|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
IP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$323.14 |
| Max. Negotiated Rate |
$660.96 |
| Rate for Payer: Aetna American Axle |
$477.36
|
| Rate for Payer: Aetna Commercial |
$624.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.36
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Advantage |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$631.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$660.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$550.80
|
| Rate for Payer: PHP Commercial |
$624.24
|
| Rate for Payer: Priority Health SBD |
$462.67
|
| Rate for Payer: UMR Bronson Commercial |
$323.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.80
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
IP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.19 |
| Max. Negotiated Rate |
$798.11 |
| Rate for Payer: Aetna American Axle |
$576.41
|
| Rate for Payer: Aetna Commercial |
$753.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$576.41
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Advantage |
$620.75
|
| Rate for Payer: Cofinity Commercial |
$762.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Healthscope Commercial |
$798.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$620.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$665.09
|
| Rate for Payer: PHP Commercial |
$753.77
|
| Rate for Payer: Priority Health SBD |
$558.68
|
| Rate for Payer: UMR Bronson Commercial |
$390.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.09
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
OP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$798.11 |
| Rate for Payer: Aetna American Axle |
$576.41
|
| Rate for Payer: Aetna Commercial |
$753.77
|
| Rate for Payer: Aetna Medicare |
$443.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$576.41
|
| Rate for Payer: BCBS Complete |
$354.72
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Advantage |
$620.75
|
| Rate for Payer: Cofinity Commercial |
$762.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Healthscope Commercial |
$798.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$620.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$709.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$665.09
|
| Rate for Payer: PHP Commercial |
$753.77
|
| Rate for Payer: Priority Health SBD |
$558.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$576.41
|
| Rate for Payer: UHC Core |
$462.02
|
| Rate for Payer: UHC Exchange |
$348.51
|
| Rate for Payer: UMR Bronson Commercial |
$328.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.09
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
IP
|
$763.51
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$335.94 |
| Max. Negotiated Rate |
$687.16 |
| Rate for Payer: Aetna American Axle |
$496.28
|
| Rate for Payer: Aetna Commercial |
$648.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.28
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cofinity Advantage |
$534.46
|
| Rate for Payer: Cofinity Commercial |
$656.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.81
|
| Rate for Payer: Healthscope Commercial |
$687.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$534.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$572.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.63
|
| Rate for Payer: PHP Commercial |
$648.98
|
| Rate for Payer: Priority Health SBD |
$481.01
|
| Rate for Payer: UMR Bronson Commercial |
$335.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$572.63
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
OP
|
$763.51
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.50 |
| Max. Negotiated Rate |
$3,318.39 |
| Rate for Payer: Aetna American Axle |
$496.28
|
| Rate for Payer: Aetna Commercial |
$648.98
|
| Rate for Payer: Aetna Medicare |
$381.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.28
|
| Rate for Payer: BCBS Complete |
$305.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,318.39
|
| Rate for Payer: BCN Commercial |
$3,318.39
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cash Price |
$610.81
|
| Rate for Payer: Cofinity Advantage |
$534.46
|
| Rate for Payer: Cofinity Commercial |
$656.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.81
|
| Rate for Payer: Healthscope Commercial |
$687.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$534.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$572.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$610.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$572.63
|
| Rate for Payer: PHP Commercial |
$648.98
|
| Rate for Payer: Priority Health SBD |
$481.01
|
| Rate for Payer: UMR Bronson Commercial |
$282.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$572.63
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
IP
|
$1,963.53
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$863.95 |
| Max. Negotiated Rate |
$1,767.18 |
| Rate for Payer: Aetna American Axle |
$1,276.29
|
| Rate for Payer: Aetna Commercial |
$1,669.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.29
|
| Rate for Payer: Cash Price |
$1,570.82
|
| Rate for Payer: Cofinity Advantage |
$1,374.47
|
| Rate for Payer: Cofinity Commercial |
$1,688.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.82
|
| Rate for Payer: Healthscope Commercial |
$1,767.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,374.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,472.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,472.65
|
| Rate for Payer: PHP Commercial |
$1,669.00
|
| Rate for Payer: Priority Health SBD |
$1,237.02
|
| Rate for Payer: UMR Bronson Commercial |
$863.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,472.65
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
OP
|
$1,963.53
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$726.51 |
| Max. Negotiated Rate |
$1,767.18 |
| Rate for Payer: Aetna American Axle |
$1,276.29
|
| Rate for Payer: Aetna Commercial |
$1,669.00
|
| Rate for Payer: Aetna Medicare |
$981.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.29
|
| Rate for Payer: BCBS Complete |
$785.41
|
| Rate for Payer: Cash Price |
$1,570.82
|
| Rate for Payer: Cofinity Advantage |
$1,374.47
|
| Rate for Payer: Cofinity Commercial |
$1,688.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.82
|
| Rate for Payer: Healthscope Commercial |
$1,767.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,374.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,472.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,570.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,472.65
|
| Rate for Payer: PHP Commercial |
$1,669.00
|
| Rate for Payer: Priority Health SBD |
$1,237.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,276.29
|
| Rate for Payer: UHC Core |
$1,023.00
|
| Rate for Payer: UHC Exchange |
$771.67
|
| Rate for Payer: UMR Bronson Commercial |
$726.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,472.65
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
OP
|
$82.47
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$74.22 |
| Rate for Payer: Aetna American Axle |
$53.61
|
| Rate for Payer: Aetna Commercial |
$70.10
|
| Rate for Payer: Aetna Medicare |
$41.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.61
|
| Rate for Payer: BCBS Complete |
$32.99
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Advantage |
$57.73
|
| Rate for Payer: Cofinity Commercial |
$70.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$74.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.85
|
| Rate for Payer: PHP Commercial |
$70.10
|
| Rate for Payer: Priority Health SBD |
$51.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.61
|
| Rate for Payer: UHC Core |
$42.97
|
| Rate for Payer: UHC Exchange |
$32.41
|
| Rate for Payer: UMR Bronson Commercial |
$30.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.85
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
IP
|
$82.47
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.29 |
| Max. Negotiated Rate |
$74.22 |
| Rate for Payer: Aetna American Axle |
$53.61
|
| Rate for Payer: Aetna Commercial |
$70.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.61
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Advantage |
$57.73
|
| Rate for Payer: Cofinity Commercial |
$70.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$74.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.85
|
| Rate for Payer: PHP Commercial |
$70.10
|
| Rate for Payer: Priority Health SBD |
$51.96
|
| Rate for Payer: UMR Bronson Commercial |
$36.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.85
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
OP
|
$249.07
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$224.16 |
| Rate for Payer: Aetna American Axle |
$161.90
|
| Rate for Payer: Aetna Commercial |
$211.71
|
| Rate for Payer: Aetna Medicare |
$124.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.90
|
| Rate for Payer: BCBS Complete |
$99.63
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Cofinity Advantage |
$174.35
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.26
|
| Rate for Payer: Healthscope Commercial |
$224.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.80
|
| Rate for Payer: PHP Commercial |
$211.71
|
| Rate for Payer: Priority Health SBD |
$156.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.90
|
| Rate for Payer: UHC Core |
$129.77
|
| Rate for Payer: UHC Exchange |
$97.88
|
| Rate for Payer: UMR Bronson Commercial |
$92.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.80
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
IP
|
$249.07
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.59 |
| Max. Negotiated Rate |
$224.16 |
| Rate for Payer: Aetna American Axle |
$161.90
|
| Rate for Payer: Aetna Commercial |
$211.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.90
|
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Cofinity Advantage |
$174.35
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.26
|
| Rate for Payer: Healthscope Commercial |
$224.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.80
|
| Rate for Payer: PHP Commercial |
$211.71
|
| Rate for Payer: Priority Health SBD |
$156.91
|
| Rate for Payer: UMR Bronson Commercial |
$109.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.80
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
IP
|
$3,253.01
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,431.32 |
| Max. Negotiated Rate |
$2,927.71 |
| Rate for Payer: Aetna American Axle |
$2,114.46
|
| Rate for Payer: Aetna Commercial |
$2,765.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,114.46
|
| Rate for Payer: Cash Price |
$2,602.41
|
| Rate for Payer: Cofinity Advantage |
$2,277.11
|
| Rate for Payer: Cofinity Commercial |
$2,797.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,602.41
|
| Rate for Payer: Healthscope Commercial |
$2,927.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,277.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,439.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,765.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,439.76
|
| Rate for Payer: PHP Commercial |
$2,765.06
|
| Rate for Payer: Priority Health SBD |
$2,049.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,431.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,439.76
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
OP
|
$3,253.01
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,203.61 |
| Max. Negotiated Rate |
$2,927.71 |
| Rate for Payer: Aetna American Axle |
$2,114.46
|
| Rate for Payer: Aetna Commercial |
$2,765.06
|
| Rate for Payer: Aetna Medicare |
$1,626.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,114.46
|
| Rate for Payer: BCBS Complete |
$1,301.20
|
| Rate for Payer: Cash Price |
$2,602.41
|
| Rate for Payer: Cofinity Advantage |
$2,277.11
|
| Rate for Payer: Cofinity Commercial |
$2,797.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,602.41
|
| Rate for Payer: Healthscope Commercial |
$2,927.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,277.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,439.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,602.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,765.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,439.76
|
| Rate for Payer: PHP Commercial |
$2,765.06
|
| Rate for Payer: Priority Health SBD |
$2,049.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,203.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,439.76
|
|
|
HC BANANA IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC BANANA IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
OP
|
$13.96
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna Commercial |
$11.87
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: Cash Price |
$11.17
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.17
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.47
|
| Rate for Payer: PHP Commercial |
$11.87
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.07
|
| Rate for Payer: UHC Core |
$7.27
|
| Rate for Payer: UHC Exchange |
$5.49
|
| Rate for Payer: UMR Bronson Commercial |
$5.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.47
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
IP
|
$13.96
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna Commercial |
$11.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Cash Price |
$11.17
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.17
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.47
|
| Rate for Payer: PHP Commercial |
$11.87
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: UMR Bronson Commercial |
$6.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.47
|
|
|
HC BANDING
|
Facility
|
IP
|
$984.95
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$433.38 |
| Max. Negotiated Rate |
$886.46 |
| Rate for Payer: Aetna American Axle |
$640.22
|
| Rate for Payer: Aetna Commercial |
$837.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.22
|
| Rate for Payer: Cash Price |
$787.96
|
| Rate for Payer: Cofinity Advantage |
$689.47
|
| Rate for Payer: Cofinity Commercial |
$847.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.96
|
| Rate for Payer: Healthscope Commercial |
$886.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$689.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$738.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$837.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$738.71
|
| Rate for Payer: PHP Commercial |
$837.21
|
| Rate for Payer: Priority Health SBD |
$620.52
|
| Rate for Payer: UMR Bronson Commercial |
$433.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$738.71
|
|
|
HC BANDING
|
Facility
|
OP
|
$984.95
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.43 |
| Max. Negotiated Rate |
$886.46 |
| Rate for Payer: Aetna American Axle |
$640.22
|
| Rate for Payer: Aetna Commercial |
$837.21
|
| Rate for Payer: Aetna Medicare |
$492.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.22
|
| Rate for Payer: BCBS Complete |
$393.98
|
| Rate for Payer: Cash Price |
$787.96
|
| Rate for Payer: Cofinity Advantage |
$689.47
|
| Rate for Payer: Cofinity Commercial |
$847.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$787.96
|
| Rate for Payer: Healthscope Commercial |
$886.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$689.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$738.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$787.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$837.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$738.71
|
| Rate for Payer: PHP Commercial |
$837.21
|
| Rate for Payer: Priority Health SBD |
$620.52
|
| Rate for Payer: UMR Bronson Commercial |
$364.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$738.71
|
|
|
HC BARBITURATE URIN
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna American Axle |
$72.31
|
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$71.84
|
| Rate for Payer: BCN Commercial |
$71.84
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.44
|
| Rate for Payer: Mclaren Medicaid |
$62.14
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: UMR Bronson Commercial |
$41.16
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.44
|
|
|
HC BARBITURATE URIN
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna American Axle |
$72.31
|
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: UMR Bronson Commercial |
$48.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.44
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna American Axle |
$41.92
|
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna Medicare |
$32.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: BCBS Complete |
$25.80
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Advantage |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health SBD |
$40.63
|
| Rate for Payer: UMR Bronson Commercial |
$23.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.38
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.38 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna American Axle |
$41.92
|
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Advantage |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health SBD |
$40.63
|
| Rate for Payer: UMR Bronson Commercial |
$28.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.38
|
|
|
HC BARRIER ADHESION
|
Facility
|
IP
|
$601.76
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
27000463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$264.77 |
| Max. Negotiated Rate |
$541.58 |
| Rate for Payer: Aetna American Axle |
$391.14
|
| Rate for Payer: Aetna Commercial |
$511.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.14
|
| Rate for Payer: Cash Price |
$481.41
|
| Rate for Payer: Cofinity Advantage |
$421.23
|
| Rate for Payer: Cofinity Commercial |
$517.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.41
|
| Rate for Payer: Healthscope Commercial |
$541.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.32
|
| Rate for Payer: PHP Commercial |
$511.50
|
| Rate for Payer: Priority Health SBD |
$379.11
|
| Rate for Payer: UMR Bronson Commercial |
$264.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.32
|
|
|
HC BARRIER ADHESION
|
Facility
|
OP
|
$601.76
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
27000463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$222.65 |
| Max. Negotiated Rate |
$541.58 |
| Rate for Payer: Aetna American Axle |
$391.14
|
| Rate for Payer: Aetna Commercial |
$511.50
|
| Rate for Payer: Aetna Medicare |
$300.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.14
|
| Rate for Payer: BCBS Complete |
$240.70
|
| Rate for Payer: Cash Price |
$481.41
|
| Rate for Payer: Cofinity Advantage |
$421.23
|
| Rate for Payer: Cofinity Commercial |
$517.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.41
|
| Rate for Payer: Healthscope Commercial |
$541.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$481.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.32
|
| Rate for Payer: PHP Commercial |
$511.50
|
| Rate for Payer: Priority Health SBD |
$379.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.14
|
| Rate for Payer: UHC Core |
$313.52
|
| Rate for Payer: UHC Exchange |
$236.49
|
| Rate for Payer: UMR Bronson Commercial |
$222.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.32
|
|
