|
HC INTRO AORTA TRANSLUMBAR
|
Facility
|
OP
|
$3,745.44
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
36100621
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.44 |
| Max. Negotiated Rate |
$3,370.90 |
| Rate for Payer: Aetna American Axle |
$2,434.54
|
| Rate for Payer: Aetna Commercial |
$3,183.62
|
| Rate for Payer: Aetna Medicare |
$1,872.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,434.54
|
| Rate for Payer: BCBS Complete |
$1,498.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,760.01
|
| Rate for Payer: BCN Commercial |
$1,760.01
|
| Rate for Payer: Cash Price |
$2,996.35
|
| Rate for Payer: Cash Price |
$2,996.35
|
| Rate for Payer: Cash Price |
$2,996.35
|
| Rate for Payer: Cofinity Commercial |
$3,221.08
|
| Rate for Payer: Cofinity Commercial |
$2,621.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,621.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,996.35
|
| Rate for Payer: Healthscope Commercial |
$3,370.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,621.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,809.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,183.62
|
| Rate for Payer: PHP Commercial |
$3,183.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,434.54
|
| Rate for Payer: Priority Health SBD |
$2,359.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.18
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$117.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,385.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,809.08
|
|
|
HC INTRO AORTA TRANSLUMBAR
|
Facility
|
IP
|
$3,745.44
|
|
|
Service Code
|
CPT 36160
|
| Hospital Charge Code |
36100621
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,647.99 |
| Max. Negotiated Rate |
$3,370.90 |
| Rate for Payer: Aetna American Axle |
$2,434.54
|
| Rate for Payer: Aetna Commercial |
$3,183.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,434.54
|
| Rate for Payer: Cash Price |
$2,996.35
|
| Rate for Payer: Cofinity Commercial |
$2,621.81
|
| Rate for Payer: Cofinity Commercial |
$3,221.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,621.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,996.35
|
| Rate for Payer: Healthscope Commercial |
$3,370.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,621.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,809.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,183.62
|
| Rate for Payer: PHP Commercial |
$3,183.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,434.54
|
| Rate for Payer: Priority Health SBD |
$2,359.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,647.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,809.08
|
|
|
HC INTRODUCER
|
Facility
|
OP
|
$299.58
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$269.62 |
| Rate for Payer: Aetna American Axle |
$194.73
|
| Rate for Payer: Aetna Commercial |
$254.64
|
| Rate for Payer: Aetna Medicare |
$149.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.73
|
| Rate for Payer: BCBS Complete |
$119.83
|
| Rate for Payer: Cash Price |
$239.66
|
| Rate for Payer: Cofinity Commercial |
$209.71
|
| Rate for Payer: Cofinity Commercial |
$257.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.66
|
| Rate for Payer: Healthscope Commercial |
$269.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.64
|
| Rate for Payer: PHP Commercial |
$254.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.73
|
| Rate for Payer: Priority Health SBD |
$188.74
|
| Rate for Payer: UMR Bronson Commercial |
$110.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.68
|
|
|
HC INTRODUCER
|
Facility
|
IP
|
$299.58
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.82 |
| Max. Negotiated Rate |
$269.62 |
| Rate for Payer: Aetna American Axle |
$194.73
|
| Rate for Payer: Aetna Commercial |
$254.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.73
|
| Rate for Payer: Cash Price |
$239.66
|
| Rate for Payer: Cofinity Commercial |
$209.71
|
| Rate for Payer: Cofinity Commercial |
$257.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.66
|
| Rate for Payer: Healthscope Commercial |
$269.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.64
|
| Rate for Payer: PHP Commercial |
$254.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.73
|
| Rate for Payer: Priority Health SBD |
$188.74
|
| Rate for Payer: UMR Bronson Commercial |
$131.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.68
|
|
|
HC INTRODUCER LONG
|
Facility
|
IP
|
$254.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.17 |
| Max. Negotiated Rate |
$229.44 |
| Rate for Payer: Aetna American Axle |
$165.70
|
| Rate for Payer: Aetna Commercial |
$216.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.70
|
| Rate for Payer: Cash Price |
$203.94
|
| Rate for Payer: Cofinity Commercial |
$178.45
|
| Rate for Payer: Cofinity Commercial |
$219.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.94
|
| Rate for Payer: Healthscope Commercial |
$229.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.69
|
| Rate for Payer: PHP Commercial |
$216.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.70
|
| Rate for Payer: Priority Health SBD |
$160.61
|
| Rate for Payer: UMR Bronson Commercial |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.20
|
|
|
HC INTRODUCER LONG
|
Facility
|
OP
|
$254.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$229.44 |
| Rate for Payer: Aetna American Axle |
$165.70
|
| Rate for Payer: Aetna Commercial |
$216.69
|
| Rate for Payer: Aetna Medicare |
$127.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.70
|
| Rate for Payer: BCBS Complete |
$101.97
|
| Rate for Payer: Cash Price |
$203.94
|
| Rate for Payer: Cofinity Commercial |
$178.45
|
| Rate for Payer: Cofinity Commercial |
$219.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.94
|
| Rate for Payer: Healthscope Commercial |
$229.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.69
|
| Rate for Payer: PHP Commercial |
$216.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.70
|
| Rate for Payer: Priority Health SBD |
$160.61
|
| Rate for Payer: UMR Bronson Commercial |
$94.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.20
|
|
|
HC INTRODUCER REGULAR
|
Facility
|
OP
|
$94.68
|
|
|
Service Code
|
HCPCS C1893
|
| Hospital Charge Code |
27200051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$85.21 |
| Rate for Payer: Aetna American Axle |
$61.54
|
| Rate for Payer: Aetna Commercial |
$80.48
|
| Rate for Payer: Aetna Medicare |
$47.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.54
|
| Rate for Payer: BCBS Complete |
$37.87
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cofinity Commercial |
$66.28
|
| Rate for Payer: Cofinity Commercial |
$81.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.74
|
| Rate for Payer: Healthscope Commercial |
$85.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.48
|
| Rate for Payer: PHP Commercial |
$80.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.54
|
| Rate for Payer: Priority Health SBD |
$59.65
|
| Rate for Payer: UMR Bronson Commercial |
$35.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.01
|
|
|
HC INTRODUCER REGULAR
|
Facility
|
IP
|
$94.68
|
|
|
Service Code
|
HCPCS C1893
|
| Hospital Charge Code |
27200051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$85.21 |
| Rate for Payer: Aetna American Axle |
$61.54
|
| Rate for Payer: Aetna Commercial |
$80.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.54
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cofinity Commercial |
$66.28
|
| Rate for Payer: Cofinity Commercial |
$81.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.74
|
| Rate for Payer: Healthscope Commercial |
$85.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.48
|
| Rate for Payer: PHP Commercial |
$80.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.54
|
| Rate for Payer: Priority Health SBD |
$59.65
|
| Rate for Payer: UMR Bronson Commercial |
$41.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.01
|
|
|
HC INTRODUCTION OF URETRAL CATH VIA NEPHROSTOMY
|
Facility
|
OP
|
$3,457.60
|
|
|
Service Code
|
CPT 50553
|
| Hospital Charge Code |
36100246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$299.92 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna American Axle |
$2,247.44
|
| Rate for Payer: Aetna Commercial |
$2,938.96
|
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,247.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,710.51
|
| Rate for Payer: BCN Commercial |
$2,710.51
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Cash Price |
$2,766.08
|
| Rate for Payer: Cash Price |
$2,766.08
|
| Rate for Payer: Cash Price |
$2,766.08
|
| Rate for Payer: Cofinity Commercial |
$2,973.54
|
| Rate for Payer: Cofinity Commercial |
$2,420.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,420.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,766.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Healthscope Commercial |
$3,111.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,420.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,593.20
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,938.96
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Commercial |
$2,938.96
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,247.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Priority Health SBD |
$2,178.29
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.91
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$299.92
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,279.31
|
| Rate for Payer: VA VA |
$4,980.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,593.20
|
|
|
HC INTRODUCTION OF URETRAL CATH VIA NEPHROSTOMY
|
Facility
|
IP
|
$3,457.60
|
|
|
Service Code
|
CPT 50553
|
| Hospital Charge Code |
36100246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,521.34 |
| Max. Negotiated Rate |
$3,111.84 |
| Rate for Payer: Aetna American Axle |
$2,247.44
|
| Rate for Payer: Aetna Commercial |
$2,938.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,247.44
|
| Rate for Payer: Cash Price |
$2,766.08
|
| Rate for Payer: Cofinity Commercial |
$2,420.32
|
| Rate for Payer: Cofinity Commercial |
$2,973.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,420.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,766.08
|
| Rate for Payer: Healthscope Commercial |
$3,111.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,420.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,593.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,938.96
|
| Rate for Payer: PHP Commercial |
$2,938.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,247.44
|
| Rate for Payer: Priority Health SBD |
$2,178.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,521.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,593.20
|
|
|
HC INTRO SHEATH NON GUIDE LVL 1
|
Facility
|
OP
|
$41.77
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.45 |
| Max. Negotiated Rate |
$37.59 |
| Rate for Payer: Aetna American Axle |
$27.15
|
| Rate for Payer: Aetna Commercial |
$35.50
|
| Rate for Payer: Aetna Medicare |
$20.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.15
|
| Rate for Payer: BCBS Complete |
$16.71
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Cofinity Commercial |
$35.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.42
|
| Rate for Payer: Healthscope Commercial |
$37.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.50
|
| Rate for Payer: PHP Commercial |
$35.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.15
|
| Rate for Payer: Priority Health SBD |
$26.32
|
| Rate for Payer: UMR Bronson Commercial |
$15.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.33
|
|
|
HC INTRO SHEATH NON GUIDE LVL 1
|
Facility
|
IP
|
$41.77
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$37.59 |
| Rate for Payer: Aetna American Axle |
$27.15
|
| Rate for Payer: Aetna Commercial |
$35.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.15
|
| Rate for Payer: Cash Price |
$33.42
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Cofinity Commercial |
$35.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.42
|
| Rate for Payer: Healthscope Commercial |
$37.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.50
|
| Rate for Payer: PHP Commercial |
$35.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.15
|
| Rate for Payer: Priority Health SBD |
$26.32
|
| Rate for Payer: UMR Bronson Commercial |
$18.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.33
|
|
|
HC INTRO SHEATH NON GUIDE LVL 11
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.80 |
| Max. Negotiated Rate |
$1,075.50 |
| Rate for Payer: PHP Commercial |
$1,015.75
|
| Rate for Payer: Aetna American Axle |
$776.75
|
| Rate for Payer: Aetna Commercial |
$1,015.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.75
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cofinity Commercial |
$1,027.70
|
| Rate for Payer: Cofinity Commercial |
$836.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$836.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.00
|
| Rate for Payer: Healthscope Commercial |
$1,075.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$836.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$896.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,015.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$776.75
|
| Rate for Payer: Priority Health SBD |
$752.85
|
| Rate for Payer: UMR Bronson Commercial |
$525.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$896.25
|
|
|
HC INTRO SHEATH NON GUIDE LVL 11
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200322
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.15 |
| Max. Negotiated Rate |
$1,075.50 |
| Rate for Payer: Aetna American Axle |
$776.75
|
| Rate for Payer: Aetna Commercial |
$1,015.75
|
| Rate for Payer: Aetna Medicare |
$597.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.75
|
| Rate for Payer: BCBS Complete |
$478.00
|
| Rate for Payer: Cash Price |
$956.00
|
| Rate for Payer: Cofinity Commercial |
$1,027.70
|
| Rate for Payer: Cofinity Commercial |
$836.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$836.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.00
|
| Rate for Payer: Healthscope Commercial |
$1,075.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$836.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$896.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,015.75
|
| Rate for Payer: PHP Commercial |
$1,015.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$776.75
|
| Rate for Payer: Priority Health SBD |
$752.85
|
| Rate for Payer: UMR Bronson Commercial |
$442.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$896.25
|
|
|
HC INTRO SHEATH NON GUIDE LVL 2
|
Facility
|
IP
|
$162.30
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.41 |
| Max. Negotiated Rate |
$146.07 |
| Rate for Payer: Aetna American Axle |
$105.50
|
| Rate for Payer: Aetna Commercial |
$137.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.50
|
| Rate for Payer: Cash Price |
$129.84
|
| Rate for Payer: Cofinity Commercial |
$113.61
|
| Rate for Payer: Cofinity Commercial |
$139.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.84
|
| Rate for Payer: Healthscope Commercial |
$146.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.96
|
| Rate for Payer: PHP Commercial |
$137.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.50
|
| Rate for Payer: Priority Health SBD |
$102.25
|
| Rate for Payer: UMR Bronson Commercial |
$71.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.72
|
|
|
HC INTRO SHEATH NON GUIDE LVL 2
|
Facility
|
OP
|
$162.30
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.05 |
| Max. Negotiated Rate |
$146.07 |
| Rate for Payer: Aetna American Axle |
$105.50
|
| Rate for Payer: Aetna Commercial |
$137.96
|
| Rate for Payer: Aetna Medicare |
$81.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.50
|
| Rate for Payer: BCBS Complete |
$64.92
|
| Rate for Payer: Cash Price |
$129.84
|
| Rate for Payer: Cofinity Commercial |
$113.61
|
| Rate for Payer: Cofinity Commercial |
$139.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.84
|
| Rate for Payer: Healthscope Commercial |
$146.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.96
|
| Rate for Payer: PHP Commercial |
$137.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.50
|
| Rate for Payer: Priority Health SBD |
$102.25
|
| Rate for Payer: UMR Bronson Commercial |
$60.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.72
|
|
|
HC INTRO SHEATH NON GUIDE LVL 3
|
Facility
|
IP
|
$337.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200042
|
|
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 INTRO SHEATH NON GUIDE LVL 3
|
Facility
|
OP
|
$337.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200042
|
|
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 INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
OP
|
$485.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.51 |
| Max. Negotiated Rate |
$436.64 |
| Rate for Payer: Aetna American Axle |
$315.35
|
| Rate for Payer: Aetna Commercial |
$412.39
|
| Rate for Payer: Aetna Medicare |
$242.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.35
|
| Rate for Payer: BCBS Complete |
$194.06
|
| Rate for Payer: Cash Price |
$388.13
|
| Rate for Payer: Cofinity Commercial |
$339.61
|
| Rate for Payer: Cofinity Commercial |
$417.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.13
|
| Rate for Payer: Healthscope Commercial |
$436.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.39
|
| Rate for Payer: PHP Commercial |
$412.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.35
|
| Rate for Payer: Priority Health SBD |
$305.65
|
| Rate for Payer: UMR Bronson Commercial |
$179.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.87
|
|
|
HC INTRO SHEATH NON GUIDE LVL 4
|
Facility
|
IP
|
$485.16
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200277
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.47 |
| Max. Negotiated Rate |
$436.64 |
| Rate for Payer: PHP Commercial |
$412.39
|
| Rate for Payer: Aetna American Axle |
$315.35
|
| Rate for Payer: Aetna Commercial |
$412.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.35
|
| Rate for Payer: Cash Price |
$388.13
|
| Rate for Payer: Cofinity Commercial |
$339.61
|
| Rate for Payer: Cofinity Commercial |
$417.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$339.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.13
|
| Rate for Payer: Healthscope Commercial |
$436.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.35
|
| Rate for Payer: Priority Health SBD |
$305.65
|
| Rate for Payer: UMR Bronson Commercial |
$213.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.87
|
|
|
HC IODINE, S
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$25.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.14
|
| Rate for Payer: BCBS Complete |
$13.57
|
| Rate for Payer: BCBS MAPPO |
$24.11
|
| Rate for Payer: BCBS Trust/PPO |
$23.23
|
| Rate for Payer: BCN Commercial |
$23.23
|
| Rate for Payer: BCN Medicare Advantage |
$24.11
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.11
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$12.92
|
| Rate for Payer: Mclaren Medicare |
$24.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.32
|
| Rate for Payer: Meridian Medicaid |
$13.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$36.16
|
| Rate for Payer: PACE Medicare |
$22.90
|
| Rate for Payer: PACE SWMI |
$24.11
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$24.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.11
|
| Rate for Payer: Priority Health Medicare |
$24.11
|
| Rate for Payer: Priority Health Narrow Network |
$19.29
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$24.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.11
|
| Rate for Payer: UHC Exchange |
$24.11
|
| Rate for Payer: UHC Medicare Advantage |
$24.11
|
| Rate for Payer: UHCCP Medicaid |
$12.92
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: VA VA |
$24.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.82
|
|
|
HC IODINE, S
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
30100687
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UMR Bronson Commercial |
$27.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.82
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
OP
|
$5,436.63
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$743.98 |
| Max. Negotiated Rate |
$4,892.97 |
| Rate for Payer: Aetna American Axle |
$3,533.81
|
| Rate for Payer: Aetna Commercial |
$4,621.14
|
| Rate for Payer: Aetna Medicare |
$1,443.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,533.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,735.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,735.02
|
| Rate for Payer: BCBS Complete |
$781.18
|
| Rate for Payer: BCBS MAPPO |
$1,388.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,465.06
|
| Rate for Payer: BCN Commercial |
$1,465.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,388.02
|
| Rate for Payer: Cash Price |
$4,349.30
|
| Rate for Payer: Cash Price |
$4,349.30
|
| Rate for Payer: Cofinity Commercial |
$4,675.50
|
| Rate for Payer: Cofinity Commercial |
$3,805.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,805.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,349.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,388.02
|
| Rate for Payer: Healthscope Commercial |
$4,892.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,805.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,077.47
|
| Rate for Payer: Mclaren Medicaid |
$743.98
|
| Rate for Payer: Mclaren Medicare |
$1,388.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,457.42
|
| Rate for Payer: Meridian Medicaid |
$781.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,596.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,621.14
|
| Rate for Payer: Nomi Health Commercial |
$4,164.06
|
| Rate for Payer: PACE Medicare |
$1,318.62
|
| Rate for Payer: PACE SWMI |
$1,388.02
|
| Rate for Payer: PHP Commercial |
$4,621.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,388.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$743.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,533.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,994.75
|
| Rate for Payer: Priority Health Medicare |
$1,388.02
|
| Rate for Payer: Priority Health Narrow Network |
$3,195.80
|
| Rate for Payer: Priority Health SBD |
$3,425.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,388.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,907.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,388.02
|
| Rate for Payer: UHC Exchange |
$2,652.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,388.02
|
| Rate for Payer: UHCCP Medicaid |
$743.98
|
| Rate for Payer: UMR Bronson Commercial |
$2,011.55
|
| Rate for Payer: VA VA |
$1,388.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,077.47
|
|
|
HC IOFLUPANE I-123 PER STUDY
|
Facility
|
IP
|
$5,436.63
|
|
|
Service Code
|
HCPCS A9584
|
| Hospital Charge Code |
34300035
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2,392.12 |
| Max. Negotiated Rate |
$4,892.97 |
| Rate for Payer: Aetna American Axle |
$3,533.81
|
| Rate for Payer: Aetna Commercial |
$4,621.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,533.81
|
| Rate for Payer: Cash Price |
$4,349.30
|
| Rate for Payer: Cofinity Commercial |
$3,805.64
|
| Rate for Payer: Cofinity Commercial |
$4,675.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,805.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,349.30
|
| Rate for Payer: Healthscope Commercial |
$4,892.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,805.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,077.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,621.14
|
| Rate for Payer: PHP Commercial |
$4,621.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,533.81
|
| Rate for Payer: Priority Health SBD |
$3,425.08
|
| Rate for Payer: UMR Bronson Commercial |
$2,392.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,077.47
|
|
|
HC IOM EEG CAROTID ENDARTERECTOMY
|
Facility
|
IP
|
$1,297.89
|
|
|
Service Code
|
CPT 95955
|
| Hospital Charge Code |
74000014
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$571.07 |
| Max. Negotiated Rate |
$1,168.10 |
| Rate for Payer: Aetna American Axle |
$843.63
|
| Rate for Payer: Aetna Commercial |
$1,103.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$843.63
|
| Rate for Payer: Cash Price |
$1,038.31
|
| Rate for Payer: Cofinity Commercial |
$1,116.19
|
| Rate for Payer: Cofinity Commercial |
$908.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$908.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,038.31
|
| Rate for Payer: Healthscope Commercial |
$1,168.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$908.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$973.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,103.21
|
| Rate for Payer: PHP Commercial |
$1,103.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.63
|
| Rate for Payer: Priority Health SBD |
$817.67
|
| Rate for Payer: UMR Bronson Commercial |
$571.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$973.42
|
|
