|
HC G TUBE REPLACEMENT
|
Facility
|
OP
|
$565.20
|
|
| Hospital Charge Code |
36000046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$209.12 |
| Max. Negotiated Rate |
$508.68 |
| Rate for Payer: Aetna American Axle |
$367.38
|
| Rate for Payer: Aetna Commercial |
$480.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.38
|
| Rate for Payer: BCBS Complete |
$226.08
|
| Rate for Payer: Cash Price |
$452.16
|
| Rate for Payer: Cofinity Commercial |
$395.64
|
| Rate for Payer: Cofinity Commercial |
$486.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.16
|
| Rate for Payer: Healthscope Commercial |
$508.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.42
|
| Rate for Payer: PHP Commercial |
$480.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.64
|
| Rate for Payer: Priority Health SBD |
$356.08
|
| Rate for Payer: UMR Bronson Commercial |
$209.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.90
|
|
|
HC GUIDANT / ABBOTT PERIPHERAL ST
|
Facility
|
IP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,315.27 |
| Max. Negotiated Rate |
$2,690.32 |
| Rate for Payer: Aetna American Axle |
$1,943.01
|
| Rate for Payer: Aetna Commercial |
$2,540.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,943.01
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Commercial |
$2,092.47
|
| Rate for Payer: Cofinity Commercial |
$2,570.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.39
|
| Rate for Payer: Healthscope Commercial |
$2,690.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,092.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,241.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,540.85
|
| Rate for Payer: PHP Commercial |
$2,540.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.47
|
| Rate for Payer: Priority Health SBD |
$1,883.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,315.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,241.93
|
|
|
HC GUIDANT / ABBOTT PERIPHERAL ST
|
Facility
|
OP
|
$2,989.24
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.02 |
| Max. Negotiated Rate |
$2,690.32 |
| Rate for Payer: Aetna American Axle |
$1,943.01
|
| Rate for Payer: Aetna Commercial |
$2,540.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,943.01
|
| Rate for Payer: BCBS Complete |
$1,195.70
|
| Rate for Payer: Cash Price |
$2,391.39
|
| Rate for Payer: Cofinity Commercial |
$2,092.47
|
| Rate for Payer: Cofinity Commercial |
$2,570.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,391.39
|
| Rate for Payer: Healthscope Commercial |
$2,690.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,092.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,241.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,540.85
|
| Rate for Payer: PHP Commercial |
$2,540.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,092.47
|
| Rate for Payer: Priority Health SBD |
$1,883.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,106.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,241.93
|
|
|
HC GUIDANT CAROTID STENT
|
Facility
|
OP
|
$5,707.26
|
|
| Hospital Charge Code |
27800044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,111.69 |
| Max. Negotiated Rate |
$5,136.53 |
| Rate for Payer: Aetna American Axle |
$3,709.72
|
| Rate for Payer: Aetna Commercial |
$4,851.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,709.72
|
| Rate for Payer: BCBS Complete |
$2,282.90
|
| Rate for Payer: Cash Price |
$4,565.81
|
| Rate for Payer: Cofinity Commercial |
$3,995.08
|
| Rate for Payer: Cofinity Commercial |
$4,908.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,565.81
|
| Rate for Payer: Healthscope Commercial |
$5,136.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,995.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,280.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,851.17
|
| Rate for Payer: PHP Commercial |
$4,851.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,995.08
|
| Rate for Payer: Priority Health SBD |
$3,595.57
|
| Rate for Payer: UMR Bronson Commercial |
$2,111.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,280.44
|
|
|
HC GUIDANT CAROTID STENT
|
Facility
|
IP
|
$5,707.26
|
|
| Hospital Charge Code |
27800044
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,511.19 |
| Max. Negotiated Rate |
$5,136.53 |
| Rate for Payer: Aetna American Axle |
$3,709.72
|
| Rate for Payer: Aetna Commercial |
$4,851.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,709.72
|
| Rate for Payer: Cash Price |
$4,565.81
|
| Rate for Payer: Cofinity Commercial |
$3,995.08
|
| Rate for Payer: Cofinity Commercial |
$4,908.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,565.81
|
| Rate for Payer: Healthscope Commercial |
$5,136.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,995.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,280.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,851.17
|
| Rate for Payer: PHP Commercial |
$4,851.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,995.08
|
| Rate for Payer: Priority Health SBD |
$3,595.57
|
| Rate for Payer: UMR Bronson Commercial |
$2,511.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,280.44
|
|
|
HC GUIDANT CRT LEAD
|
Facility
|
OP
|
$10,150.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$9,135.00 |
| Rate for Payer: Aetna American Axle |
$6,597.50
|
| Rate for Payer: Aetna Commercial |
$8,627.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,597.50
|
| Rate for Payer: BCBS Complete |
$4,060.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cofinity Commercial |
$7,105.00
|
| Rate for Payer: Cofinity Commercial |
$8,729.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,120.00
|
| Rate for Payer: Healthscope Commercial |
$9,135.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,105.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,612.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,627.50
|
| Rate for Payer: PHP Commercial |
$8,627.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,105.00
|
| Rate for Payer: Priority Health SBD |
$6,394.50
|
| Rate for Payer: UMR Bronson Commercial |
$3,755.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,612.50
|
|
|
HC GUIDANT CRT LEAD
|
Facility
|
IP
|
$10,150.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27800013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,466.00 |
| Max. Negotiated Rate |
$9,135.00 |
| Rate for Payer: Aetna American Axle |
$6,597.50
|
| Rate for Payer: Aetna Commercial |
$8,627.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,597.50
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cofinity Commercial |
$7,105.00
|
| Rate for Payer: Cofinity Commercial |
$8,729.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,120.00
|
| Rate for Payer: Healthscope Commercial |
$9,135.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,105.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,612.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,627.50
|
| Rate for Payer: PHP Commercial |
$8,627.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,105.00
|
| Rate for Payer: Priority Health SBD |
$6,394.50
|
| Rate for Payer: UMR Bronson Commercial |
$4,466.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,612.50
|
|
|
HC GUIDANT PERIPHERAL BALLOON
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna American Axle |
$468.00
|
| Rate for Payer: Aetna Commercial |
$612.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.00
|
| Rate for Payer: BCBS Complete |
$288.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$619.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.00
|
| Rate for Payer: Healthscope Commercial |
$648.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$504.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$540.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.00
|
| Rate for Payer: PHP Commercial |
$612.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.00
|
| Rate for Payer: Priority Health SBD |
$453.60
|
| Rate for Payer: UMR Bronson Commercial |
$266.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$540.00
|
|
|
HC GUIDANT PERIPHERAL BALLOON
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.80 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna American Axle |
$468.00
|
| Rate for Payer: Aetna Commercial |
$612.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$619.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.00
|
| Rate for Payer: Healthscope Commercial |
$648.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$504.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$540.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$612.00
|
| Rate for Payer: PHP Commercial |
$612.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.00
|
| Rate for Payer: Priority Health SBD |
$453.60
|
| Rate for Payer: UMR Bronson Commercial |
$316.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$540.00
|
|
|
HC GUIDANT TACHY (ICD) LEAD
|
Facility
|
OP
|
$12,993.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,807.41 |
| Max. Negotiated Rate |
$11,693.70 |
| Rate for Payer: Aetna American Axle |
$8,445.45
|
| Rate for Payer: Aetna Commercial |
$11,044.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,445.45
|
| Rate for Payer: BCBS Complete |
$5,197.20
|
| Rate for Payer: Cash Price |
$10,394.40
|
| Rate for Payer: Cofinity Commercial |
$11,173.98
|
| Rate for Payer: Cofinity Commercial |
$9,095.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,394.40
|
| Rate for Payer: Healthscope Commercial |
$11,693.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,095.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,744.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,044.05
|
| Rate for Payer: PHP Commercial |
$11,044.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,095.10
|
| Rate for Payer: Priority Health SBD |
$8,185.59
|
| Rate for Payer: UMR Bronson Commercial |
$4,807.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,744.75
|
|
|
HC GUIDANT TACHY (ICD) LEAD
|
Facility
|
IP
|
$12,993.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27800014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,716.92 |
| Max. Negotiated Rate |
$11,693.70 |
| Rate for Payer: Aetna American Axle |
$8,445.45
|
| Rate for Payer: Aetna Commercial |
$11,044.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,445.45
|
| Rate for Payer: Cash Price |
$10,394.40
|
| Rate for Payer: Cofinity Commercial |
$11,173.98
|
| Rate for Payer: Cofinity Commercial |
$9,095.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,394.40
|
| Rate for Payer: Healthscope Commercial |
$11,693.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,095.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,744.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,044.05
|
| Rate for Payer: PHP Commercial |
$11,044.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,095.10
|
| Rate for Payer: Priority Health SBD |
$8,185.59
|
| Rate for Payer: UMR Bronson Commercial |
$5,716.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,744.75
|
|
|
HC GUIDED DRAIN CATH PLACEMENT
|
Facility
|
IP
|
$524.10
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
32000229
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.60 |
| Max. Negotiated Rate |
$471.69 |
| Rate for Payer: Aetna American Axle |
$340.66
|
| Rate for Payer: Aetna Commercial |
$445.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.66
|
| Rate for Payer: Cash Price |
$419.28
|
| Rate for Payer: Cofinity Commercial |
$366.87
|
| Rate for Payer: Cofinity Commercial |
$450.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.28
|
| Rate for Payer: Healthscope Commercial |
$471.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.48
|
| Rate for Payer: PHP Commercial |
$445.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.87
|
| Rate for Payer: Priority Health SBD |
$330.18
|
| Rate for Payer: UMR Bronson Commercial |
$230.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.08
|
|
|
HC GUIDED DRAIN CATH PLACEMENT
|
Facility
|
OP
|
$524.10
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
32000229
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.37 |
| Max. Negotiated Rate |
$471.69 |
| Rate for Payer: Aetna American Axle |
$340.66
|
| Rate for Payer: Aetna Commercial |
$445.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.66
|
| Rate for Payer: BCBS Complete |
$209.64
|
| Rate for Payer: BCBS Trust/PPO |
$110.22
|
| Rate for Payer: Cash Price |
$419.28
|
| Rate for Payer: Cash Price |
$419.28
|
| Rate for Payer: Cofinity Commercial |
$366.87
|
| Rate for Payer: Cofinity Commercial |
$450.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.28
|
| Rate for Payer: Healthscope Commercial |
$471.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.48
|
| Rate for Payer: PHP Commercial |
$445.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.87
|
| Rate for Payer: Priority Health SBD |
$330.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.31
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Exchange |
$109.37
|
| Rate for Payer: UMR Bronson Commercial |
$193.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.08
|
|
|
HC GUIDELINER CATHETER
|
Facility
|
OP
|
$1,718.55
|
|
| Hospital Charge Code |
27200126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.86 |
| Max. Negotiated Rate |
$1,546.70 |
| Rate for Payer: Aetna American Axle |
$1,117.06
|
| Rate for Payer: Aetna Commercial |
$1,460.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,117.06
|
| Rate for Payer: BCBS Complete |
$687.42
|
| Rate for Payer: Cash Price |
$1,374.84
|
| Rate for Payer: Cofinity Commercial |
$1,202.98
|
| Rate for Payer: Cofinity Commercial |
$1,477.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,374.84
|
| Rate for Payer: Healthscope Commercial |
$1,546.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,202.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,288.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,460.77
|
| Rate for Payer: PHP Commercial |
$1,460.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,202.98
|
| Rate for Payer: Priority Health SBD |
$1,082.69
|
| Rate for Payer: UMR Bronson Commercial |
$635.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,288.91
|
|
|
HC GUIDELINER CATHETER
|
Facility
|
IP
|
$1,718.55
|
|
| Hospital Charge Code |
27200126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.16 |
| Max. Negotiated Rate |
$1,546.70 |
| Rate for Payer: Aetna American Axle |
$1,117.06
|
| Rate for Payer: Aetna Commercial |
$1,460.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,117.06
|
| Rate for Payer: Cash Price |
$1,374.84
|
| Rate for Payer: Cofinity Commercial |
$1,202.98
|
| Rate for Payer: Cofinity Commercial |
$1,477.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,374.84
|
| Rate for Payer: Healthscope Commercial |
$1,546.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,202.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,288.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,460.77
|
| Rate for Payer: PHP Commercial |
$1,460.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,202.98
|
| Rate for Payer: Priority Health SBD |
$1,082.69
|
| Rate for Payer: UMR Bronson Commercial |
$756.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,288.91
|
|
|
HC GUIDEWIRE
|
Facility
|
OP
|
$48.41
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.91 |
| Max. Negotiated Rate |
$43.57 |
| Rate for Payer: Aetna American Axle |
$31.47
|
| Rate for Payer: Aetna Commercial |
$41.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.47
|
| Rate for Payer: BCBS Complete |
$19.36
|
| Rate for Payer: Cash Price |
$38.73
|
| Rate for Payer: Cofinity Commercial |
$33.89
|
| Rate for Payer: Cofinity Commercial |
$41.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.73
|
| Rate for Payer: Healthscope Commercial |
$43.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.15
|
| Rate for Payer: PHP Commercial |
$41.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.89
|
| Rate for Payer: Priority Health SBD |
$30.50
|
| Rate for Payer: UMR Bronson Commercial |
$17.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.31
|
|
|
HC GUIDEWIRE
|
Facility
|
IP
|
$48.41
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$43.57 |
| Rate for Payer: Aetna American Axle |
$31.47
|
| Rate for Payer: Aetna Commercial |
$41.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.47
|
| Rate for Payer: Cash Price |
$38.73
|
| Rate for Payer: Cofinity Commercial |
$33.89
|
| Rate for Payer: Cofinity Commercial |
$41.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.73
|
| Rate for Payer: Healthscope Commercial |
$43.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.15
|
| Rate for Payer: PHP Commercial |
$41.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.89
|
| Rate for Payer: Priority Health SBD |
$30.50
|
| Rate for Payer: UMR Bronson Commercial |
$21.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.31
|
|
|
HC GUIDE WIRE DILATATION
|
Facility
|
OP
|
$1,319.07
|
|
| Hospital Charge Code |
36000050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$488.06 |
| Max. Negotiated Rate |
$1,187.16 |
| Rate for Payer: Aetna American Axle |
$857.40
|
| Rate for Payer: Aetna Commercial |
$1,121.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.40
|
| Rate for Payer: BCBS Complete |
$527.63
|
| Rate for Payer: Cash Price |
$1,055.26
|
| Rate for Payer: Cofinity Commercial |
$1,134.40
|
| Rate for Payer: Cofinity Commercial |
$923.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,055.26
|
| Rate for Payer: Healthscope Commercial |
$1,187.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$923.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$989.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,121.21
|
| Rate for Payer: PHP Commercial |
$1,121.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.35
|
| Rate for Payer: Priority Health SBD |
$831.01
|
| Rate for Payer: UMR Bronson Commercial |
$488.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$989.30
|
|
|
HC GUIDE WIRE DILATATION
|
Facility
|
IP
|
$1,319.07
|
|
| Hospital Charge Code |
36000050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$580.39 |
| Max. Negotiated Rate |
$1,187.16 |
| Rate for Payer: Aetna American Axle |
$857.40
|
| Rate for Payer: Aetna Commercial |
$1,121.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.40
|
| Rate for Payer: Cash Price |
$1,055.26
|
| Rate for Payer: Cofinity Commercial |
$1,134.40
|
| Rate for Payer: Cofinity Commercial |
$923.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,055.26
|
| Rate for Payer: Healthscope Commercial |
$1,187.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$923.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$989.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,121.21
|
| Rate for Payer: PHP Commercial |
$1,121.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.35
|
| Rate for Payer: Priority Health SBD |
$831.01
|
| Rate for Payer: UMR Bronson Commercial |
$580.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$989.30
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 1
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna American Axle |
$50.70
|
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: UMR Bronson Commercial |
$28.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 1
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna American Axle |
$50.70
|
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: UMR Bronson Commercial |
$34.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 2
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.61 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: UMR Bronson Commercial |
$56.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 2
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.32 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: UMR Bronson Commercial |
$67.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 3
|
Facility
|
OP
|
$318.15
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$286.34 |
| Rate for Payer: Aetna American Axle |
$206.80
|
| Rate for Payer: Aetna Commercial |
$270.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.80
|
| Rate for Payer: BCBS Complete |
$127.26
|
| Rate for Payer: Cash Price |
$254.52
|
| Rate for Payer: Cofinity Commercial |
$222.70
|
| Rate for Payer: Cofinity Commercial |
$273.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.52
|
| Rate for Payer: Healthscope Commercial |
$286.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.43
|
| Rate for Payer: PHP Commercial |
$270.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.70
|
| Rate for Payer: Priority Health SBD |
$200.43
|
| Rate for Payer: UMR Bronson Commercial |
$117.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.61
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 3
|
Facility
|
IP
|
$318.15
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$286.34 |
| Rate for Payer: Aetna American Axle |
$206.80
|
| Rate for Payer: Aetna Commercial |
$270.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.80
|
| Rate for Payer: Cash Price |
$254.52
|
| Rate for Payer: Cofinity Commercial |
$222.70
|
| Rate for Payer: Cofinity Commercial |
$273.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.52
|
| Rate for Payer: Healthscope Commercial |
$286.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.43
|
| Rate for Payer: PHP Commercial |
$270.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.70
|
| Rate for Payer: Priority Health SBD |
$200.43
|
| Rate for Payer: UMR Bronson Commercial |
$139.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.61
|
|
