|
HC BACK SCREEN
|
Facility
|
IP
|
$52.02
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna American Axle |
$33.81
|
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: UMR Bronson Commercial |
$22.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
IP
|
$68.34
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Aetna American Axle |
$44.42
|
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.42
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$47.84
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.09
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: Priority Health SBD |
$43.05
|
| Rate for Payer: UMR Bronson Commercial |
$30.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.26
|
|
|
HC BACK SCREEN, VBISD
|
Facility
|
OP
|
$68.34
|
|
| Hospital Charge Code |
43000014
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$25.29 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$44.42
|
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: Aetna Medicare |
$34.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.42
|
| Rate for Payer: BCBS Complete |
$27.34
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Cofinity Commercial |
$47.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.09
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: Priority Health SBD |
$43.05
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UMR Bronson Commercial |
$25.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.26
|
|
|
HC BACTERIAL VAGINOSIS PANEL
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
30600337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.61 |
| Max. Negotiated Rate |
$171.16 |
| Rate for Payer: Aetna American Axle |
$99.45
|
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$137.41
|
| Rate for Payer: BCN Commercial |
$137.41
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| 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 Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.16
|
| Rate for Payer: UHC Exchange |
$142.63
|
| Rate for Payer: UMR Bronson Commercial |
$56.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC BACTERIAL VAGINOSIS PANEL
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 0352U
|
| Hospital Charge Code |
30600337
|
|
Hospital Revenue Code
|
306
|
| 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: Cofinity Medicare Advantage |
$107.10
|
| 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 Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| 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 BAG BLOOD TRANSFER
|
Facility
|
OP
|
$8.87
|
|
| Hospital Charge Code |
27000161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$7.98 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.54
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$6.21
|
| Rate for Payer: Cofinity Commercial |
$7.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.54
|
| Rate for Payer: PHP Commercial |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.77
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.65
|
|
|
HC BAG BLOOD TRANSFER
|
Facility
|
IP
|
$8.87
|
|
| Hospital Charge Code |
27000161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$7.98 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$6.21
|
| Rate for Payer: Cofinity Commercial |
$7.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.54
|
| Rate for Payer: PHP Commercial |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.77
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.65
|
|
|
HC BAG WASTE
|
Facility
|
IP
|
$64.26
|
|
| Hospital Charge Code |
27000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$57.83 |
| Rate for Payer: Aetna American Axle |
$41.77
|
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.77
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.41
|
| Rate for Payer: Healthscope Commercial |
$57.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.62
|
| Rate for Payer: PHP Commercial |
$54.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.77
|
| Rate for Payer: Priority Health SBD |
$40.48
|
| Rate for Payer: UMR Bronson Commercial |
$28.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.20
|
|
|
HC BAG WASTE
|
Facility
|
OP
|
$64.26
|
|
| Hospital Charge Code |
27000670
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$57.83 |
| Rate for Payer: Aetna American Axle |
$41.77
|
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: Aetna Medicare |
$32.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.77
|
| Rate for Payer: BCBS Complete |
$25.70
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.41
|
| Rate for Payer: Healthscope Commercial |
$57.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.62
|
| Rate for Payer: PHP Commercial |
$54.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.77
|
| Rate for Payer: Priority Health SBD |
$40.48
|
| Rate for Payer: UMR Bronson Commercial |
$23.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.20
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 10
|
Facility
|
IP
|
$1,041.42
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$458.22 |
| Max. Negotiated Rate |
$937.28 |
| Rate for Payer: Aetna American Axle |
$676.92
|
| Rate for Payer: Aetna Commercial |
$885.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.92
|
| Rate for Payer: Cash Price |
$833.14
|
| Rate for Payer: Cofinity Commercial |
$728.99
|
| Rate for Payer: Cofinity Commercial |
$895.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$728.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.14
|
| Rate for Payer: Healthscope Commercial |
$937.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$781.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.21
|
| Rate for Payer: PHP Commercial |
$885.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.92
|
| Rate for Payer: Priority Health SBD |
$656.09
|
| Rate for Payer: UMR Bronson Commercial |
$458.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$781.06
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 10
|
Facility
|
OP
|
$1,041.42
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$937.28 |
| Rate for Payer: Aetna American Axle |
$676.92
|
| Rate for Payer: Aetna Commercial |
$885.21
|
| Rate for Payer: Aetna Medicare |
$520.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.92
|
| Rate for Payer: BCBS Complete |
$416.57
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$833.14
|
| Rate for Payer: Cash Price |
$833.14
|
| Rate for Payer: Cofinity Commercial |
$728.99
|
| Rate for Payer: Cofinity Commercial |
$895.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$728.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.14
|
| Rate for Payer: Healthscope Commercial |
$937.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$728.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$781.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.21
|
| Rate for Payer: PHP Commercial |
$885.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.92
|
| Rate for Payer: Priority Health SBD |
$656.09
|
| Rate for Payer: UMR Bronson Commercial |
$385.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$781.06
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 12
|
Facility
|
IP
|
$1,289.14
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$567.22 |
| Max. Negotiated Rate |
$1,160.23 |
| Rate for Payer: Aetna American Axle |
$837.94
|
| Rate for Payer: Aetna Commercial |
$1,095.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.94
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cofinity Commercial |
$1,108.66
|
| Rate for Payer: Cofinity Commercial |
$902.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$902.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.31
|
| Rate for Payer: Healthscope Commercial |
$1,160.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.77
|
| Rate for Payer: PHP Commercial |
$1,095.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.94
|
| Rate for Payer: Priority Health SBD |
$812.16
|
| Rate for Payer: UMR Bronson Commercial |
$567.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.86
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 12
|
Facility
|
OP
|
$1,289.14
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,160.23 |
| Rate for Payer: Aetna American Axle |
$837.94
|
| Rate for Payer: Aetna Commercial |
$1,095.77
|
| Rate for Payer: Aetna Medicare |
$644.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.94
|
| Rate for Payer: BCBS Complete |
$515.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cash Price |
$1,031.31
|
| Rate for Payer: Cofinity Commercial |
$1,108.66
|
| Rate for Payer: Cofinity Commercial |
$902.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$902.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.31
|
| Rate for Payer: Healthscope Commercial |
$1,160.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.77
|
| Rate for Payer: PHP Commercial |
$1,095.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.94
|
| Rate for Payer: Priority Health SBD |
$812.16
|
| Rate for Payer: UMR Bronson Commercial |
$476.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.86
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 15
|
Facility
|
IP
|
$1,553.34
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$683.47 |
| Max. Negotiated Rate |
$1,398.01 |
| Rate for Payer: Aetna American Axle |
$1,009.67
|
| Rate for Payer: Aetna Commercial |
$1,320.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,009.67
|
| Rate for Payer: Cash Price |
$1,242.67
|
| Rate for Payer: Cofinity Commercial |
$1,087.34
|
| Rate for Payer: Cofinity Commercial |
$1,335.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,087.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,242.67
|
| Rate for Payer: Healthscope Commercial |
$1,398.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,087.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,165.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,320.34
|
| Rate for Payer: PHP Commercial |
$1,320.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,009.67
|
| Rate for Payer: Priority Health SBD |
$978.60
|
| Rate for Payer: UMR Bronson Commercial |
$683.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,165.00
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 15
|
Facility
|
OP
|
$1,553.34
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,398.01 |
| Rate for Payer: Aetna American Axle |
$1,009.67
|
| Rate for Payer: Aetna Commercial |
$1,320.34
|
| Rate for Payer: Aetna Medicare |
$776.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,009.67
|
| Rate for Payer: BCBS Complete |
$621.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$1,242.67
|
| Rate for Payer: Cash Price |
$1,242.67
|
| Rate for Payer: Cofinity Commercial |
$1,087.34
|
| Rate for Payer: Cofinity Commercial |
$1,335.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,087.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,242.67
|
| Rate for Payer: Healthscope Commercial |
$1,398.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,087.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,165.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,320.34
|
| Rate for Payer: PHP Commercial |
$1,320.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,009.67
|
| Rate for Payer: Priority Health SBD |
$978.60
|
| Rate for Payer: UMR Bronson Commercial |
$574.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,165.00
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 24
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,077.12 |
| Max. Negotiated Rate |
$2,203.20 |
| Rate for Payer: Aetna American Axle |
$1,591.20
|
| Rate for Payer: Aetna Commercial |
$2,080.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,713.60
|
| Rate for Payer: Cofinity Commercial |
$2,105.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,713.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,958.40
|
| Rate for Payer: Healthscope Commercial |
$2,203.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,713.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,836.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,080.80
|
| Rate for Payer: PHP Commercial |
$2,080.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health SBD |
$1,542.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,077.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,836.00
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 24
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$2,203.20 |
| Rate for Payer: Aetna American Axle |
$1,591.20
|
| Rate for Payer: Aetna Commercial |
$2,080.80
|
| Rate for Payer: Aetna Medicare |
$1,224.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,591.20
|
| Rate for Payer: BCBS Complete |
$979.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,713.60
|
| Rate for Payer: Cofinity Commercial |
$2,105.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,713.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,958.40
|
| Rate for Payer: Healthscope Commercial |
$2,203.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,713.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,836.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,080.80
|
| Rate for Payer: PHP Commercial |
$2,080.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health SBD |
$1,542.24
|
| Rate for Payer: UMR Bronson Commercial |
$905.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,836.00
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 4
|
Facility
|
IP
|
$421.04
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.26 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna American Axle |
$273.68
|
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.68
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$294.73
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: Priority Health SBD |
$265.26
|
| Rate for Payer: UMR Bronson Commercial |
$185.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.78
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 4
|
Facility
|
OP
|
$421.04
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200053
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna American Axle |
$273.68
|
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: Aetna Medicare |
$210.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.68
|
| Rate for Payer: BCBS Complete |
$168.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$294.73
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: Priority Health SBD |
$265.26
|
| Rate for Payer: UMR Bronson Commercial |
$155.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.78
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 5
|
Facility
|
OP
|
$588.11
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$529.30 |
| Rate for Payer: Aetna American Axle |
$382.27
|
| Rate for Payer: Aetna Commercial |
$499.89
|
| Rate for Payer: Aetna Medicare |
$294.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.27
|
| Rate for Payer: BCBS Complete |
$235.24
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$470.49
|
| Rate for Payer: Cash Price |
$470.49
|
| Rate for Payer: Cofinity Commercial |
$411.68
|
| Rate for Payer: Cofinity Commercial |
$505.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$411.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.49
|
| Rate for Payer: Healthscope Commercial |
$529.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$411.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$441.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.89
|
| Rate for Payer: PHP Commercial |
$499.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.27
|
| Rate for Payer: Priority Health SBD |
$370.51
|
| Rate for Payer: UMR Bronson Commercial |
$217.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$441.08
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 5
|
Facility
|
IP
|
$588.11
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$258.77 |
| Max. Negotiated Rate |
$529.30 |
| Rate for Payer: Aetna American Axle |
$382.27
|
| Rate for Payer: Aetna Commercial |
$499.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.27
|
| Rate for Payer: Cash Price |
$470.49
|
| Rate for Payer: Cofinity Commercial |
$411.68
|
| Rate for Payer: Cofinity Commercial |
$505.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$411.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.49
|
| Rate for Payer: Healthscope Commercial |
$529.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$411.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$441.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.89
|
| Rate for Payer: PHP Commercial |
$499.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.27
|
| Rate for Payer: Priority Health SBD |
$370.51
|
| Rate for Payer: UMR Bronson Commercial |
$258.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$441.08
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 6
|
Facility
|
IP
|
$691.56
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$304.29 |
| Max. Negotiated Rate |
$622.40 |
| Rate for Payer: Aetna American Axle |
$449.51
|
| Rate for Payer: Aetna Commercial |
$587.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.51
|
| Rate for Payer: Cash Price |
$553.25
|
| Rate for Payer: Cofinity Commercial |
$484.09
|
| Rate for Payer: Cofinity Commercial |
$594.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$484.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.25
|
| Rate for Payer: Healthscope Commercial |
$622.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$484.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.83
|
| Rate for Payer: PHP Commercial |
$587.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.51
|
| Rate for Payer: Priority Health SBD |
$435.68
|
| Rate for Payer: UMR Bronson Commercial |
$304.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.67
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 6
|
Facility
|
OP
|
$691.56
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$622.40 |
| Rate for Payer: Aetna American Axle |
$449.51
|
| Rate for Payer: Aetna Commercial |
$587.83
|
| Rate for Payer: Aetna Medicare |
$345.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$449.51
|
| Rate for Payer: BCBS Complete |
$276.62
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$553.25
|
| Rate for Payer: Cash Price |
$553.25
|
| Rate for Payer: Cofinity Commercial |
$484.09
|
| Rate for Payer: Cofinity Commercial |
$594.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$484.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.25
|
| Rate for Payer: Healthscope Commercial |
$622.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$484.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.83
|
| Rate for Payer: PHP Commercial |
$587.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.51
|
| Rate for Payer: Priority Health SBD |
$435.68
|
| Rate for Payer: UMR Bronson Commercial |
$255.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.67
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 69
|
Facility
|
OP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$6,243.93 |
| Rate for Payer: Aetna American Axle |
$4,509.50
|
| Rate for Payer: Aetna Commercial |
$5,897.04
|
| Rate for Payer: Aetna Medicare |
$3,468.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,509.50
|
| Rate for Payer: BCBS Complete |
$2,775.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$4,856.39
|
| Rate for Payer: Cofinity Commercial |
$5,966.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,856.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,243.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,856.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,203.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,897.04
|
| Rate for Payer: PHP Commercial |
$5,897.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,509.50
|
| Rate for Payer: Priority Health SBD |
$4,370.75
|
| Rate for Payer: UMR Bronson Commercial |
$2,566.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,203.28
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 69
|
Facility
|
IP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,052.59 |
| Max. Negotiated Rate |
$6,243.93 |
| Rate for Payer: Aetna American Axle |
$4,509.50
|
| Rate for Payer: Aetna Commercial |
$5,897.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,509.50
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$4,856.39
|
| Rate for Payer: Cofinity Commercial |
$5,966.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,856.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,550.16
|
| Rate for Payer: Healthscope Commercial |
$6,243.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,856.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,203.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,897.04
|
| Rate for Payer: PHP Commercial |
$5,897.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,509.50
|
| Rate for Payer: Priority Health SBD |
$4,370.75
|
| Rate for Payer: UMR Bronson Commercial |
$3,052.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,203.28
|
|
