|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
IP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$323.14 |
| Max. Negotiated Rate |
$660.96 |
| Rate for Payer: Aetna American Axle |
$477.36
|
| Rate for Payer: Aetna Commercial |
$624.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.36
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Commercial |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$631.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$514.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$660.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: PHP Commercial |
$624.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.36
|
| Rate for Payer: Priority Health SBD |
$462.67
|
| Rate for Payer: UMR Bronson Commercial |
$323.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.80
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
OP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$660.96 |
| Rate for Payer: Aetna American Axle |
$477.36
|
| Rate for Payer: Aetna Commercial |
$624.24
|
| Rate for Payer: Aetna Medicare |
$367.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$477.36
|
| Rate for Payer: BCBS Complete |
$293.76
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Commercial |
$514.08
|
| Rate for Payer: Cofinity Commercial |
$631.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$514.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$660.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: PHP Commercial |
$624.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.36
|
| Rate for Payer: Priority Health SBD |
$462.67
|
| Rate for Payer: UMR Bronson Commercial |
$271.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.80
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
OP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$798.11 |
| Rate for Payer: Aetna American Axle |
$576.41
|
| Rate for Payer: Aetna Commercial |
$753.77
|
| Rate for Payer: Aetna Medicare |
$443.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$576.41
|
| Rate for Payer: BCBS Complete |
$354.72
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Commercial |
$620.75
|
| Rate for Payer: Cofinity Commercial |
$762.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$620.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Healthscope Commercial |
$798.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$620.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: PHP Commercial |
$753.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.41
|
| Rate for Payer: Priority Health SBD |
$558.68
|
| Rate for Payer: UMR Bronson Commercial |
$328.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.09
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
IP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$390.19 |
| Max. Negotiated Rate |
$798.11 |
| Rate for Payer: Aetna American Axle |
$576.41
|
| Rate for Payer: Aetna Commercial |
$753.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$576.41
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Commercial |
$620.75
|
| Rate for Payer: Cofinity Commercial |
$762.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$620.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Healthscope Commercial |
$798.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$620.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: PHP Commercial |
$753.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.41
|
| Rate for Payer: Priority Health SBD |
$558.68
|
| Rate for Payer: UMR Bronson Commercial |
$390.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.09
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
IP
|
$748.54
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.36 |
| Max. Negotiated Rate |
$673.69 |
| Rate for Payer: Aetna American Axle |
$486.55
|
| Rate for Payer: Aetna Commercial |
$636.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.55
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$523.98
|
| Rate for Payer: Cofinity Commercial |
$643.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$523.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$673.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$523.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: PHP Commercial |
$636.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health SBD |
$471.58
|
| Rate for Payer: UMR Bronson Commercial |
$329.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.40
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
OP
|
$748.54
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.11 |
| Max. Negotiated Rate |
$3,145.99 |
| Rate for Payer: Aetna American Axle |
$486.55
|
| Rate for Payer: Aetna Commercial |
$636.26
|
| Rate for Payer: Aetna Medicare |
$374.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.55
|
| Rate for Payer: BCBS Complete |
$299.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,145.99
|
| Rate for Payer: BCN Commercial |
$3,145.99
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$643.74
|
| Rate for Payer: Cofinity Commercial |
$523.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$523.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$673.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$523.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: PHP Commercial |
$636.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health SBD |
$471.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.22
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$171.11
|
| Rate for Payer: UMR Bronson Commercial |
$276.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.40
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
OP
|
$1,925.03
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$712.26 |
| Max. Negotiated Rate |
$1,732.53 |
| Rate for Payer: Aetna American Axle |
$1,251.27
|
| Rate for Payer: Aetna Commercial |
$1,636.28
|
| Rate for Payer: Aetna Medicare |
$962.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.27
|
| Rate for Payer: BCBS Complete |
$770.01
|
| Rate for Payer: Cash Price |
$1,540.02
|
| Rate for Payer: Cofinity Commercial |
$1,347.52
|
| Rate for Payer: Cofinity Commercial |
$1,655.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,347.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.02
|
| Rate for Payer: Healthscope Commercial |
$1,732.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,347.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,443.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.28
|
| Rate for Payer: PHP Commercial |
$1,636.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.27
|
| Rate for Payer: Priority Health SBD |
$1,212.77
|
| Rate for Payer: UMR Bronson Commercial |
$712.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,443.77
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
IP
|
$1,925.03
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$847.01 |
| Max. Negotiated Rate |
$1,732.53 |
| Rate for Payer: Aetna American Axle |
$1,251.27
|
| Rate for Payer: Aetna Commercial |
$1,636.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.27
|
| Rate for Payer: Cash Price |
$1,540.02
|
| Rate for Payer: Cofinity Commercial |
$1,347.52
|
| Rate for Payer: Cofinity Commercial |
$1,655.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,347.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.02
|
| Rate for Payer: Healthscope Commercial |
$1,732.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,347.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,443.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.28
|
| Rate for Payer: PHP Commercial |
$1,636.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.27
|
| Rate for Payer: Priority Health SBD |
$1,212.77
|
| Rate for Payer: UMR Bronson Commercial |
$847.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,443.77
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
IP
|
$82.47
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.29 |
| Max. Negotiated Rate |
$74.22 |
| Rate for Payer: Aetna American Axle |
$53.61
|
| Rate for Payer: Aetna Commercial |
$70.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.61
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$57.73
|
| Rate for Payer: Cofinity Commercial |
$70.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$74.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.10
|
| Rate for Payer: PHP Commercial |
$70.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.61
|
| Rate for Payer: Priority Health SBD |
$51.96
|
| Rate for Payer: UMR Bronson Commercial |
$36.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.85
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
OP
|
$82.47
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$74.22 |
| Rate for Payer: Aetna American Axle |
$53.61
|
| Rate for Payer: Aetna Commercial |
$70.10
|
| Rate for Payer: Aetna Medicare |
$41.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.61
|
| Rate for Payer: BCBS Complete |
$32.99
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$57.73
|
| Rate for Payer: Cofinity Commercial |
$70.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$74.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.10
|
| Rate for Payer: PHP Commercial |
$70.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.61
|
| Rate for Payer: Priority Health SBD |
$51.96
|
| Rate for Payer: UMR Bronson Commercial |
$30.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.85
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
IP
|
$249.07
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.59 |
| Max. Negotiated Rate |
$224.16 |
| Rate for Payer: Aetna American Axle |
$161.90
|
| Rate for Payer: Aetna Commercial |
$211.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.90
|
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Cofinity Commercial |
$174.35
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.26
|
| Rate for Payer: Healthscope Commercial |
$224.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.71
|
| Rate for Payer: PHP Commercial |
$211.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.90
|
| Rate for Payer: Priority Health SBD |
$156.91
|
| Rate for Payer: UMR Bronson Commercial |
$109.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.80
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
OP
|
$249.07
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$224.16 |
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Cofinity Commercial |
$174.35
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.35
|
| Rate for Payer: Aetna American Axle |
$161.90
|
| Rate for Payer: Aetna Commercial |
$211.71
|
| Rate for Payer: Aetna Medicare |
$124.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.90
|
| Rate for Payer: BCBS Complete |
$99.63
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.26
|
| Rate for Payer: Healthscope Commercial |
$224.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.71
|
| Rate for Payer: PHP Commercial |
$211.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.90
|
| Rate for Payer: Priority Health SBD |
$156.91
|
| Rate for Payer: UMR Bronson Commercial |
$92.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.80
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
OP
|
$3,189.23
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,180.02 |
| Max. Negotiated Rate |
$2,870.31 |
| Rate for Payer: Aetna American Axle |
$2,073.00
|
| Rate for Payer: Aetna Commercial |
$2,710.85
|
| Rate for Payer: Aetna Medicare |
$1,594.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,073.00
|
| Rate for Payer: BCBS Complete |
$1,275.69
|
| Rate for Payer: Cash Price |
$2,551.38
|
| Rate for Payer: Cofinity Commercial |
$2,232.46
|
| Rate for Payer: Cofinity Commercial |
$2,742.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,232.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,551.38
|
| Rate for Payer: Healthscope Commercial |
$2,870.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,232.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,391.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,710.85
|
| Rate for Payer: PHP Commercial |
$2,710.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,073.00
|
| Rate for Payer: Priority Health SBD |
$2,009.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,180.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,391.92
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
IP
|
$3,189.23
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,403.26 |
| Max. Negotiated Rate |
$2,870.31 |
| Rate for Payer: Aetna American Axle |
$2,073.00
|
| Rate for Payer: Aetna Commercial |
$2,710.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,073.00
|
| Rate for Payer: Cash Price |
$2,551.38
|
| Rate for Payer: Cofinity Commercial |
$2,232.46
|
| Rate for Payer: Cofinity Commercial |
$2,742.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,232.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,551.38
|
| Rate for Payer: Healthscope Commercial |
$2,870.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,232.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,391.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,710.85
|
| Rate for Payer: PHP Commercial |
$2,710.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,073.00
|
| Rate for Payer: Priority Health SBD |
$2,009.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,403.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,391.92
|
|
|
HC BANANA IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: UMR Bronson Commercial |
$11.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC BANANA IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna American Axle |
$16.50
|
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.04
|
| Rate for Payer: BCN Commercial |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.39
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
IP
|
$13.69
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$12.32 |
| Rate for Payer: Aetna American Axle |
$8.90
|
| Rate for Payer: Aetna Commercial |
$11.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.90
|
| Rate for Payer: Cash Price |
$10.95
|
| Rate for Payer: Cofinity Commercial |
$11.77
|
| Rate for Payer: Cofinity Commercial |
$9.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.95
|
| Rate for Payer: Healthscope Commercial |
$12.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.64
|
| Rate for Payer: PHP Commercial |
$11.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.90
|
| Rate for Payer: Priority Health SBD |
$8.62
|
| Rate for Payer: UMR Bronson Commercial |
$6.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.27
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
OP
|
$13.69
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$12.32 |
| Rate for Payer: Aetna American Axle |
$8.90
|
| Rate for Payer: Aetna Commercial |
$11.64
|
| Rate for Payer: Aetna Medicare |
$6.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.90
|
| Rate for Payer: BCBS Complete |
$5.48
|
| Rate for Payer: Cash Price |
$10.95
|
| Rate for Payer: Cofinity Commercial |
$11.77
|
| Rate for Payer: Cofinity Commercial |
$9.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.95
|
| Rate for Payer: Healthscope Commercial |
$12.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.64
|
| Rate for Payer: PHP Commercial |
$11.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.90
|
| Rate for Payer: Priority Health SBD |
$8.62
|
| Rate for Payer: UMR Bronson Commercial |
$5.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.27
|
|
|
HC BANDING
|
Facility
|
IP
|
$965.64
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$424.88 |
| Max. Negotiated Rate |
$869.08 |
| Rate for Payer: Aetna American Axle |
$627.67
|
| Rate for Payer: Aetna Commercial |
$820.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.67
|
| Rate for Payer: Cash Price |
$772.51
|
| Rate for Payer: Cofinity Commercial |
$675.95
|
| Rate for Payer: Cofinity Commercial |
$830.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$675.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.51
|
| Rate for Payer: Healthscope Commercial |
$869.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$724.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.79
|
| Rate for Payer: PHP Commercial |
$820.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.67
|
| Rate for Payer: Priority Health SBD |
$608.35
|
| Rate for Payer: UMR Bronson Commercial |
$424.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$724.23
|
|
|
HC BANDING
|
Facility
|
OP
|
$965.64
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$357.29 |
| Max. Negotiated Rate |
$869.08 |
| Rate for Payer: Aetna American Axle |
$627.67
|
| Rate for Payer: Aetna Commercial |
$820.79
|
| Rate for Payer: Aetna Medicare |
$482.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.67
|
| Rate for Payer: BCBS Complete |
$386.26
|
| Rate for Payer: Cash Price |
$772.51
|
| Rate for Payer: Cofinity Commercial |
$675.95
|
| Rate for Payer: Cofinity Commercial |
$830.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$675.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.51
|
| Rate for Payer: Healthscope Commercial |
$869.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$675.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$724.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.79
|
| Rate for Payer: PHP Commercial |
$820.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.67
|
| Rate for Payer: Priority Health SBD |
$608.35
|
| Rate for Payer: UMR Bronson Commercial |
$357.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$724.23
|
|
|
HC BARBITURATE URIN
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.73 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna American Axle |
$66.08
|
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.08
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$71.16
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health SBD |
$64.05
|
| Rate for Payer: UMR Bronson Commercial |
$44.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.24
|
|
|
HC BARBITURATE URIN
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$93.21 |
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Aetna American Axle |
$66.08
|
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$59.88
|
| Rate for Payer: BCN Commercial |
$59.88
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Cofinity Commercial |
$71.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.24
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$49.71
|
| Rate for Payer: Priority Health SBD |
$64.05
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$33.31
|
| Rate for Payer: UMR Bronson Commercial |
$37.61
|
| Rate for Payer: VA VA |
$62.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.24
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna American Axle |
$41.11
|
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Commercial |
$44.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health SBD |
$39.84
|
| Rate for Payer: UHC Core |
$122.36
|
| Rate for Payer: UMR Bronson Commercial |
$23.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna American Axle |
$41.11
|
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$44.27
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health SBD |
$39.84
|
| Rate for Payer: UMR Bronson Commercial |
$27.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC BARRIER ADHESION
|
Facility
|
IP
|
$589.96
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
27000463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$259.58 |
| Max. Negotiated Rate |
$530.96 |
| Rate for Payer: Aetna American Axle |
$383.47
|
| Rate for Payer: Aetna Commercial |
$501.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.47
|
| Rate for Payer: Cash Price |
$471.97
|
| Rate for Payer: Cofinity Commercial |
$412.97
|
| Rate for Payer: Cofinity Commercial |
$507.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$412.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.97
|
| Rate for Payer: Healthscope Commercial |
$530.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$412.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.47
|
| Rate for Payer: PHP Commercial |
$501.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.47
|
| Rate for Payer: Priority Health SBD |
$371.67
|
| Rate for Payer: UMR Bronson Commercial |
$259.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.47
|
|
