|
HC STATLOCK
|
Facility
|
IP
|
$140.87
|
|
| Hospital Charge Code |
27000152
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.98 |
| Max. Negotiated Rate |
$126.78 |
| Rate for Payer: Aetna American Axle |
$91.57
|
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.57
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$121.15
|
| Rate for Payer: Cofinity Commercial |
$98.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.70
|
| Rate for Payer: Healthscope Commercial |
$126.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.74
|
| Rate for Payer: PHP Commercial |
$119.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.61
|
| Rate for Payer: Priority Health SBD |
$88.75
|
| Rate for Payer: UMR Bronson Commercial |
$61.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.65
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna American Axle |
$22.10
|
| Rate for Payer: Aetna Commercial |
$28.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.10
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.90
|
| Rate for Payer: PHP Commercial |
$28.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: Priority Health SBD |
$21.42
|
| Rate for Payer: UMR Bronson Commercial |
$14.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.50
|
|
|
HC STENGER TEST PURE TONE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
76100500
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$22.10
|
| Rate for Payer: Aetna Commercial |
$28.90
|
| Rate for Payer: Aetna Medicare |
$56.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.96
|
| Rate for Payer: BCBS Complete |
$31.23
|
| Rate for Payer: BCBS MAPPO |
$54.37
|
| Rate for Payer: BCBS Trust/PPO |
$98.86
|
| Rate for Payer: BCN Medicare Advantage |
$54.37
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.37
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.50
|
| Rate for Payer: Mclaren Medicaid |
$29.74
|
| Rate for Payer: Mclaren Medicare |
$54.37
|
| Rate for Payer: Meridian Medicaid |
$31.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.90
|
| Rate for Payer: PACE Medicare |
$51.65
|
| Rate for Payer: PACE SWMI |
$54.37
|
| Rate for Payer: PHP Commercial |
$28.90
|
| Rate for Payer: PHP Medicare Advantage |
$54.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.15
|
| Rate for Payer: Priority Health Medicare |
$54.37
|
| Rate for Payer: Priority Health Narrow Network |
$136.92
|
| Rate for Payer: Priority Health SBD |
$21.42
|
| Rate for Payer: Railroad Medicare Medicare |
$54.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.69
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.37
|
| Rate for Payer: UHC Exchange |
$20.63
|
| Rate for Payer: UHC Medicare Advantage |
$56.00
|
| Rate for Payer: UMR Bronson Commercial |
$12.58
|
| Rate for Payer: VA VA |
$54.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.50
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
IP
|
$1,421.00
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$625.24 |
| Max. Negotiated Rate |
$1,278.90 |
| Rate for Payer: Aetna American Axle |
$923.65
|
| Rate for Payer: Aetna Commercial |
$1,207.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.65
|
| Rate for Payer: Cash Price |
$1,136.80
|
| Rate for Payer: Cofinity Commercial |
$1,222.06
|
| Rate for Payer: Cofinity Commercial |
$994.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.80
|
| Rate for Payer: Healthscope Commercial |
$1,278.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.85
|
| Rate for Payer: PHP Commercial |
$1,207.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.70
|
| Rate for Payer: Priority Health SBD |
$895.23
|
| Rate for Payer: UMR Bronson Commercial |
$625.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.75
|
|
|
HC STENGER TEST SPEECH
|
Facility
|
OP
|
$1,421.00
|
|
|
Service Code
|
CPT 92577
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.61 |
| Max. Negotiated Rate |
$1,499.80 |
| Rate for Payer: Aetna American Axle |
$923.65
|
| Rate for Payer: Aetna Commercial |
$1,207.85
|
| Rate for Payer: Aetna Medicare |
$495.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$100.54
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$1,136.80
|
| Rate for Payer: Cash Price |
$1,136.80
|
| Rate for Payer: Cofinity Commercial |
$1,222.06
|
| Rate for Payer: Cofinity Commercial |
$994.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$1,278.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.75
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.85
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$1,207.85
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,499.80
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,199.84
|
| Rate for Payer: Priority Health SBD |
$895.23
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.42
|
| Rate for Payer: UHC Exchange |
$21.61
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: UMR Bronson Commercial |
$525.77
|
| Rate for Payer: VA VA |
$476.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.75
|
|
|
HC STENT
|
Facility
|
IP
|
$934.47
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.17 |
| Max. Negotiated Rate |
$841.02 |
| Rate for Payer: Aetna American Axle |
$607.41
|
| Rate for Payer: Aetna Commercial |
$794.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.41
|
| Rate for Payer: Cash Price |
$747.58
|
| Rate for Payer: Cofinity Commercial |
$654.13
|
| Rate for Payer: Cofinity Commercial |
$803.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.58
|
| Rate for Payer: Healthscope Commercial |
$841.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$654.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$700.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$794.30
|
| Rate for Payer: PHP Commercial |
$794.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$654.13
|
| Rate for Payer: Priority Health SBD |
$588.72
|
| Rate for Payer: UMR Bronson Commercial |
$411.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$700.85
|
|
|
HC STENT
|
Facility
|
OP
|
$934.47
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
27800030
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$345.75 |
| Max. Negotiated Rate |
$841.02 |
| Rate for Payer: Aetna American Axle |
$607.41
|
| Rate for Payer: Aetna Commercial |
$794.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.41
|
| Rate for Payer: BCBS Complete |
$373.79
|
| Rate for Payer: Cash Price |
$747.58
|
| Rate for Payer: Cofinity Commercial |
$654.13
|
| Rate for Payer: Cofinity Commercial |
$803.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.58
|
| Rate for Payer: Healthscope Commercial |
$841.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$654.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$700.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$794.30
|
| Rate for Payer: PHP Commercial |
$794.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$654.13
|
| Rate for Payer: Priority Health SBD |
$588.72
|
| Rate for Payer: UMR Bronson Commercial |
$345.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$700.85
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
IP
|
$16,677.03
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,337.89 |
| Max. Negotiated Rate |
$15,009.33 |
| Rate for Payer: Aetna American Axle |
$10,840.07
|
| Rate for Payer: Aetna Commercial |
$14,175.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,840.07
|
| Rate for Payer: Cash Price |
$13,341.62
|
| Rate for Payer: Cofinity Commercial |
$11,673.92
|
| Rate for Payer: Cofinity Commercial |
$14,342.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,341.62
|
| Rate for Payer: Healthscope Commercial |
$15,009.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,673.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,507.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,175.48
|
| Rate for Payer: PHP Commercial |
$14,175.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,673.92
|
| Rate for Payer: Priority Health SBD |
$10,506.53
|
| Rate for Payer: UMR Bronson Commercial |
$7,337.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,507.77
|
|
|
HC STENT ADD.BRANCH
|
Facility
|
OP
|
$16,677.03
|
|
|
Service Code
|
CPT 92929
|
| Hospital Charge Code |
48100074
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$566.93 |
| Max. Negotiated Rate |
$15,009.33 |
| Rate for Payer: Aetna American Axle |
$10,840.07
|
| Rate for Payer: Aetna Commercial |
$14,175.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,840.07
|
| Rate for Payer: BCBS Complete |
$6,670.81
|
| Rate for Payer: BCBS Trust/PPO |
$566.93
|
| Rate for Payer: Cash Price |
$13,341.62
|
| Rate for Payer: Cash Price |
$13,341.62
|
| Rate for Payer: Cofinity Commercial |
$11,673.92
|
| Rate for Payer: Cofinity Commercial |
$14,342.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,341.62
|
| Rate for Payer: Healthscope Commercial |
$15,009.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,673.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,507.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,175.48
|
| Rate for Payer: PHP Commercial |
$14,175.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,673.92
|
| Rate for Payer: Priority Health SBD |
$10,506.53
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UMR Bronson Commercial |
$6,170.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,507.77
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
OP
|
$11,642.46
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,307.71 |
| Max. Negotiated Rate |
$10,478.21 |
| Rate for Payer: Aetna American Axle |
$7,567.60
|
| Rate for Payer: Aetna Commercial |
$9,896.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,567.60
|
| Rate for Payer: BCBS Complete |
$4,656.98
|
| Rate for Payer: Cash Price |
$9,313.97
|
| Rate for Payer: Cofinity Commercial |
$10,012.52
|
| Rate for Payer: Cofinity Commercial |
$8,149.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,313.97
|
| Rate for Payer: Healthscope Commercial |
$10,478.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,149.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,731.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,896.09
|
| Rate for Payer: PHP Commercial |
$9,896.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,149.72
|
| Rate for Payer: Priority Health SBD |
$7,334.75
|
| Rate for Payer: UMR Bronson Commercial |
$4,307.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,731.84
|
|
|
HC STENT COATED W DELIVERY SYSTEM
|
Facility
|
IP
|
$11,642.46
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,122.68 |
| Max. Negotiated Rate |
$10,478.21 |
| Rate for Payer: Aetna American Axle |
$7,567.60
|
| Rate for Payer: Aetna Commercial |
$9,896.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,567.60
|
| Rate for Payer: Cash Price |
$9,313.97
|
| Rate for Payer: Cofinity Commercial |
$10,012.52
|
| Rate for Payer: Cofinity Commercial |
$8,149.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,313.97
|
| Rate for Payer: Healthscope Commercial |
$10,478.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,149.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,731.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,896.09
|
| Rate for Payer: PHP Commercial |
$9,896.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,149.72
|
| Rate for Payer: Priority Health SBD |
$7,334.75
|
| Rate for Payer: UMR Bronson Commercial |
$5,122.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,731.84
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
OP
|
$5,463.15
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.37 |
| Max. Negotiated Rate |
$4,916.84 |
| Rate for Payer: Aetna American Axle |
$3,551.05
|
| Rate for Payer: Aetna Commercial |
$4,643.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,551.05
|
| Rate for Payer: BCBS Complete |
$2,185.26
|
| Rate for Payer: Cash Price |
$4,370.52
|
| Rate for Payer: Cofinity Commercial |
$3,824.20
|
| Rate for Payer: Cofinity Commercial |
$4,698.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,370.52
|
| Rate for Payer: Healthscope Commercial |
$4,916.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,824.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,097.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,643.68
|
| Rate for Payer: PHP Commercial |
$4,643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,824.20
|
| Rate for Payer: Priority Health SBD |
$3,441.78
|
| Rate for Payer: UMR Bronson Commercial |
$2,021.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,097.36
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 12
|
Facility
|
IP
|
$5,463.15
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800096
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,403.79 |
| Max. Negotiated Rate |
$4,916.84 |
| Rate for Payer: Aetna American Axle |
$3,551.05
|
| Rate for Payer: Aetna Commercial |
$4,643.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,551.05
|
| Rate for Payer: Cash Price |
$4,370.52
|
| Rate for Payer: Cofinity Commercial |
$3,824.20
|
| Rate for Payer: Cofinity Commercial |
$4,698.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,370.52
|
| Rate for Payer: Healthscope Commercial |
$4,916.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,824.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,097.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,643.68
|
| Rate for Payer: PHP Commercial |
$4,643.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,824.20
|
| Rate for Payer: Priority Health SBD |
$3,441.78
|
| Rate for Payer: UMR Bronson Commercial |
$2,403.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,097.36
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
OP
|
$6,349.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,349.49 |
| Max. Negotiated Rate |
$5,714.98 |
| Rate for Payer: Aetna American Axle |
$4,127.49
|
| Rate for Payer: Aetna Commercial |
$5,397.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,127.49
|
| Rate for Payer: BCBS Complete |
$2,539.99
|
| Rate for Payer: Cash Price |
$5,079.98
|
| Rate for Payer: Cofinity Commercial |
$4,444.99
|
| Rate for Payer: Cofinity Commercial |
$5,460.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,079.98
|
| Rate for Payer: Healthscope Commercial |
$5,714.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,444.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,762.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,397.48
|
| Rate for Payer: PHP Commercial |
$5,397.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,444.99
|
| Rate for Payer: Priority Health SBD |
$4,000.49
|
| Rate for Payer: UMR Bronson Commercial |
$2,349.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,762.48
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 13
|
Facility
|
IP
|
$6,349.98
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,793.99 |
| Max. Negotiated Rate |
$5,714.98 |
| Rate for Payer: Aetna American Axle |
$4,127.49
|
| Rate for Payer: Aetna Commercial |
$5,397.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,127.49
|
| Rate for Payer: Cash Price |
$5,079.98
|
| Rate for Payer: Cofinity Commercial |
$4,444.99
|
| Rate for Payer: Cofinity Commercial |
$5,460.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,079.98
|
| Rate for Payer: Healthscope Commercial |
$5,714.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,444.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,762.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,397.48
|
| Rate for Payer: PHP Commercial |
$5,397.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,444.99
|
| Rate for Payer: Priority Health SBD |
$4,000.49
|
| Rate for Payer: UMR Bronson Commercial |
$2,793.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,762.48
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
OP
|
$8,602.78
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,183.03 |
| Max. Negotiated Rate |
$7,742.50 |
| Rate for Payer: Aetna American Axle |
$5,591.81
|
| Rate for Payer: Aetna Commercial |
$7,312.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,591.81
|
| Rate for Payer: BCBS Complete |
$3,441.11
|
| Rate for Payer: Cash Price |
$6,882.22
|
| Rate for Payer: Cofinity Commercial |
$6,021.95
|
| Rate for Payer: Cofinity Commercial |
$7,398.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,882.22
|
| Rate for Payer: Healthscope Commercial |
$7,742.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,021.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,452.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,312.36
|
| Rate for Payer: PHP Commercial |
$7,312.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,021.95
|
| Rate for Payer: Priority Health SBD |
$5,419.75
|
| Rate for Payer: UMR Bronson Commercial |
$3,183.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,452.08
|
|
|
HC STENT COATED W DELIVERY SYSTEM LVL 14
|
Facility
|
IP
|
$8,602.78
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,785.22 |
| Max. Negotiated Rate |
$7,742.50 |
| Rate for Payer: Aetna American Axle |
$5,591.81
|
| Rate for Payer: Aetna Commercial |
$7,312.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,591.81
|
| Rate for Payer: Cash Price |
$6,882.22
|
| Rate for Payer: Cofinity Commercial |
$6,021.95
|
| Rate for Payer: Cofinity Commercial |
$7,398.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,882.22
|
| Rate for Payer: Healthscope Commercial |
$7,742.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,021.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,452.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,312.36
|
| Rate for Payer: PHP Commercial |
$7,312.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,021.95
|
| Rate for Payer: Priority Health SBD |
$5,419.75
|
| Rate for Payer: UMR Bronson Commercial |
$3,785.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,452.08
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
OP
|
$2,767.74
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.06 |
| Max. Negotiated Rate |
$2,490.97 |
| Rate for Payer: Aetna American Axle |
$1,799.03
|
| Rate for Payer: Aetna Commercial |
$2,352.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,799.03
|
| Rate for Payer: BCBS Complete |
$1,107.10
|
| Rate for Payer: Cash Price |
$2,214.19
|
| Rate for Payer: Cofinity Commercial |
$1,937.42
|
| Rate for Payer: Cofinity Commercial |
$2,380.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,214.19
|
| Rate for Payer: Healthscope Commercial |
$2,490.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,937.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,075.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,352.58
|
| Rate for Payer: PHP Commercial |
$2,352.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,937.42
|
| Rate for Payer: Priority Health SBD |
$1,743.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,024.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,075.80
|
|
|
HC STENT NON COATED NON CVD NO DELIV SYS
|
Facility
|
IP
|
$2,767.74
|
|
|
Service Code
|
HCPCS C1877
|
| Hospital Charge Code |
27800083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,217.81 |
| Max. Negotiated Rate |
$2,490.97 |
| Rate for Payer: Aetna American Axle |
$1,799.03
|
| Rate for Payer: Aetna Commercial |
$2,352.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,799.03
|
| Rate for Payer: Cash Price |
$2,214.19
|
| Rate for Payer: Cofinity Commercial |
$1,937.42
|
| Rate for Payer: Cofinity Commercial |
$2,380.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,214.19
|
| Rate for Payer: Healthscope Commercial |
$2,490.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,937.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,075.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,352.58
|
| Rate for Payer: PHP Commercial |
$2,352.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,937.42
|
| Rate for Payer: Priority Health SBD |
$1,743.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,217.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,075.80
|
|
|
HC STENT NON-COATED W/DELIVERY SYS
|
Facility
|
OP
|
$4,962.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,835.94 |
| Max. Negotiated Rate |
$4,465.80 |
| Rate for Payer: Aetna American Axle |
$3,225.30
|
| Rate for Payer: Aetna Commercial |
$4,217.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,225.30
|
| Rate for Payer: BCBS Complete |
$1,984.80
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Commercial |
$3,473.40
|
| Rate for Payer: Cofinity Commercial |
$4,267.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Healthscope Commercial |
$4,465.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,473.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,721.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,217.70
|
| Rate for Payer: PHP Commercial |
$4,217.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,473.40
|
| Rate for Payer: Priority Health SBD |
$3,126.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,835.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,721.50
|
|
|
HC STENT NON-COATED W/DELIVERY SYS
|
Facility
|
IP
|
$4,962.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,183.28 |
| Max. Negotiated Rate |
$4,465.80 |
| Rate for Payer: Aetna American Axle |
$3,225.30
|
| Rate for Payer: Aetna Commercial |
$4,217.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,225.30
|
| Rate for Payer: Cash Price |
$3,969.60
|
| Rate for Payer: Cofinity Commercial |
$3,473.40
|
| Rate for Payer: Cofinity Commercial |
$4,267.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,969.60
|
| Rate for Payer: Healthscope Commercial |
$4,465.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,473.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,721.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,217.70
|
| Rate for Payer: PHP Commercial |
$4,217.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,473.40
|
| Rate for Payer: Priority Health SBD |
$3,126.06
|
| Rate for Payer: UMR Bronson Commercial |
$2,183.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,721.50
|
|
|
HC STENT NONCOATED W SYS LVL 19
|
Facility
|
OP
|
$19,625.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
27800145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,261.25 |
| Max. Negotiated Rate |
$17,662.50 |
| Rate for Payer: Aetna American Axle |
$12,756.25
|
| Rate for Payer: Aetna Commercial |
$16,681.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,756.25
|
| Rate for Payer: BCBS Complete |
$7,850.00
|
| Rate for Payer: Cash Price |
$15,700.00
|
| Rate for Payer: Cofinity Commercial |
$13,737.50
|
| Rate for Payer: Cofinity Commercial |
$16,877.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,700.00
|
| Rate for Payer: Healthscope Commercial |
$17,662.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,737.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,718.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,681.25
|
| Rate for Payer: PHP Commercial |
$16,681.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,737.50
|
| Rate for Payer: Priority Health SBD |
$12,363.75
|
| Rate for Payer: UMR Bronson Commercial |
$7,261.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,718.75
|
|
|
HC STENT NONCOATED W SYS LVL 19
|
Facility
|
IP
|
$19,625.00
|
|
|
Service Code
|
CPT C1876
|
| Hospital Charge Code |
27800145
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,635.00 |
| Max. Negotiated Rate |
$17,662.50 |
| Rate for Payer: Aetna American Axle |
$12,756.25
|
| Rate for Payer: Aetna Commercial |
$16,681.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,756.25
|
| Rate for Payer: Cash Price |
$15,700.00
|
| Rate for Payer: Cofinity Commercial |
$13,737.50
|
| Rate for Payer: Cofinity Commercial |
$16,877.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,700.00
|
| Rate for Payer: Healthscope Commercial |
$17,662.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,737.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,718.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16,681.25
|
| Rate for Payer: PHP Commercial |
$16,681.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,737.50
|
| Rate for Payer: Priority Health SBD |
$12,363.75
|
| Rate for Payer: UMR Bronson Commercial |
$8,635.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,718.75
|
|
|
HC STENT NON COATED W SYS LVL 5
|
Facility
|
IP
|
$1,420.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.09 |
| Max. Negotiated Rate |
$1,278.58 |
| Rate for Payer: Aetna American Axle |
$923.42
|
| Rate for Payer: Aetna Commercial |
$1,207.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.42
|
| Rate for Payer: Cash Price |
$1,136.52
|
| Rate for Payer: Cofinity Commercial |
$1,221.76
|
| Rate for Payer: Cofinity Commercial |
$994.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.52
|
| Rate for Payer: Healthscope Commercial |
$1,278.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.55
|
| Rate for Payer: PHP Commercial |
$1,207.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.46
|
| Rate for Payer: Priority Health SBD |
$895.01
|
| Rate for Payer: UMR Bronson Commercial |
$625.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.49
|
|
|
HC STENT NON COATED W SYS LVL 5
|
Facility
|
OP
|
$1,420.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.64 |
| Max. Negotiated Rate |
$1,278.58 |
| Rate for Payer: Aetna American Axle |
$923.42
|
| Rate for Payer: Aetna Commercial |
$1,207.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.42
|
| Rate for Payer: BCBS Complete |
$568.26
|
| Rate for Payer: Cash Price |
$1,136.52
|
| Rate for Payer: Cofinity Commercial |
$1,221.76
|
| Rate for Payer: Cofinity Commercial |
$994.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.52
|
| Rate for Payer: Healthscope Commercial |
$1,278.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,207.55
|
| Rate for Payer: PHP Commercial |
$1,207.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.46
|
| Rate for Payer: Priority Health SBD |
$895.01
|
| Rate for Payer: UMR Bronson Commercial |
$525.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.49
|
|
