|
HC GUIDEWIRE GLIDEWIRE LVL4
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.32 |
| Max. Negotiated Rate |
$407.70 |
| Rate for Payer: Aetna American Axle |
$294.45
|
| Rate for Payer: Aetna Commercial |
$385.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.45
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cofinity Commercial |
$317.10
|
| Rate for Payer: Cofinity Commercial |
$389.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.40
|
| Rate for Payer: Healthscope Commercial |
$407.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.05
|
| Rate for Payer: PHP Commercial |
$385.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.10
|
| Rate for Payer: Priority Health SBD |
$285.39
|
| Rate for Payer: UMR Bronson Commercial |
$199.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.75
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL4
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.61 |
| Max. Negotiated Rate |
$407.70 |
| Rate for Payer: Aetna American Axle |
$294.45
|
| Rate for Payer: Aetna Commercial |
$385.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.45
|
| Rate for Payer: BCBS Complete |
$181.20
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cofinity Commercial |
$317.10
|
| Rate for Payer: Cofinity Commercial |
$389.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.40
|
| Rate for Payer: Healthscope Commercial |
$407.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.05
|
| Rate for Payer: PHP Commercial |
$385.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.10
|
| Rate for Payer: Priority Health SBD |
$285.39
|
| Rate for Payer: UMR Bronson Commercial |
$167.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.75
|
|
|
HC GUIDEWIRE GLIDWIRE LVL 5
|
Facility
|
OP
|
$658.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.64 |
| Max. Negotiated Rate |
$592.63 |
| Rate for Payer: Aetna American Axle |
$428.01
|
| Rate for Payer: Aetna Commercial |
$559.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.01
|
| Rate for Payer: BCBS Complete |
$263.39
|
| Rate for Payer: Cash Price |
$526.78
|
| Rate for Payer: Cofinity Commercial |
$460.94
|
| Rate for Payer: Cofinity Commercial |
$566.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.78
|
| Rate for Payer: Healthscope Commercial |
$592.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$559.71
|
| Rate for Payer: PHP Commercial |
$559.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.94
|
| Rate for Payer: Priority Health SBD |
$414.84
|
| Rate for Payer: UMR Bronson Commercial |
$243.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.86
|
|
|
HC GUIDEWIRE GLIDWIRE LVL 5
|
Facility
|
IP
|
$658.48
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.73 |
| Max. Negotiated Rate |
$592.63 |
| Rate for Payer: Aetna American Axle |
$428.01
|
| Rate for Payer: Aetna Commercial |
$559.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.01
|
| Rate for Payer: Cash Price |
$526.78
|
| Rate for Payer: Cofinity Commercial |
$460.94
|
| Rate for Payer: Cofinity Commercial |
$566.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.78
|
| Rate for Payer: Healthscope Commercial |
$592.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$559.71
|
| Rate for Payer: PHP Commercial |
$559.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.94
|
| Rate for Payer: Priority Health SBD |
$414.84
|
| Rate for Payer: UMR Bronson Commercial |
$289.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.86
|
|
|
HC GUIDING CATHETER LVL 1
|
Facility
|
IP
|
$43.03
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$38.73 |
| Rate for Payer: Aetna American Axle |
$27.97
|
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.97
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Cofinity Commercial |
$30.12
|
| Rate for Payer: Cofinity Commercial |
$37.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.42
|
| Rate for Payer: Healthscope Commercial |
$38.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.58
|
| Rate for Payer: PHP Commercial |
$36.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.12
|
| Rate for Payer: Priority Health SBD |
$27.11
|
| Rate for Payer: UMR Bronson Commercial |
$18.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.27
|
|
|
HC GUIDING CATHETER LVL 1
|
Facility
|
OP
|
$43.03
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$38.73 |
| Rate for Payer: Aetna American Axle |
$27.97
|
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.97
|
| Rate for Payer: BCBS Complete |
$17.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Cofinity Commercial |
$30.12
|
| Rate for Payer: Cofinity Commercial |
$37.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.42
|
| Rate for Payer: Healthscope Commercial |
$38.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.58
|
| Rate for Payer: PHP Commercial |
$36.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.12
|
| Rate for Payer: Priority Health SBD |
$27.11
|
| Rate for Payer: UMR Bronson Commercial |
$15.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.27
|
|
|
HC GUIDING CATHETER LVL 17
|
Facility
|
IP
|
$1,789.01
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.16 |
| Max. Negotiated Rate |
$1,610.11 |
| Rate for Payer: Aetna American Axle |
$1,162.86
|
| Rate for Payer: Aetna Commercial |
$1,520.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,162.86
|
| Rate for Payer: Cash Price |
$1,431.21
|
| Rate for Payer: Cofinity Commercial |
$1,252.31
|
| Rate for Payer: Cofinity Commercial |
$1,538.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,431.21
|
| Rate for Payer: Healthscope Commercial |
$1,610.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,252.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,341.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,520.66
|
| Rate for Payer: PHP Commercial |
$1,520.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,252.31
|
| Rate for Payer: Priority Health SBD |
$1,127.08
|
| Rate for Payer: UMR Bronson Commercial |
$787.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,341.76
|
|
|
HC GUIDING CATHETER LVL 17
|
Facility
|
OP
|
$1,789.01
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,610.11 |
| Rate for Payer: Aetna American Axle |
$1,162.86
|
| Rate for Payer: Aetna Commercial |
$1,520.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,162.86
|
| Rate for Payer: BCBS Complete |
$715.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$1,431.21
|
| Rate for Payer: Cash Price |
$1,431.21
|
| Rate for Payer: Cofinity Commercial |
$1,252.31
|
| Rate for Payer: Cofinity Commercial |
$1,538.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,431.21
|
| Rate for Payer: Healthscope Commercial |
$1,610.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,252.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,341.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,520.66
|
| Rate for Payer: PHP Commercial |
$1,520.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,252.31
|
| Rate for Payer: Priority Health SBD |
$1,127.08
|
| Rate for Payer: UMR Bronson Commercial |
$661.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,341.76
|
|
|
HC GUIDING CATHETER LVL19
|
Facility
|
IP
|
$1,978.37
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.48 |
| Max. Negotiated Rate |
$1,780.53 |
| Rate for Payer: Aetna American Axle |
$1,285.94
|
| Rate for Payer: Aetna Commercial |
$1,681.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,285.94
|
| Rate for Payer: Cash Price |
$1,582.70
|
| Rate for Payer: Cofinity Commercial |
$1,384.86
|
| Rate for Payer: Cofinity Commercial |
$1,701.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.70
|
| Rate for Payer: Healthscope Commercial |
$1,780.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,384.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,483.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,681.61
|
| Rate for Payer: PHP Commercial |
$1,681.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,384.86
|
| Rate for Payer: Priority Health SBD |
$1,246.37
|
| Rate for Payer: UMR Bronson Commercial |
$870.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,483.78
|
|
|
HC GUIDING CATHETER LVL19
|
Facility
|
OP
|
$1,978.37
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,780.53 |
| Rate for Payer: Aetna American Axle |
$1,285.94
|
| Rate for Payer: Aetna Commercial |
$1,681.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,285.94
|
| Rate for Payer: BCBS Complete |
$791.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$1,582.70
|
| Rate for Payer: Cash Price |
$1,582.70
|
| Rate for Payer: Cofinity Commercial |
$1,701.40
|
| Rate for Payer: Cofinity Commercial |
$1,384.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.70
|
| Rate for Payer: Healthscope Commercial |
$1,780.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,384.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,483.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,681.61
|
| Rate for Payer: PHP Commercial |
$1,681.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,384.86
|
| Rate for Payer: Priority Health SBD |
$1,246.37
|
| Rate for Payer: UMR Bronson Commercial |
$732.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,483.78
|
|
|
HC GUIDING CATHETER LVL 2
|
Facility
|
OP
|
$280.38
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$252.34 |
| Rate for Payer: Aetna American Axle |
$182.25
|
| Rate for Payer: Aetna Commercial |
$238.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.25
|
| Rate for Payer: BCBS Complete |
$112.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$224.30
|
| Rate for Payer: Cash Price |
$224.30
|
| Rate for Payer: Cofinity Commercial |
$241.13
|
| Rate for Payer: Cofinity Commercial |
$196.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.30
|
| Rate for Payer: Healthscope Commercial |
$252.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.32
|
| Rate for Payer: PHP Commercial |
$238.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.27
|
| Rate for Payer: Priority Health SBD |
$176.64
|
| Rate for Payer: UMR Bronson Commercial |
$103.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.28
|
|
|
HC GUIDING CATHETER LVL 2
|
Facility
|
IP
|
$280.38
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.37 |
| Max. Negotiated Rate |
$252.34 |
| Rate for Payer: Aetna American Axle |
$182.25
|
| Rate for Payer: Aetna Commercial |
$238.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.25
|
| Rate for Payer: Cash Price |
$224.30
|
| Rate for Payer: Cofinity Commercial |
$196.27
|
| Rate for Payer: Cofinity Commercial |
$241.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.30
|
| Rate for Payer: Healthscope Commercial |
$252.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.32
|
| Rate for Payer: PHP Commercial |
$238.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.27
|
| Rate for Payer: Priority Health SBD |
$176.64
|
| Rate for Payer: UMR Bronson Commercial |
$123.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.28
|
|
|
HC GUIDING CATHETER LVL 24
|
Facility
|
IP
|
$2,429.14
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,068.82 |
| Max. Negotiated Rate |
$2,186.23 |
| Rate for Payer: Aetna American Axle |
$1,578.94
|
| Rate for Payer: Aetna Commercial |
$2,064.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,578.94
|
| Rate for Payer: Cash Price |
$1,943.31
|
| Rate for Payer: Cofinity Commercial |
$1,700.40
|
| Rate for Payer: Cofinity Commercial |
$2,089.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,943.31
|
| Rate for Payer: Healthscope Commercial |
$2,186.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,700.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,821.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,064.77
|
| Rate for Payer: PHP Commercial |
$2,064.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,700.40
|
| Rate for Payer: Priority Health SBD |
$1,530.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,068.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,821.86
|
|
|
HC GUIDING CATHETER LVL 24
|
Facility
|
OP
|
$2,429.14
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$2,186.23 |
| Rate for Payer: Aetna American Axle |
$1,578.94
|
| Rate for Payer: Aetna Commercial |
$2,064.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,578.94
|
| Rate for Payer: BCBS Complete |
$971.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$1,943.31
|
| Rate for Payer: Cash Price |
$1,943.31
|
| Rate for Payer: Cofinity Commercial |
$1,700.40
|
| Rate for Payer: Cofinity Commercial |
$2,089.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,943.31
|
| Rate for Payer: Healthscope Commercial |
$2,186.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,700.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,821.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,064.77
|
| Rate for Payer: PHP Commercial |
$2,064.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,700.40
|
| Rate for Payer: Priority Health SBD |
$1,530.36
|
| Rate for Payer: UMR Bronson Commercial |
$898.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,821.86
|
|
|
HC GUIDING CATHETER LVL 3
|
Facility
|
IP
|
$330.88
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.59 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: Aetna American Axle |
$215.07
|
| Rate for Payer: Aetna Commercial |
$281.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.07
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Cofinity Commercial |
$231.62
|
| Rate for Payer: Cofinity Commercial |
$284.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.70
|
| Rate for Payer: Healthscope Commercial |
$297.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.25
|
| Rate for Payer: PHP Commercial |
$281.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.62
|
| Rate for Payer: Priority Health SBD |
$208.45
|
| Rate for Payer: UMR Bronson Commercial |
$145.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.16
|
|
|
HC GUIDING CATHETER LVL 3
|
Facility
|
OP
|
$330.88
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$297.79 |
| Rate for Payer: Aetna American Axle |
$215.07
|
| Rate for Payer: Aetna Commercial |
$281.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.07
|
| Rate for Payer: BCBS Complete |
$132.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Cash Price |
$264.70
|
| Rate for Payer: Cofinity Commercial |
$231.62
|
| Rate for Payer: Cofinity Commercial |
$284.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.70
|
| Rate for Payer: Healthscope Commercial |
$297.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$281.25
|
| Rate for Payer: PHP Commercial |
$281.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.62
|
| Rate for Payer: Priority Health SBD |
$208.45
|
| Rate for Payer: UMR Bronson Commercial |
$122.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.16
|
|
|
HC GUIDING CATHETER LVL 35
|
Facility
|
IP
|
$3,522.11
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,549.73 |
| Max. Negotiated Rate |
$3,169.90 |
| Rate for Payer: Aetna American Axle |
$2,289.37
|
| Rate for Payer: Aetna Commercial |
$2,993.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,289.37
|
| Rate for Payer: Cash Price |
$2,817.69
|
| Rate for Payer: Cofinity Commercial |
$2,465.48
|
| Rate for Payer: Cofinity Commercial |
$3,029.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,817.69
|
| Rate for Payer: Healthscope Commercial |
$3,169.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,465.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,641.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,993.79
|
| Rate for Payer: PHP Commercial |
$2,993.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,465.48
|
| Rate for Payer: Priority Health SBD |
$2,218.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,549.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,641.58
|
|
|
HC GUIDING CATHETER LVL 35
|
Facility
|
OP
|
$3,522.11
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$3,169.90 |
| Rate for Payer: Aetna American Axle |
$2,289.37
|
| Rate for Payer: Aetna Commercial |
$2,993.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,289.37
|
| Rate for Payer: BCBS Complete |
$1,408.84
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$2,817.69
|
| Rate for Payer: Cash Price |
$2,817.69
|
| Rate for Payer: Cofinity Commercial |
$2,465.48
|
| Rate for Payer: Cofinity Commercial |
$3,029.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,817.69
|
| Rate for Payer: Healthscope Commercial |
$3,169.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,465.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,641.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,993.79
|
| Rate for Payer: PHP Commercial |
$2,993.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,465.48
|
| Rate for Payer: Priority Health SBD |
$2,218.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,303.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,641.58
|
|
|
HC GUIDING CATHETER LVL 4
|
Facility
|
OP
|
$480.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$432.81 |
| Rate for Payer: Aetna American Axle |
$312.58
|
| Rate for Payer: Aetna Commercial |
$408.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.58
|
| Rate for Payer: BCBS Complete |
$192.36
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$384.72
|
| Rate for Payer: Cash Price |
$384.72
|
| Rate for Payer: Cofinity Commercial |
$336.63
|
| Rate for Payer: Cofinity Commercial |
$413.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.72
|
| Rate for Payer: Healthscope Commercial |
$432.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$336.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.76
|
| Rate for Payer: PHP Commercial |
$408.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.63
|
| Rate for Payer: Priority Health SBD |
$302.97
|
| Rate for Payer: UMR Bronson Commercial |
$177.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.68
|
|
|
HC GUIDING CATHETER LVL 4
|
Facility
|
IP
|
$480.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.60 |
| Max. Negotiated Rate |
$432.81 |
| Rate for Payer: Aetna American Axle |
$312.58
|
| Rate for Payer: Aetna Commercial |
$408.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.58
|
| Rate for Payer: Cash Price |
$384.72
|
| Rate for Payer: Cofinity Commercial |
$336.63
|
| Rate for Payer: Cofinity Commercial |
$413.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$384.72
|
| Rate for Payer: Healthscope Commercial |
$432.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$336.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$360.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.76
|
| Rate for Payer: PHP Commercial |
$408.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.63
|
| Rate for Payer: Priority Health SBD |
$302.97
|
| Rate for Payer: UMR Bronson Commercial |
$211.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$360.68
|
|
|
HC GUIDING CATHETER LVL 42
|
Facility
|
IP
|
$4,295.53
|
|
| Hospital Charge Code |
27200130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,890.03 |
| Max. Negotiated Rate |
$3,865.98 |
| Rate for Payer: Aetna American Axle |
$2,792.09
|
| Rate for Payer: Aetna Commercial |
$3,651.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,792.09
|
| Rate for Payer: Cash Price |
$3,436.42
|
| Rate for Payer: Cofinity Commercial |
$3,006.87
|
| Rate for Payer: Cofinity Commercial |
$3,694.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,436.42
|
| Rate for Payer: Healthscope Commercial |
$3,865.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,006.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,221.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,651.20
|
| Rate for Payer: PHP Commercial |
$3,651.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,006.87
|
| Rate for Payer: Priority Health SBD |
$2,706.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,890.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,221.65
|
|
|
HC GUIDING CATHETER LVL 42
|
Facility
|
OP
|
$4,295.53
|
|
| Hospital Charge Code |
27200130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,589.35 |
| Max. Negotiated Rate |
$3,865.98 |
| Rate for Payer: Aetna American Axle |
$2,792.09
|
| Rate for Payer: Aetna Commercial |
$3,651.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,792.09
|
| Rate for Payer: BCBS Complete |
$1,718.21
|
| Rate for Payer: Cash Price |
$3,436.42
|
| Rate for Payer: Cofinity Commercial |
$3,006.87
|
| Rate for Payer: Cofinity Commercial |
$3,694.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,436.42
|
| Rate for Payer: Healthscope Commercial |
$3,865.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,006.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,221.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,651.20
|
| Rate for Payer: PHP Commercial |
$3,651.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,006.87
|
| Rate for Payer: Priority Health SBD |
$2,706.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,589.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,221.65
|
|
|
HC GUIDING CATHETER LVL 57
|
Facility
|
IP
|
$5,712.15
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,513.35 |
| Max. Negotiated Rate |
$5,140.94 |
| Rate for Payer: Aetna American Axle |
$3,712.90
|
| Rate for Payer: Aetna Commercial |
$4,855.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,712.90
|
| Rate for Payer: Cash Price |
$4,569.72
|
| Rate for Payer: Cofinity Commercial |
$3,998.50
|
| Rate for Payer: Cofinity Commercial |
$4,912.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,569.72
|
| Rate for Payer: Healthscope Commercial |
$5,140.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,998.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,284.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,855.33
|
| Rate for Payer: PHP Commercial |
$4,855.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,998.50
|
| Rate for Payer: Priority Health SBD |
$3,598.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,513.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,284.11
|
|
|
HC GUIDING CATHETER LVL 57
|
Facility
|
OP
|
$5,712.15
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$5,140.94 |
| Rate for Payer: Aetna American Axle |
$3,712.90
|
| Rate for Payer: Aetna Commercial |
$4,855.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,712.90
|
| Rate for Payer: BCBS Complete |
$2,284.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$4,569.72
|
| Rate for Payer: Cash Price |
$4,569.72
|
| Rate for Payer: Cofinity Commercial |
$3,998.50
|
| Rate for Payer: Cofinity Commercial |
$4,912.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,569.72
|
| Rate for Payer: Healthscope Commercial |
$5,140.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,998.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,284.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,855.33
|
| Rate for Payer: PHP Commercial |
$4,855.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,998.50
|
| Rate for Payer: Priority Health SBD |
$3,598.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,113.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,284.11
|
|
|
HC HAEMOPHILUS INFLUENZAE
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600269
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
