|
HC LD RECOVERY 2-4 HRS
|
Facility
|
IP
|
$2,881.83
|
|
| Hospital Charge Code |
71000014
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,268.01 |
| Max. Negotiated Rate |
$2,593.65 |
| Rate for Payer: Aetna American Axle |
$1,873.19
|
| Rate for Payer: Aetna Commercial |
$2,449.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,873.19
|
| Rate for Payer: Cash Price |
$2,305.46
|
| Rate for Payer: Cofinity Commercial |
$2,017.28
|
| Rate for Payer: Cofinity Commercial |
$2,478.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,305.46
|
| Rate for Payer: Healthscope Commercial |
$2,593.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,017.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,161.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,449.56
|
| Rate for Payer: PHP Commercial |
$2,449.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,017.28
|
| Rate for Payer: Priority Health SBD |
$1,815.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,268.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,161.37
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
OP
|
$3,202.09
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,184.77 |
| Max. Negotiated Rate |
$2,881.88 |
| Rate for Payer: Aetna American Axle |
$2,081.36
|
| Rate for Payer: Aetna Commercial |
$2,721.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,081.36
|
| Rate for Payer: BCBS Complete |
$1,280.84
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cofinity Commercial |
$2,241.46
|
| Rate for Payer: Cofinity Commercial |
$2,753.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,561.67
|
| Rate for Payer: Healthscope Commercial |
$2,881.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,241.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,401.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.78
|
| Rate for Payer: PHP Commercial |
$2,721.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.46
|
| Rate for Payer: Priority Health SBD |
$2,017.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,184.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,401.57
|
|
|
HC LD RECOVERY 4-6 HRS
|
Facility
|
IP
|
$3,202.09
|
|
| Hospital Charge Code |
71000015
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,408.92 |
| Max. Negotiated Rate |
$2,881.88 |
| Rate for Payer: Aetna American Axle |
$2,081.36
|
| Rate for Payer: Aetna Commercial |
$2,721.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,081.36
|
| Rate for Payer: Cash Price |
$2,561.67
|
| Rate for Payer: Cofinity Commercial |
$2,241.46
|
| Rate for Payer: Cofinity Commercial |
$2,753.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,561.67
|
| Rate for Payer: Healthscope Commercial |
$2,881.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,241.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,401.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,721.78
|
| Rate for Payer: PHP Commercial |
$2,721.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,241.46
|
| Rate for Payer: Priority Health SBD |
$2,017.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,408.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,401.57
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
IP
|
$1,188.59
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$522.98 |
| Max. Negotiated Rate |
$1,069.73 |
| Rate for Payer: Aetna American Axle |
$772.58
|
| Rate for Payer: Aetna Commercial |
$1,010.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.58
|
| Rate for Payer: Cash Price |
$950.87
|
| Rate for Payer: Cofinity Commercial |
$1,022.19
|
| Rate for Payer: Cofinity Commercial |
$832.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.87
|
| Rate for Payer: Healthscope Commercial |
$1,069.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$832.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.30
|
| Rate for Payer: PHP Commercial |
$1,010.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.01
|
| Rate for Payer: Priority Health SBD |
$748.81
|
| Rate for Payer: UMR Bronson Commercial |
$522.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.44
|
|
|
HC LD RECOVERY 6-8 HRS
|
Facility
|
OP
|
$1,188.59
|
|
| Hospital Charge Code |
71000016
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$439.78 |
| Max. Negotiated Rate |
$1,069.73 |
| Rate for Payer: Aetna American Axle |
$772.58
|
| Rate for Payer: Aetna Commercial |
$1,010.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.58
|
| Rate for Payer: BCBS Complete |
$475.44
|
| Rate for Payer: Cash Price |
$950.87
|
| Rate for Payer: Cofinity Commercial |
$1,022.19
|
| Rate for Payer: Cofinity Commercial |
$832.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.87
|
| Rate for Payer: Healthscope Commercial |
$1,069.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$832.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.30
|
| Rate for Payer: PHP Commercial |
$1,010.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.01
|
| Rate for Payer: Priority Health SBD |
$748.81
|
| Rate for Payer: UMR Bronson Commercial |
$439.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.44
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
OP
|
$1,427.13
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$528.04 |
| Max. Negotiated Rate |
$1,284.42 |
| Rate for Payer: Aetna American Axle |
$927.63
|
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$927.63
|
| Rate for Payer: BCBS Complete |
$570.85
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: Cofinity Commercial |
$1,227.33
|
| Rate for Payer: Cofinity Commercial |
$998.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,141.70
|
| Rate for Payer: Healthscope Commercial |
$1,284.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$998.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,070.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,213.06
|
| Rate for Payer: PHP Commercial |
$1,213.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$998.99
|
| Rate for Payer: Priority Health SBD |
$899.09
|
| Rate for Payer: UMR Bronson Commercial |
$528.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,070.35
|
|
|
HC LD RECOVERY 8-10 HRS
|
Facility
|
IP
|
$1,427.13
|
|
| Hospital Charge Code |
71000017
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$627.94 |
| Max. Negotiated Rate |
$1,284.42 |
| Rate for Payer: Aetna American Axle |
$927.63
|
| Rate for Payer: Aetna Commercial |
$1,213.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$927.63
|
| Rate for Payer: Cash Price |
$1,141.70
|
| Rate for Payer: Cofinity Commercial |
$1,227.33
|
| Rate for Payer: Cofinity Commercial |
$998.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,141.70
|
| Rate for Payer: Healthscope Commercial |
$1,284.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$998.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,070.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,213.06
|
| Rate for Payer: PHP Commercial |
$1,213.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$998.99
|
| Rate for Payer: Priority Health SBD |
$899.09
|
| Rate for Payer: UMR Bronson Commercial |
$627.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,070.35
|
|
|
HC LEAD
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna American Axle |
$28.60
|
| Rate for Payer: Aetna Commercial |
$37.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.20
|
| Rate for Payer: Healthscope Commercial |
$39.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.40
|
| Rate for Payer: PHP Commercial |
$37.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health SBD |
$27.72
|
| Rate for Payer: UMR Bronson Commercial |
$19.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.00
|
|
|
HC LEAD
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100275
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna American Axle |
$28.60
|
| Rate for Payer: Aetna Commercial |
$37.40
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.14
|
| Rate for Payer: BCBS Complete |
$6.96
|
| Rate for Payer: BCBS MAPPO |
$12.11
|
| Rate for Payer: BCBS Trust/PPO |
$10.89
|
| Rate for Payer: BCN Medicare Advantage |
$12.11
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$39.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.00
|
| Rate for Payer: Mclaren Medicaid |
$6.62
|
| Rate for Payer: Mclaren Medicare |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.40
|
| Rate for Payer: PACE Medicare |
$11.50
|
| Rate for Payer: PACE SWMI |
$12.11
|
| Rate for Payer: PHP Commercial |
$37.40
|
| Rate for Payer: PHP Medicare Advantage |
$12.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.61
|
| Rate for Payer: Priority Health Medicare |
$12.11
|
| Rate for Payer: Priority Health Narrow Network |
$13.29
|
| Rate for Payer: Priority Health SBD |
$27.72
|
| Rate for Payer: Railroad Medicare Medicare |
$12.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.53
|
| Rate for Payer: UHC Core |
$19.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.11
|
| Rate for Payer: UHC Exchange |
$12.11
|
| Rate for Payer: UHC Medicare Advantage |
$12.47
|
| Rate for Payer: UMR Bronson Commercial |
$16.28
|
| Rate for Payer: VA VA |
$12.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.00
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
OP
|
$14,450.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,346.50 |
| Max. Negotiated Rate |
$13,005.00 |
| Rate for Payer: Aetna American Axle |
$9,392.50
|
| Rate for Payer: Aetna Commercial |
$12,282.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,392.50
|
| Rate for Payer: BCBS Complete |
$5,780.00
|
| Rate for Payer: Cash Price |
$11,560.00
|
| Rate for Payer: Cofinity Commercial |
$10,115.00
|
| Rate for Payer: Cofinity Commercial |
$12,427.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,560.00
|
| Rate for Payer: Healthscope Commercial |
$13,005.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,115.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,837.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,282.50
|
| Rate for Payer: PHP Commercial |
$12,282.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,115.00
|
| Rate for Payer: Priority Health SBD |
$9,103.50
|
| Rate for Payer: UMR Bronson Commercial |
$5,346.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,837.50
|
|
|
HC LEAD CARDIOVERTER DEFIB ENDOCARDIAL SINGLE COIL
|
Facility
|
IP
|
$14,450.00
|
|
|
Service Code
|
HCPCS C1777
|
| Hospital Charge Code |
27800088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,358.00 |
| Max. Negotiated Rate |
$13,005.00 |
| Rate for Payer: Aetna American Axle |
$9,392.50
|
| Rate for Payer: Aetna Commercial |
$12,282.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,392.50
|
| Rate for Payer: Cash Price |
$11,560.00
|
| Rate for Payer: Cofinity Commercial |
$10,115.00
|
| Rate for Payer: Cofinity Commercial |
$12,427.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,560.00
|
| Rate for Payer: Healthscope Commercial |
$13,005.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,115.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,837.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,282.50
|
| Rate for Payer: PHP Commercial |
$12,282.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,115.00
|
| Rate for Payer: Priority Health SBD |
$9,103.50
|
| Rate for Payer: UMR Bronson Commercial |
$6,358.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,837.50
|
|
|
HC LEAD NEUROSTIM TEST KIT LEVEL 20
|
Facility
|
IP
|
$2,040.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.60 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Aetna American Axle |
$1,326.00
|
| Rate for Payer: Aetna Commercial |
$1,734.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,326.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cofinity Commercial |
$1,428.00
|
| Rate for Payer: Cofinity Commercial |
$1,754.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,632.00
|
| Rate for Payer: Healthscope Commercial |
$1,836.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,428.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,530.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,734.00
|
| Rate for Payer: PHP Commercial |
$1,734.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,428.00
|
| Rate for Payer: Priority Health SBD |
$1,285.20
|
| Rate for Payer: UMR Bronson Commercial |
$897.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,530.00
|
|
|
HC LEAD NEUROSTIM TEST KIT LEVEL 20
|
Facility
|
OP
|
$2,040.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800134
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$754.80 |
| Max. Negotiated Rate |
$1,836.00 |
| Rate for Payer: Aetna American Axle |
$1,326.00
|
| Rate for Payer: Aetna Commercial |
$1,734.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,326.00
|
| Rate for Payer: BCBS Complete |
$816.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cofinity Commercial |
$1,428.00
|
| Rate for Payer: Cofinity Commercial |
$1,754.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,632.00
|
| Rate for Payer: Healthscope Commercial |
$1,836.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,428.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,530.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,734.00
|
| Rate for Payer: PHP Commercial |
$1,734.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,428.00
|
| Rate for Payer: Priority Health SBD |
$1,285.20
|
| Rate for Payer: UMR Bronson Commercial |
$754.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,530.00
|
|
|
HC LEAD NEUROSTIMULATOR
|
Facility
|
IP
|
$7,656.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,368.64 |
| Max. Negotiated Rate |
$6,890.40 |
| Rate for Payer: Aetna American Axle |
$4,976.40
|
| Rate for Payer: Aetna Commercial |
$6,507.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,976.40
|
| Rate for Payer: Cash Price |
$6,124.80
|
| Rate for Payer: Cofinity Commercial |
$5,359.20
|
| Rate for Payer: Cofinity Commercial |
$6,584.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,124.80
|
| Rate for Payer: Healthscope Commercial |
$6,890.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,359.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,742.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,507.60
|
| Rate for Payer: PHP Commercial |
$6,507.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,359.20
|
| Rate for Payer: Priority Health SBD |
$4,823.28
|
| Rate for Payer: UMR Bronson Commercial |
$3,368.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,742.00
|
|
|
HC LEAD NEUROSTIMULATOR
|
Facility
|
OP
|
$7,656.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27800017
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,832.72 |
| Max. Negotiated Rate |
$6,890.40 |
| Rate for Payer: Aetna American Axle |
$4,976.40
|
| Rate for Payer: Aetna Commercial |
$6,507.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,976.40
|
| Rate for Payer: BCBS Complete |
$3,062.40
|
| Rate for Payer: Cash Price |
$6,124.80
|
| Rate for Payer: Cofinity Commercial |
$5,359.20
|
| Rate for Payer: Cofinity Commercial |
$6,584.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,124.80
|
| Rate for Payer: Healthscope Commercial |
$6,890.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,359.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,742.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,507.60
|
| Rate for Payer: PHP Commercial |
$6,507.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,359.20
|
| Rate for Payer: Priority Health SBD |
$4,823.28
|
| Rate for Payer: UMR Bronson Commercial |
$2,832.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,742.00
|
|
|
HC LEAD NOS LVL 1
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna American Axle |
$126.75
|
| Rate for Payer: Aetna Commercial |
$165.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.75
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$136.50
|
| Rate for Payer: Cofinity Commercial |
$167.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.00
|
| Rate for Payer: Healthscope Commercial |
$175.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.75
|
| Rate for Payer: PHP Commercial |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health SBD |
$122.85
|
| Rate for Payer: UMR Bronson Commercial |
$85.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.25
|
|
|
HC LEAD NOS LVL 1
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna American Axle |
$126.75
|
| Rate for Payer: Aetna Commercial |
$165.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.75
|
| Rate for Payer: BCBS Complete |
$78.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$136.50
|
| Rate for Payer: Cofinity Commercial |
$167.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.00
|
| Rate for Payer: Healthscope Commercial |
$175.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.75
|
| Rate for Payer: PHP Commercial |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health SBD |
$122.85
|
| Rate for Payer: UMR Bronson Commercial |
$72.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.25
|
|
|
HC LEAD REMOVAL DUAL
|
Facility
|
OP
|
$2,868.17
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
36100074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$614.61 |
| Max. Negotiated Rate |
$10,988.67 |
| Rate for Payer: Aetna American Axle |
$1,864.31
|
| Rate for Payer: Aetna Commercial |
$2,437.94
|
| Rate for Payer: Aetna Medicare |
$3,630.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,864.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,363.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,363.29
|
| Rate for Payer: BCBS Complete |
$2,005.02
|
| Rate for Payer: BCBS MAPPO |
$3,490.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,396.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,490.63
|
| Rate for Payer: Cash Price |
$2,294.54
|
| Rate for Payer: Cash Price |
$2,294.54
|
| Rate for Payer: Cofinity Commercial |
$2,466.63
|
| Rate for Payer: Cofinity Commercial |
$2,007.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,294.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,490.63
|
| Rate for Payer: Healthscope Commercial |
$2,581.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,007.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,151.13
|
| Rate for Payer: Mclaren Medicaid |
$1,909.37
|
| Rate for Payer: Mclaren Medicare |
$3,490.63
|
| Rate for Payer: Meridian Medicaid |
$2,005.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,665.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,014.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,437.94
|
| Rate for Payer: PACE Medicare |
$3,316.10
|
| Rate for Payer: PACE SWMI |
$3,490.63
|
| Rate for Payer: PHP Commercial |
$2,437.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,490.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,909.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,007.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,988.67
|
| Rate for Payer: Priority Health Medicare |
$3,490.63
|
| Rate for Payer: Priority Health Narrow Network |
$8,790.94
|
| Rate for Payer: Priority Health SBD |
$1,806.95
|
| Rate for Payer: Railroad Medicare Medicare |
$3,490.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$676.07
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,490.63
|
| Rate for Payer: UHC Exchange |
$614.61
|
| Rate for Payer: UHC Medicare Advantage |
$3,595.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,061.22
|
| Rate for Payer: VA VA |
$3,490.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,151.13
|
|
|
HC LEAD REMOVAL DUAL
|
Facility
|
IP
|
$2,868.17
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
36100074
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,261.99 |
| Max. Negotiated Rate |
$2,581.35 |
| Rate for Payer: Aetna American Axle |
$1,864.31
|
| Rate for Payer: Aetna Commercial |
$2,437.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,864.31
|
| Rate for Payer: Cash Price |
$2,294.54
|
| Rate for Payer: Cofinity Commercial |
$2,007.72
|
| Rate for Payer: Cofinity Commercial |
$2,466.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,294.54
|
| Rate for Payer: Healthscope Commercial |
$2,581.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,007.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,151.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,437.94
|
| Rate for Payer: PHP Commercial |
$2,437.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,007.72
|
| Rate for Payer: Priority Health SBD |
$1,806.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,261.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,151.13
|
|
|
HC LEAD REMOVAL SINGLE
|
Facility
|
IP
|
$3,632.23
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
36100073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,598.18 |
| Max. Negotiated Rate |
$3,269.01 |
| Rate for Payer: Aetna American Axle |
$2,360.95
|
| Rate for Payer: Aetna Commercial |
$3,087.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,360.95
|
| Rate for Payer: Cash Price |
$2,905.78
|
| Rate for Payer: Cofinity Commercial |
$2,542.56
|
| Rate for Payer: Cofinity Commercial |
$3,123.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,905.78
|
| Rate for Payer: Healthscope Commercial |
$3,269.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,542.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,724.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,087.40
|
| Rate for Payer: PHP Commercial |
$3,087.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,542.56
|
| Rate for Payer: Priority Health SBD |
$2,288.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,598.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,724.17
|
|
|
HC LEAD REMOVAL SINGLE
|
Facility
|
OP
|
$3,632.23
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
36100073
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.59 |
| Max. Negotiated Rate |
$10,988.67 |
| Rate for Payer: Aetna American Axle |
$2,360.95
|
| Rate for Payer: Aetna Commercial |
$3,087.40
|
| Rate for Payer: Aetna Medicare |
$3,630.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,360.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,363.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,363.29
|
| Rate for Payer: BCBS Complete |
$2,005.02
|
| Rate for Payer: BCBS MAPPO |
$3,490.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,054.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,490.63
|
| Rate for Payer: Cash Price |
$2,905.78
|
| Rate for Payer: Cash Price |
$2,905.78
|
| Rate for Payer: Cofinity Commercial |
$3,123.72
|
| Rate for Payer: Cofinity Commercial |
$2,542.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,905.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,490.63
|
| Rate for Payer: Healthscope Commercial |
$3,269.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,542.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,724.17
|
| Rate for Payer: Mclaren Medicaid |
$1,909.37
|
| Rate for Payer: Mclaren Medicare |
$3,490.63
|
| Rate for Payer: Meridian Medicaid |
$2,005.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,665.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,014.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,087.40
|
| Rate for Payer: PACE Medicare |
$3,316.10
|
| Rate for Payer: PACE SWMI |
$3,490.63
|
| Rate for Payer: PHP Commercial |
$3,087.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,490.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,909.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,542.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,988.67
|
| Rate for Payer: Priority Health Medicare |
$3,490.63
|
| Rate for Payer: Priority Health Narrow Network |
$8,790.94
|
| Rate for Payer: Priority Health SBD |
$2,288.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,490.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.35
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,490.63
|
| Rate for Payer: UHC Exchange |
$467.59
|
| Rate for Payer: UHC Medicare Advantage |
$3,595.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,343.93
|
| Rate for Payer: VA VA |
$3,490.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,724.17
|
|
|
HC LECITHIN-SPHINGOMYELIN
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 83661
|
| Hospital Charge Code |
30100634
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna American Axle |
$61.75
|
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health SBD |
$59.85
|
| Rate for Payer: UMR Bronson Commercial |
$41.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
HC LECITHIN-SPHINGOMYELIN
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 83661
|
| Hospital Charge Code |
30100634
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna American Axle |
$61.75
|
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Medicare |
$22.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.49
|
| Rate for Payer: BCBS Complete |
$12.63
|
| Rate for Payer: BCBS MAPPO |
$21.99
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Medicare Advantage |
$21.99
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.99
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Mclaren Medicaid |
$12.03
|
| Rate for Payer: Mclaren Medicare |
$21.99
|
| Rate for Payer: Meridian Medicaid |
$12.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PACE Medicare |
$20.89
|
| Rate for Payer: PACE SWMI |
$21.99
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: PHP Medicare Advantage |
$21.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.16
|
| Rate for Payer: Priority Health Medicare |
$21.99
|
| Rate for Payer: Priority Health Narrow Network |
$24.13
|
| Rate for Payer: Priority Health SBD |
$59.85
|
| Rate for Payer: Railroad Medicare Medicare |
$21.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.39
|
| Rate for Payer: UHC Core |
$36.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.99
|
| Rate for Payer: UHC Exchange |
$21.99
|
| Rate for Payer: UHC Medicare Advantage |
$22.65
|
| Rate for Payer: UMR Bronson Commercial |
$35.15
|
| Rate for Payer: VA VA |
$21.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
HC LEFT ATRIAL APPENDAGE CLOS WITH ENDOCARDIAL IMPLANT
|
Facility
|
OP
|
$28,917.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
48100112
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$747.88 |
| Max. Negotiated Rate |
$26,025.30 |
| Rate for Payer: Aetna American Axle |
$18,796.05
|
| Rate for Payer: Aetna Commercial |
$24,579.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,796.05
|
| Rate for Payer: BCBS Complete |
$11,566.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,797.25
|
| Rate for Payer: Cash Price |
$23,133.60
|
| Rate for Payer: Cash Price |
$23,133.60
|
| Rate for Payer: Cofinity Commercial |
$20,241.90
|
| Rate for Payer: Cofinity Commercial |
$24,868.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,133.60
|
| Rate for Payer: Healthscope Commercial |
$26,025.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,241.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,687.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,579.45
|
| Rate for Payer: PHP Commercial |
$24,579.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,241.90
|
| Rate for Payer: Priority Health SBD |
$18,217.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$822.67
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$747.88
|
| Rate for Payer: UMR Bronson Commercial |
$10,699.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,687.75
|
|
|
HC LEFT ATRIAL APPENDAGE CLOS WITH ENDOCARDIAL IMPLANT
|
Facility
|
IP
|
$28,917.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
48100112
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,723.48 |
| Max. Negotiated Rate |
$26,025.30 |
| Rate for Payer: Aetna American Axle |
$18,796.05
|
| Rate for Payer: Aetna Commercial |
$24,579.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,796.05
|
| Rate for Payer: Cash Price |
$23,133.60
|
| Rate for Payer: Cofinity Commercial |
$20,241.90
|
| Rate for Payer: Cofinity Commercial |
$24,868.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,133.60
|
| Rate for Payer: Healthscope Commercial |
$26,025.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20,241.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,687.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,579.45
|
| Rate for Payer: PHP Commercial |
$24,579.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,241.90
|
| Rate for Payer: Priority Health SBD |
$18,217.71
|
| Rate for Payer: UMR Bronson Commercial |
$12,723.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,687.75
|
|
