2,497.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,909.70
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cofinity Commercial |
$2,056.60
|
| Rate for Payer: Cofinity Commercial |
$2,526.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,350.40
|
| Rate for Payer: Healthscope Commercial |
$2,644.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,056.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,203.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,497.30
|
| Rate for Payer: PHP Commercial |
$2,497.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,056.60
|
| Rate for Payer: Priority Health SBD |
$1,850.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,292.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,203.50
|
|
|
HC ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS
|
Facility
|
OP
|
$2,938.00
|
|
|
Service Code
|
CPT 36479
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.32 |
| Max. Negotiated Rate |
$2,644.20 |
| Rate for Payer: Aetna American Axle |
$1,909.70
|
| Rate for Payer: Aetna Commercial |
$2,497.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,909.70
|
| Rate for Payer: BCBS Complete |
$1,175.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.32
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cofinity Commercial |
$2,056.60
|
| Rate for Payer: Cofinity Commercial |
$2,526.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,350.40
|
| Rate for Payer: Healthscope Commercial |
$2,644.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,056.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,203.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,497.30
|
| Rate for Payer: PHP Commercial |
$2,497.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,056.60
|
| Rate for Payer: Priority Health SBD |
$1,850.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.35
|
| Rate for Payer: UHC Exchange |
$130.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,087.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,203.50
|
|
|
HC ENDOVENOUS ABLAT EXTR W IMAGING PERC FIRST VEIN
|
Facility
|
IP
|
$3,998.90
|
|
|
Service Code
|
CPT 36473
|
| Hospital Charge Code |
36100523
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,759.52 |
| Max. Negotiated Rate |
$3,599.01 |
| Rate for Payer: Aetna American Axle |
$2,599.28
|
| Rate for Payer: Aetna Commercial |
$3,399.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,599.28
|
| Rate for Payer: Cash Price |
$3,199.12
|
| Rate for Payer: Cofinity Commercial |
$2,799.23
|
| Rate for Payer: Cofinity Commercial |
$3,439.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,199.12
|
| Rate for Payer: Healthscope Commercial |
$3,599.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,799.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,999.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,399.06
|
| Rate for Payer: PHP Commercial |
$3,399.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,799.23
|
| Rate for Payer: Priority Health SBD |
$2,519.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,759.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,999.18
|
|
|
HC ENDOVENOUS ABLAT EXTR W IMAGING PERC FIRST VEIN
|
Facility
|
OP
|
$3,998.90
|
|
|
Service Code
|
CPT 36473
|
| Hospital Charge Code |
36100523
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna American Axle |
$2,599.28
|
| Rate for Payer: Aetna Commercial |
$3,399.06
|
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,599.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$3,199.12
|
| Rate for Payer: Cash Price |
$3,199.12
|
| Rate for Payer: Cofinity Commercial |
$2,799.23
|
| Rate for Payer: Cofinity Commercial |
$3,439.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,199.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$3,599.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,799.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,999.18
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,399.06
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,399.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,799.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Priority Health SBD |
$2,519.31
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.62
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$174.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,479.59
|
| Rate for Payer: VA VA |
$2,833.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,999.18
|
|
|
HC ENDOVENOUS ABLAT SUBS VEIN SEP ACCESS SITE EXTR
|
Facility
|
OP
|
$256.40
|
|
|
Service Code
|
CPT 36474
|
| Hospital Charge Code |
36100524
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.13 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$166.66
|
| Rate for Payer: Aetna Commercial |
$217.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.66
|
| Rate for Payer: BCBS Complete |
$102.56
|
| Rate for Payer: Cash Price |
$205.12
|
| Rate for Payer: Cash Price |
$205.12
|
| Rate for Payer: Cofinity Commercial |
$220.50
|
| Rate for Payer: Cofinity Commercial |
$179.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.12
|
| Rate for Payer: Healthscope Commercial |
$230.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.94
|
| Rate for Payer: PHP Commercial |
$217.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.48
|
| Rate for Payer: Priority Health SBD |
$161.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.64
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$85.13
|
| Rate for Payer: UMR Bronson Commercial |
$94.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.30
|
|
|
HC ENDOVENOUS ABLAT SUBS VEIN SEP ACCESS SITE EXTR
|
Facility
|
IP
|
$256.40
|
|
|
Service Code
|
CPT 36474
|
| Hospital Charge Code |
36100524
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.82 |
| Max. Negotiated Rate |
$230.76 |
| Rate for Payer: Aetna American Axle |
$166.66
|
| Rate for Payer: Aetna Commercial |
$217.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.66
|
| Rate for Payer: Cash Price |
$205.12
|
| Rate for Payer: Cofinity Commercial |
$179.48
|
| Rate for Payer: Cofinity Commercial |
$220.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.12
|
| Rate for Payer: Healthscope Commercial |
$230.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$217.94
|
| Rate for Payer: PHP Commercial |
$217.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.48
|
| Rate for Payer: Priority Health SBD |
$161.53
|
| Rate for Payer: UMR Bronson Commercial |
$112.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.30
|
|
|
HC ENDOVENOUS LASER 1ST VEIN
|
Facility
|
IP
|
$4,041.53
|
|
|
Service Code
|
CPT 36478
|
| Hospital Charge Code |
76100184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,778.27 |
| Max. Negotiated Rate |
$3,637.38 |
| Rate for Payer: Aetna American Axle |
$2,626.99
|
| Rate for Payer: Aetna Commercial |
$3,435.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,626.99
|
| Rate for Payer: Cash Price |
$3,233.22
|
| Rate for Payer: Cofinity Commercial |
$3,475.72
|
| Rate for Payer: Cofinity Commercial |
$2,829.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,233.22
|
| Rate for Payer: Healthscope Commercial |
$3,637.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,829.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,031.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,435.30
|
| Rate for Payer: PHP Commercial |
$3,435.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,829.07
|
| Rate for Payer: Priority Health SBD |
$2,546.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,778.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,031.15
|
|
|
HC ENDOVENOUS LASER 1ST VEIN
|
Facility
|
OP
|
$4,041.53
|
|
|
Service Code
|
CPT 36478
|
| Hospital Charge Code |
76100184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.87 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna American Axle |
$2,626.99
|
| Rate for Payer: Aetna Commercial |
$3,435.30
|
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,626.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,471.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Cash Price |
$3,233.22
|
| Rate for Payer: Cash Price |
$3,233.22
|
| Rate for Payer: Cofinity Commercial |
$3,475.72
|
| Rate for Payer: Cofinity Commercial |
$2,829.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,233.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Healthscope Commercial |
$3,637.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,829.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,031.15
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,435.30
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Commercial |
$3,435.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,829.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Priority Health SBD |
$2,546.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$266.87
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,495.37
|
| Rate for Payer: VA VA |
$2,833.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,031.15
|
|
|
HC ENDOVENT
|
Facility
|
OP
|
$4,711.31
|
|
| Hospital Charge Code |
27000099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,743.18 |
| Max. Negotiated Rate |
$4,240.18 |
| Rate for Payer: Aetna American Axle |
$3,062.35
|
| Rate for Payer: Aetna Commercial |
$4,004.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,062.35
|
| Rate for Payer: BCBS Complete |
$1,884.52
|
| Rate for Payer: Cash Price |
$3,769.05
|
| Rate for Payer: Cofinity Commercial |
$3,297.92
|
| Rate for Payer: Cofinity Commercial |
$4,051.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,769.05
|
| Rate for Payer: Healthscope Commercial |
$4,240.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,297.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,533.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,004.61
|
| Rate for Payer: PHP Commercial |
$4,004.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,297.92
|
| Rate for Payer: Priority Health SBD |
$2,968.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,743.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,533.48
|
|
|
HC ENDOVENT
|
Facility
|
IP
|
$4,711.31
|
|
| Hospital Charge Code |
27000099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,072.98 |
| Max. Negotiated Rate |
$4,240.18 |
| Rate for Payer: Aetna American Axle |
$3,062.35
|
| Rate for Payer: Aetna Commercial |
$4,004.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,062.35
|
| Rate for Payer: Cash Price |
$3,769.05
|
| Rate for Payer: Cofinity Commercial |
$3,297.92
|
| Rate for Payer: Cofinity Commercial |
$4,051.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,769.05
|
| Rate for Payer: Healthscope Commercial |
$4,240.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,297.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,533.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,004.61
|
| Rate for Payer: PHP Commercial |
$4,004.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,297.92
|
| Rate for Payer: Priority Health SBD |
$2,968.13
|
| Rate for Payer: UMR Bronson Commercial |
$2,072.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,533.48
|
|
|
HC ENGLISH PLANTAIN IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200084
|
|
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
|
|
