|
HC GUIDEWIRE GLIDEWIRE LVL 14
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$649.00 |
| Max. Negotiated Rate |
$1,327.50 |
| Rate for Payer: Aetna American Axle |
$958.75
|
| Rate for Payer: Aetna Commercial |
$1,253.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$958.75
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cofinity Commercial |
$1,032.50
|
| Rate for Payer: Cofinity Commercial |
$1,268.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,032.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.00
|
| Rate for Payer: Healthscope Commercial |
$1,327.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,032.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,106.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,253.75
|
| Rate for Payer: PHP Commercial |
$1,253.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.75
|
| Rate for Payer: Priority Health SBD |
$929.25
|
| Rate for Payer: UMR Bronson Commercial |
$649.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,106.25
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 14
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$545.75 |
| Max. Negotiated Rate |
$1,327.50 |
| Rate for Payer: Aetna American Axle |
$958.75
|
| Rate for Payer: Aetna Commercial |
$1,253.75
|
| Rate for Payer: Aetna Medicare |
$737.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$958.75
|
| Rate for Payer: BCBS Complete |
$590.00
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cofinity Commercial |
$1,032.50
|
| Rate for Payer: Cofinity Commercial |
$1,268.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,032.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.00
|
| Rate for Payer: Healthscope Commercial |
$1,327.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,032.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,106.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,253.75
|
| Rate for Payer: PHP Commercial |
$1,253.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.75
|
| Rate for Payer: Priority Health SBD |
$929.25
|
| Rate for Payer: UMR Bronson Commercial |
$545.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,106.25
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 2
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.67 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna American Axle |
$101.44
|
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: UMR Bronson Commercial |
$68.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 2
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna American Axle |
$101.44
|
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: UMR Bronson Commercial |
$57.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 3
|
Facility
|
OP
|
$324.51
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.07 |
| Max. Negotiated Rate |
$292.06 |
| Rate for Payer: Aetna American Axle |
$210.93
|
| Rate for Payer: Aetna Commercial |
$275.83
|
| Rate for Payer: Aetna Medicare |
$162.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.93
|
| Rate for Payer: BCBS Complete |
$129.80
|
| Rate for Payer: Cash Price |
$259.61
|
| Rate for Payer: Cofinity Commercial |
$227.16
|
| Rate for Payer: Cofinity Commercial |
$279.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.61
|
| Rate for Payer: Healthscope Commercial |
$292.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.83
|
| Rate for Payer: PHP Commercial |
$275.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.93
|
| Rate for Payer: Priority Health SBD |
$204.44
|
| Rate for Payer: UMR Bronson Commercial |
$120.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.38
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL 3
|
Facility
|
IP
|
$324.51
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.78 |
| Max. Negotiated Rate |
$292.06 |
| Rate for Payer: Aetna American Axle |
$210.93
|
| Rate for Payer: Aetna Commercial |
$275.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.93
|
| Rate for Payer: Cash Price |
$259.61
|
| Rate for Payer: Cofinity Commercial |
$227.16
|
| Rate for Payer: Cofinity Commercial |
$279.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.61
|
| Rate for Payer: Healthscope Commercial |
$292.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.83
|
| Rate for Payer: PHP Commercial |
$275.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.93
|
| Rate for Payer: Priority Health SBD |
$204.44
|
| Rate for Payer: UMR Bronson Commercial |
$142.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.38
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL4
|
Facility
|
OP
|
$462.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.96 |
| Max. Negotiated Rate |
$415.85 |
| Rate for Payer: Aetna American Axle |
$300.34
|
| Rate for Payer: Aetna Commercial |
$392.75
|
| Rate for Payer: Aetna Medicare |
$231.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.34
|
| Rate for Payer: BCBS Complete |
$184.82
|
| Rate for Payer: Cash Price |
$369.65
|
| Rate for Payer: Cofinity Commercial |
$323.44
|
| Rate for Payer: Cofinity Commercial |
$397.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$323.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.65
|
| Rate for Payer: Healthscope Commercial |
$415.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.75
|
| Rate for Payer: PHP Commercial |
$392.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health SBD |
$291.10
|
| Rate for Payer: UMR Bronson Commercial |
$170.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.55
|
|
|
HC GUIDEWIRE GLIDEWIRE LVL4
|
Facility
|
IP
|
$462.06
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.31 |
| Max. Negotiated Rate |
$415.85 |
| Rate for Payer: Aetna American Axle |
$300.34
|
| Rate for Payer: Aetna Commercial |
$392.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.34
|
| Rate for Payer: Cash Price |
$369.65
|
| Rate for Payer: Cofinity Commercial |
$323.44
|
| Rate for Payer: Cofinity Commercial |
$397.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$323.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.65
|
| Rate for Payer: Healthscope Commercial |
$415.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.75
|
| Rate for Payer: PHP Commercial |
$392.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health SBD |
$291.10
|
| Rate for Payer: UMR Bronson Commercial |
$203.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.55
|
|
|
HC GUIDEWIRE GLIDWIRE LVL 5
|
Facility
|
OP
|
$671.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.51 |
| Max. Negotiated Rate |
$604.49 |
| Rate for Payer: Aetna American Axle |
$436.57
|
| Rate for Payer: Aetna Commercial |
$570.90
|
| Rate for Payer: Aetna Medicare |
$335.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.57
|
| Rate for Payer: BCBS Complete |
$268.66
|
| Rate for Payer: Cash Price |
$537.32
|
| Rate for Payer: Cofinity Commercial |
$470.15
|
| Rate for Payer: Cofinity Commercial |
$577.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$470.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.32
|
| Rate for Payer: Healthscope Commercial |
$604.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.90
|
| Rate for Payer: PHP Commercial |
$570.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.57
|
| Rate for Payer: Priority Health SBD |
$423.14
|
| Rate for Payer: UMR Bronson Commercial |
$248.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.74
|
|
|
HC GUIDEWIRE GLIDWIRE LVL 5
|
Facility
|
IP
|
$671.65
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$295.53 |
| Max. Negotiated Rate |
$604.49 |
| Rate for Payer: Aetna American Axle |
$436.57
|
| Rate for Payer: Aetna Commercial |
$570.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.57
|
| Rate for Payer: Cash Price |
$537.32
|
| Rate for Payer: Cofinity Commercial |
$470.15
|
| Rate for Payer: Cofinity Commercial |
$577.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$470.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$537.32
|
| Rate for Payer: Healthscope Commercial |
$604.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$470.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$503.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.90
|
| Rate for Payer: PHP Commercial |
$570.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.57
|
| Rate for Payer: Priority Health SBD |
$423.14
|
| Rate for Payer: UMR Bronson Commercial |
$295.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$503.74
|
|
|
HC GUIDING CATHETER LVL 1
|
Facility
|
OP
|
$43.89
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.24 |
| Max. Negotiated Rate |
$39.50 |
| Rate for Payer: Aetna American Axle |
$28.53
|
| Rate for Payer: Aetna Commercial |
$37.31
|
| Rate for Payer: Aetna Medicare |
$21.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.53
|
| Rate for Payer: BCBS Complete |
$17.56
|
| Rate for Payer: Cash Price |
$35.11
|
| Rate for Payer: Cofinity Commercial |
$30.72
|
| Rate for Payer: Cofinity Commercial |
$37.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.11
|
| Rate for Payer: Healthscope Commercial |
$39.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.31
|
| Rate for Payer: PHP Commercial |
$37.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.53
|
| Rate for Payer: Priority Health SBD |
$27.65
|
| Rate for Payer: UMR Bronson Commercial |
$16.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.92
|
|
|
HC GUIDING CATHETER LVL 1
|
Facility
|
IP
|
$43.89
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$39.50 |
| Rate for Payer: Aetna American Axle |
$28.53
|
| Rate for Payer: Aetna Commercial |
$37.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.53
|
| Rate for Payer: Cash Price |
$35.11
|
| Rate for Payer: Cofinity Commercial |
$30.72
|
| Rate for Payer: Cofinity Commercial |
$37.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.11
|
| Rate for Payer: Healthscope Commercial |
$39.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.31
|
| Rate for Payer: PHP Commercial |
$37.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.53
|
| Rate for Payer: Priority Health SBD |
$27.65
|
| Rate for Payer: UMR Bronson Commercial |
$19.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.92
|
|
|
HC GUIDING CATHETER LVL 17
|
Facility
|
OP
|
$1,789.01
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.93 |
| Max. Negotiated Rate |
$1,610.11 |
| Rate for Payer: Aetna American Axle |
$1,162.86
|
| Rate for Payer: Aetna Commercial |
$1,520.66
|
| Rate for Payer: Aetna Medicare |
$894.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,162.86
|
| Rate for Payer: BCBS Complete |
$715.60
|
| Rate for Payer: Cash Price |
$1,431.21
|
| Rate for Payer: Cofinity Commercial |
$1,252.31
|
| Rate for Payer: Cofinity Commercial |
$1,538.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,252.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,431.21
|
| Rate for Payer: Healthscope Commercial |
$1,610.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,252.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,341.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,520.66
|
| Rate for Payer: PHP Commercial |
$1,520.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.86
|
| Rate for Payer: Priority Health SBD |
$1,127.08
|
| Rate for Payer: UMR Bronson Commercial |
$661.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,341.76
|
|
|
HC GUIDING CATHETER LVL 17
|
Facility
|
IP
|
$1,789.01
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$787.16 |
| Max. Negotiated Rate |
$1,610.11 |
| Rate for Payer: Aetna American Axle |
$1,162.86
|
| Rate for Payer: Aetna Commercial |
$1,520.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,162.86
|
| Rate for Payer: Cash Price |
$1,431.21
|
| Rate for Payer: Cofinity Commercial |
$1,252.31
|
| Rate for Payer: Cofinity Commercial |
$1,538.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,252.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,431.21
|
| Rate for Payer: Healthscope Commercial |
$1,610.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,252.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,341.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,520.66
|
| Rate for Payer: PHP Commercial |
$1,520.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.86
|
| Rate for Payer: Priority Health SBD |
$1,127.08
|
| Rate for Payer: UMR Bronson Commercial |
$787.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,341.76
|
|
|
HC GUIDING CATHETER LVL19
|
Facility
|
OP
|
$1,978.37
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$732.00 |
| Max. Negotiated Rate |
$1,780.53 |
| Rate for Payer: Aetna American Axle |
$1,285.94
|
| Rate for Payer: Aetna Commercial |
$1,681.61
|
| Rate for Payer: Aetna Medicare |
$989.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,285.94
|
| Rate for Payer: BCBS Complete |
$791.35
|
| Rate for Payer: Cash Price |
$1,582.70
|
| Rate for Payer: Cofinity Commercial |
$1,384.86
|
| Rate for Payer: Cofinity Commercial |
$1,701.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,384.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.70
|
| Rate for Payer: Healthscope Commercial |
$1,780.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,384.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,483.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.61
|
| Rate for Payer: PHP Commercial |
$1,681.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.94
|
| Rate for Payer: Priority Health SBD |
$1,246.37
|
| Rate for Payer: UMR Bronson Commercial |
$732.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,483.78
|
|
|
HC GUIDING CATHETER LVL19
|
Facility
|
IP
|
$1,978.37
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.48 |
| Max. Negotiated Rate |
$1,780.53 |
| Rate for Payer: Aetna American Axle |
$1,285.94
|
| Rate for Payer: Aetna Commercial |
$1,681.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,285.94
|
| Rate for Payer: Cash Price |
$1,582.70
|
| Rate for Payer: Cofinity Commercial |
$1,384.86
|
| Rate for Payer: Cofinity Commercial |
$1,701.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,384.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.70
|
| Rate for Payer: Healthscope Commercial |
$1,780.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,384.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,483.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.61
|
| Rate for Payer: PHP Commercial |
$1,681.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.94
|
| Rate for Payer: Priority Health SBD |
$1,246.37
|
| Rate for Payer: UMR Bronson Commercial |
$870.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,483.78
|
|
|
HC GUIDING CATHETER LVL 2
|
Facility
|
OP
|
$285.99
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.82 |
| Max. Negotiated Rate |
$257.39 |
| Rate for Payer: Aetna American Axle |
$185.89
|
| Rate for Payer: Aetna Commercial |
$243.09
|
| Rate for Payer: Aetna Medicare |
$143.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.89
|
| Rate for Payer: BCBS Complete |
$114.40
|
| Rate for Payer: Cash Price |
$228.79
|
| Rate for Payer: Cofinity Commercial |
$200.19
|
| Rate for Payer: Cofinity Commercial |
$245.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.79
|
| Rate for Payer: Healthscope Commercial |
$257.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.09
|
| Rate for Payer: PHP Commercial |
$243.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.89
|
| Rate for Payer: Priority Health SBD |
$180.17
|
| Rate for Payer: UMR Bronson Commercial |
$105.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.49
|
|
|
HC GUIDING CATHETER LVL 2
|
Facility
|
IP
|
$285.99
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.84 |
| Max. Negotiated Rate |
$257.39 |
| Rate for Payer: Aetna American Axle |
$185.89
|
| Rate for Payer: Aetna Commercial |
$243.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.89
|
| Rate for Payer: Cash Price |
$228.79
|
| Rate for Payer: Cofinity Commercial |
$200.19
|
| Rate for Payer: Cofinity Commercial |
$245.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.79
|
| Rate for Payer: Healthscope Commercial |
$257.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.09
|
| Rate for Payer: PHP Commercial |
$243.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.89
|
| Rate for Payer: Priority Health SBD |
$180.17
|
| Rate for Payer: UMR Bronson Commercial |
$125.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.49
|
|
|
HC GUIDING CATHETER LVL 24
|
Facility
|
OP
|
$2,477.72
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$916.76 |
| Max. Negotiated Rate |
$2,229.95 |
| Rate for Payer: Aetna American Axle |
$1,610.52
|
| Rate for Payer: Aetna Commercial |
$2,106.06
|
| Rate for Payer: Aetna Medicare |
$1,238.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,610.52
|
| Rate for Payer: BCBS Complete |
$991.09
|
| Rate for Payer: Cash Price |
$1,982.18
|
| Rate for Payer: Cofinity Commercial |
$1,734.40
|
| Rate for Payer: Cofinity Commercial |
$2,130.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,734.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,982.18
|
| Rate for Payer: Healthscope Commercial |
$2,229.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,734.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,858.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,106.06
|
| Rate for Payer: PHP Commercial |
$2,106.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,610.52
|
| Rate for Payer: Priority Health SBD |
$1,560.96
|
| Rate for Payer: UMR Bronson Commercial |
$916.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,858.29
|
|
|
HC GUIDING CATHETER LVL 24
|
Facility
|
IP
|
$2,477.72
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,090.20 |
| Max. Negotiated Rate |
$2,229.95 |
| Rate for Payer: Aetna American Axle |
$1,610.52
|
| Rate for Payer: Aetna Commercial |
$2,106.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,610.52
|
| Rate for Payer: Cash Price |
$1,982.18
|
| Rate for Payer: Cofinity Commercial |
$1,734.40
|
| Rate for Payer: Cofinity Commercial |
$2,130.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,734.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,982.18
|
| Rate for Payer: Healthscope Commercial |
$2,229.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,734.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,858.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,106.06
|
| Rate for Payer: PHP Commercial |
$2,106.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,610.52
|
| Rate for Payer: Priority Health SBD |
$1,560.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,090.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,858.29
|
|
|
HC GUIDING CATHETER LVL 3
|
Facility
|
IP
|
$337.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$303.75 |
| Rate for Payer: Aetna American Axle |
$219.38
|
| Rate for Payer: Aetna Commercial |
$286.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.38
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Commercial |
$236.25
|
| Rate for Payer: Cofinity Commercial |
$290.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$303.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: PHP Commercial |
$286.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.38
|
| Rate for Payer: Priority Health SBD |
$212.62
|
| Rate for Payer: UMR Bronson Commercial |
$148.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.12
|
|
|
HC GUIDING CATHETER LVL 3
|
Facility
|
OP
|
$337.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.88 |
| Max. Negotiated Rate |
$303.75 |
| Rate for Payer: Aetna American Axle |
$219.38
|
| Rate for Payer: Aetna Commercial |
$286.88
|
| Rate for Payer: Aetna Medicare |
$168.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.38
|
| Rate for Payer: BCBS Complete |
$135.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cofinity Commercial |
$236.25
|
| Rate for Payer: Cofinity Commercial |
$290.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.00
|
| Rate for Payer: Healthscope Commercial |
$303.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.88
|
| Rate for Payer: PHP Commercial |
$286.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.38
|
| Rate for Payer: Priority Health SBD |
$212.62
|
| Rate for Payer: UMR Bronson Commercial |
$124.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.12
|
|
|
HC GUIDING CATHETER LVL 35
|
Facility
|
IP
|
$3,592.55
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,580.72 |
| Max. Negotiated Rate |
$3,233.30 |
| Rate for Payer: Aetna American Axle |
$2,335.16
|
| Rate for Payer: Aetna Commercial |
$3,053.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,335.16
|
| Rate for Payer: Cash Price |
$2,874.04
|
| Rate for Payer: Cofinity Commercial |
$2,514.78
|
| Rate for Payer: Cofinity Commercial |
$3,089.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,514.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,874.04
|
| Rate for Payer: Healthscope Commercial |
$3,233.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,514.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,694.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,053.67
|
| Rate for Payer: PHP Commercial |
$3,053.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,335.16
|
| Rate for Payer: Priority Health SBD |
$2,263.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,580.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,694.41
|
|
|
HC GUIDING CATHETER LVL 35
|
Facility
|
OP
|
$3,592.55
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27800061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.24 |
| Max. Negotiated Rate |
$3,233.30 |
| Rate for Payer: Aetna American Axle |
$2,335.16
|
| Rate for Payer: Aetna Commercial |
$3,053.67
|
| Rate for Payer: Aetna Medicare |
$1,796.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,335.16
|
| Rate for Payer: BCBS Complete |
$1,437.02
|
| Rate for Payer: Cash Price |
$2,874.04
|
| Rate for Payer: Cofinity Commercial |
$2,514.78
|
| Rate for Payer: Cofinity Commercial |
$3,089.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,514.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,874.04
|
| Rate for Payer: Healthscope Commercial |
$3,233.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,514.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,694.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,053.67
|
| Rate for Payer: PHP Commercial |
$3,053.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,335.16
|
| Rate for Payer: Priority Health SBD |
$2,263.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,329.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,694.41
|
|
|
HC GUIDING CATHETER LVL 4
|
Facility
|
IP
|
$490.52
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27200272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.83 |
| Max. Negotiated Rate |
$441.47 |
| Rate for Payer: Aetna American Axle |
$318.84
|
| Rate for Payer: Aetna Commercial |
$416.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.84
|
| Rate for Payer: Cash Price |
$392.42
|
| Rate for Payer: Cofinity Commercial |
$343.36
|
| Rate for Payer: Cofinity Commercial |
$421.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$343.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.42
|
| Rate for Payer: Healthscope Commercial |
$441.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$343.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.94
|
| Rate for Payer: PHP Commercial |
$416.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.84
|
| Rate for Payer: Priority Health SBD |
$309.03
|
| Rate for Payer: UMR Bronson Commercial |
$215.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.89
|
|
