|
HC PERIPH ARTERY DISEASE REHAB
|
Facility
|
OP
|
$103.24
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
94000006
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna American Axle |
$67.11
|
| Rate for Payer: Aetna Commercial |
$87.75
|
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.75
|
| Rate for Payer: BCN Commercial |
$17.75
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cofinity Commercial |
$72.27
|
| Rate for Payer: Cofinity Commercial |
$88.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Healthscope Commercial |
$92.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.43
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.75
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Commercial |
$87.75
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Priority Health SBD |
$65.04
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.53
|
| Rate for Payer: UHC Core |
$196.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$13.21
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: UMR Bronson Commercial |
$38.20
|
| Rate for Payer: VA VA |
$58.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.43
|
|
|
HC PERIPHERAL DIAGNOSTIC CATHETER
|
Facility
|
IP
|
$283.83
|
|
| Hospital Charge Code |
27200145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.89 |
| Max. Negotiated Rate |
$255.45 |
| Rate for Payer: Aetna American Axle |
$184.49
|
| Rate for Payer: Aetna Commercial |
$241.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.49
|
| Rate for Payer: Cash Price |
$227.06
|
| Rate for Payer: Cofinity Commercial |
$198.68
|
| Rate for Payer: Cofinity Commercial |
$244.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.06
|
| Rate for Payer: Healthscope Commercial |
$255.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.26
|
| Rate for Payer: PHP Commercial |
$241.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.49
|
| Rate for Payer: Priority Health SBD |
$178.81
|
| Rate for Payer: UMR Bronson Commercial |
$124.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.87
|
|
|
HC PERIPHERAL DIAGNOSTIC CATHETER
|
Facility
|
OP
|
$283.83
|
|
| Hospital Charge Code |
27200145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.02 |
| Max. Negotiated Rate |
$255.45 |
| Rate for Payer: Aetna American Axle |
$184.49
|
| Rate for Payer: Aetna Commercial |
$241.26
|
| Rate for Payer: Aetna Medicare |
$141.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.49
|
| Rate for Payer: BCBS Complete |
$113.53
|
| Rate for Payer: Cash Price |
$227.06
|
| Rate for Payer: Cofinity Commercial |
$198.68
|
| Rate for Payer: Cofinity Commercial |
$244.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.06
|
| Rate for Payer: Healthscope Commercial |
$255.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.26
|
| Rate for Payer: PHP Commercial |
$241.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.49
|
| Rate for Payer: Priority Health SBD |
$178.81
|
| Rate for Payer: UMR Bronson Commercial |
$105.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.87
|
|
|
HC PERIPHERAL INTRODUCER
|
Facility
|
IP
|
$684.29
|
|
| Hospital Charge Code |
27200146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.09 |
| Max. Negotiated Rate |
$615.86 |
| Rate for Payer: Aetna American Axle |
$444.79
|
| Rate for Payer: Aetna Commercial |
$581.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.79
|
| Rate for Payer: Cash Price |
$547.43
|
| Rate for Payer: Cofinity Commercial |
$479.00
|
| Rate for Payer: Cofinity Commercial |
$588.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$479.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.43
|
| Rate for Payer: Healthscope Commercial |
$615.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$479.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.65
|
| Rate for Payer: PHP Commercial |
$581.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.79
|
| Rate for Payer: Priority Health SBD |
$431.10
|
| Rate for Payer: UMR Bronson Commercial |
$301.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.22
|
|
|
HC PERIPHERAL INTRODUCER
|
Facility
|
OP
|
$684.29
|
|
| Hospital Charge Code |
27200146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.19 |
| Max. Negotiated Rate |
$615.86 |
| Rate for Payer: Aetna American Axle |
$444.79
|
| Rate for Payer: Aetna Commercial |
$581.65
|
| Rate for Payer: Aetna Medicare |
$342.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.79
|
| Rate for Payer: BCBS Complete |
$273.72
|
| Rate for Payer: Cash Price |
$547.43
|
| Rate for Payer: Cofinity Commercial |
$479.00
|
| Rate for Payer: Cofinity Commercial |
$588.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$479.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.43
|
| Rate for Payer: Healthscope Commercial |
$615.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$479.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.65
|
| Rate for Payer: PHP Commercial |
$581.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.79
|
| Rate for Payer: Priority Health SBD |
$431.10
|
| Rate for Payer: UMR Bronson Commercial |
$253.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.22
|
|
|
HC PERITONEAL DIALYSIS
|
Facility
|
IP
|
$957.03
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
83000001
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$421.09 |
| Max. Negotiated Rate |
$861.33 |
| Rate for Payer: Aetna American Axle |
$622.07
|
| Rate for Payer: Aetna Commercial |
$813.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.07
|
| Rate for Payer: Cash Price |
$765.62
|
| Rate for Payer: Cofinity Commercial |
$669.92
|
| Rate for Payer: Cofinity Commercial |
$823.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$669.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$765.62
|
| Rate for Payer: Healthscope Commercial |
$861.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$669.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$717.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.48
|
| Rate for Payer: PHP Commercial |
$813.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.07
|
| Rate for Payer: Priority Health SBD |
$602.93
|
| Rate for Payer: UMR Bronson Commercial |
$421.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$717.77
|
|
|
HC PERITONEAL DIALYSIS
|
Facility
|
OP
|
$957.03
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
83000001
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$81.17 |
| Max. Negotiated Rate |
$1,311.28 |
| Rate for Payer: Aetna American Axle |
$622.07
|
| Rate for Payer: Aetna Commercial |
$813.48
|
| Rate for Payer: Aetna Medicare |
$433.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$521.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$521.51
|
| Rate for Payer: BCBS Complete |
$234.81
|
| Rate for Payer: BCBS MAPPO |
$417.21
|
| Rate for Payer: BCN Medicare Advantage |
$417.21
|
| Rate for Payer: Cash Price |
$765.62
|
| Rate for Payer: Cash Price |
$765.62
|
| Rate for Payer: Cofinity Commercial |
$823.05
|
| Rate for Payer: Cofinity Commercial |
$669.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$669.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$765.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$417.21
|
| Rate for Payer: Healthscope Commercial |
$861.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$669.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$717.77
|
| Rate for Payer: Mclaren Medicaid |
$223.62
|
| Rate for Payer: Mclaren Medicare |
$417.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.07
|
| Rate for Payer: Meridian Medicaid |
$234.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813.48
|
| Rate for Payer: Nomi Health Commercial |
$1,251.63
|
| Rate for Payer: PACE Medicare |
$396.35
|
| Rate for Payer: PACE SWMI |
$417.21
|
| Rate for Payer: PHP Commercial |
$813.48
|
| Rate for Payer: PHP Medicare Advantage |
$417.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,311.28
|
| Rate for Payer: Priority Health Medicare |
$417.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,049.02
|
| Rate for Payer: Priority Health SBD |
$602.93
|
| Rate for Payer: Railroad Medicare Medicare |
$417.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$417.21
|
| Rate for Payer: UHC Exchange |
$81.17
|
| Rate for Payer: UHC Medicare Advantage |
$417.21
|
| Rate for Payer: UHCCP Medicaid |
$223.62
|
| Rate for Payer: UMR Bronson Commercial |
$354.10
|
| Rate for Payer: VA VA |
$417.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$717.77
|
|
|
HC PERITONEAL LVG TRAY
|
Facility
|
IP
|
$707.40
|
|
| Hospital Charge Code |
27000135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$311.26 |
| Max. Negotiated Rate |
$636.66 |
| Rate for Payer: Aetna American Axle |
$459.81
|
| Rate for Payer: Aetna Commercial |
$601.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.81
|
| Rate for Payer: Cash Price |
$565.92
|
| Rate for Payer: Cofinity Commercial |
$495.18
|
| Rate for Payer: Cofinity Commercial |
$608.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$495.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.92
|
| Rate for Payer: Healthscope Commercial |
$636.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$495.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$530.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.29
|
| Rate for Payer: PHP Commercial |
$601.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.81
|
| Rate for Payer: Priority Health SBD |
$445.66
|
| Rate for Payer: UMR Bronson Commercial |
$311.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$530.55
|
|
|
HC PERITONEAL LVG TRAY
|
Facility
|
OP
|
$707.40
|
|
| Hospital Charge Code |
27000135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$261.74 |
| Max. Negotiated Rate |
$636.66 |
| Rate for Payer: Aetna American Axle |
$459.81
|
| Rate for Payer: Aetna Commercial |
$601.29
|
| Rate for Payer: Aetna Medicare |
$353.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.81
|
| Rate for Payer: BCBS Complete |
$282.96
|
| Rate for Payer: Cash Price |
$565.92
|
| Rate for Payer: Cofinity Commercial |
$495.18
|
| Rate for Payer: Cofinity Commercial |
$608.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$495.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.92
|
| Rate for Payer: Healthscope Commercial |
$636.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$495.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$530.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.29
|
| Rate for Payer: PHP Commercial |
$601.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.81
|
| Rate for Payer: Priority Health SBD |
$445.66
|
| Rate for Payer: UMR Bronson Commercial |
$261.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$530.55
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$568.67
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$250.21 |
| Max. Negotiated Rate |
$511.80 |
| Rate for Payer: Aetna American Axle |
$369.64
|
| Rate for Payer: Aetna Commercial |
$483.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.64
|
| Rate for Payer: Cash Price |
$454.94
|
| Rate for Payer: Cofinity Commercial |
$398.07
|
| Rate for Payer: Cofinity Commercial |
$489.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$398.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.94
|
| Rate for Payer: Healthscope Commercial |
$511.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$426.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.37
|
| Rate for Payer: PHP Commercial |
$483.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.64
|
| Rate for Payer: Priority Health SBD |
$358.26
|
| Rate for Payer: UMR Bronson Commercial |
$250.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$426.50
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$568.67
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
32000294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.41 |
| Max. Negotiated Rate |
$1,688.45 |
| Rate for Payer: Aetna American Axle |
$369.64
|
| Rate for Payer: Aetna Commercial |
$483.37
|
| Rate for Payer: Aetna Medicare |
$558.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$671.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$671.51
|
| Rate for Payer: BCBS Complete |
$302.34
|
| Rate for Payer: BCBS MAPPO |
$537.21
|
| Rate for Payer: BCBS Trust/PPO |
$675.22
|
| Rate for Payer: BCN Commercial |
$675.22
|
| Rate for Payer: BCN Medicare Advantage |
$537.21
|
| Rate for Payer: Cash Price |
$454.94
|
| Rate for Payer: Cash Price |
$454.94
|
| Rate for Payer: Cofinity Commercial |
$489.06
|
| Rate for Payer: Cofinity Commercial |
$398.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$398.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.21
|
| Rate for Payer: Healthscope Commercial |
$511.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$398.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$426.50
|
| Rate for Payer: Mclaren Medicaid |
$287.94
|
| Rate for Payer: Mclaren Medicare |
$537.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.07
|
| Rate for Payer: Meridian Medicaid |
$302.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$617.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.37
|
| Rate for Payer: Nomi Health Commercial |
$1,611.63
|
| Rate for Payer: PACE Medicare |
$510.35
|
| Rate for Payer: PACE SWMI |
$537.21
|
| Rate for Payer: PHP Commercial |
$483.37
|
| Rate for Payer: PHP Medicare Advantage |
$537.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$287.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,688.45
|
| Rate for Payer: Priority Health Medicare |
$537.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,350.76
|
| Rate for Payer: Priority Health SBD |
$358.26
|
| Rate for Payer: Railroad Medicare Medicare |
$537.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,512.19
|
| Rate for Payer: UHC Core |
$262.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.21
|
| Rate for Payer: UHC Exchange |
$1,026.66
|
| Rate for Payer: UHC Medicare Advantage |
$537.21
|
| Rate for Payer: UHCCP Medicaid |
$287.94
|
| Rate for Payer: UMR Bronson Commercial |
$210.41
|
| Rate for Payer: VA VA |
$537.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$426.50
|
|
|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
OP
|
$247.07
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.42 |
| Max. Negotiated Rate |
$222.36 |
| Rate for Payer: Aetna American Axle |
$160.60
|
| Rate for Payer: Aetna Commercial |
$210.01
|
| Rate for Payer: Aetna Medicare |
$123.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.60
|
| Rate for Payer: BCBS Complete |
$98.83
|
| Rate for Payer: Cash Price |
$197.66
|
| Rate for Payer: Cofinity Commercial |
$172.95
|
| Rate for Payer: Cofinity Commercial |
$212.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.66
|
| Rate for Payer: Healthscope Commercial |
$222.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.01
|
| Rate for Payer: PHP Commercial |
$210.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.60
|
| Rate for Payer: Priority Health SBD |
$155.65
|
| Rate for Payer: UMR Bronson Commercial |
$91.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.30
|
|
|
HC PERMANENT PACEMAKER INTRODUCER
|
Facility
|
IP
|
$247.07
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27200062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.71 |
| Max. Negotiated Rate |
$222.36 |
| Rate for Payer: Aetna American Axle |
$160.60
|
| Rate for Payer: Aetna Commercial |
$210.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.60
|
| Rate for Payer: Cash Price |
$197.66
|
| Rate for Payer: Cofinity Commercial |
$172.95
|
| Rate for Payer: Cofinity Commercial |
$212.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.66
|
| Rate for Payer: Healthscope Commercial |
$222.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.01
|
| Rate for Payer: PHP Commercial |
$210.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.60
|
| Rate for Payer: Priority Health SBD |
$155.65
|
| Rate for Payer: UMR Bronson Commercial |
$108.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.30
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
OP
|
$336.72
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$124.59 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Aetna American Axle |
$218.87
|
| Rate for Payer: Aetna Commercial |
$286.21
|
| Rate for Payer: Aetna Medicare |
$168.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.87
|
| Rate for Payer: BCBS Complete |
$134.69
|
| Rate for Payer: Cash Price |
$269.38
|
| Rate for Payer: Cofinity Commercial |
$235.70
|
| Rate for Payer: Cofinity Commercial |
$289.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.38
|
| Rate for Payer: Healthscope Commercial |
$303.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.21
|
| Rate for Payer: PHP Commercial |
$286.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.87
|
| Rate for Payer: Priority Health SBD |
$212.13
|
| Rate for Payer: UMR Bronson Commercial |
$124.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.54
|
|
|
HC PERMANENT PACEMAKER PACK
|
Facility
|
IP
|
$336.72
|
|
| Hospital Charge Code |
62200010
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.16 |
| Max. Negotiated Rate |
$303.05 |
| Rate for Payer: Aetna American Axle |
$218.87
|
| Rate for Payer: Aetna Commercial |
$286.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.87
|
| Rate for Payer: Cash Price |
$269.38
|
| Rate for Payer: Cofinity Commercial |
$235.70
|
| Rate for Payer: Cofinity Commercial |
$289.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.38
|
| Rate for Payer: Healthscope Commercial |
$303.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.21
|
| Rate for Payer: PHP Commercial |
$286.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.87
|
| Rate for Payer: Priority Health SBD |
$212.13
|
| Rate for Payer: UMR Bronson Commercial |
$148.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.54
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Mclaren Medicaid |
$8.08
|
| Rate for Payer: Mclaren Medicare |
$15.08
|
| Rate for Payer: Aetna American Axle |
$30.43
|
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$15.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.85
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$15.08
|
| Rate for Payer: BCBS Trust/PPO |
$14.53
|
| Rate for Payer: BCN Commercial |
$14.53
|
| Rate for Payer: BCN Medicare Advantage |
$15.08
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.08
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.83
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$22.62
|
| Rate for Payer: PACE Medicare |
$14.33
|
| Rate for Payer: PACE SWMI |
$15.08
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$15.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.51
|
| Rate for Payer: Priority Health Medicare |
$15.08
|
| Rate for Payer: Priority Health Narrow Network |
$12.41
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: Railroad Medicare Medicare |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.10
|
| Rate for Payer: UHC Core |
$28.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.08
|
| Rate for Payer: UHC Exchange |
$15.08
|
| Rate for Payer: UHC Medicare Advantage |
$15.08
|
| Rate for Payer: UHCCP Medicaid |
$8.08
|
| Rate for Payer: UMR Bronson Commercial |
$17.32
|
| Rate for Payer: VA VA |
$15.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC PERNICIOUS ANEMIA EVALUATION
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100186
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.60 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna American Axle |
$30.43
|
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: UMR Bronson Commercial |
$20.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
IP
|
$1,768.68
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$778.22 |
| Max. Negotiated Rate |
$1,591.81 |
| Rate for Payer: Aetna American Axle |
$1,149.64
|
| Rate for Payer: Aetna Commercial |
$1,503.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,149.64
|
| Rate for Payer: Cash Price |
$1,414.94
|
| Rate for Payer: Cofinity Commercial |
$1,238.08
|
| Rate for Payer: Cofinity Commercial |
$1,521.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,238.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,414.94
|
| Rate for Payer: Healthscope Commercial |
$1,591.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,238.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,326.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.38
|
| Rate for Payer: PHP Commercial |
$1,503.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.64
|
| Rate for Payer: Priority Health SBD |
$1,114.27
|
| Rate for Payer: UMR Bronson Commercial |
$778.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,326.51
|
|
|
HC PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Facility
|
OP
|
$1,768.68
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
36100616
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.65 |
| Max. Negotiated Rate |
$1,879.00 |
| Rate for Payer: Aetna American Axle |
$1,149.64
|
| Rate for Payer: Aetna Commercial |
$1,503.38
|
| Rate for Payer: Aetna Medicare |
$884.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,149.64
|
| Rate for Payer: BCBS Complete |
$707.47
|
| Rate for Payer: BCBS Trust/PPO |
$871.89
|
| Rate for Payer: BCN Commercial |
$871.89
|
| Rate for Payer: Cash Price |
$1,414.94
|
| Rate for Payer: Cash Price |
$1,414.94
|
| Rate for Payer: Cash Price |
$1,414.94
|
| Rate for Payer: Cofinity Commercial |
$1,521.06
|
| Rate for Payer: Cofinity Commercial |
$1,238.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,238.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,414.94
|
| Rate for Payer: Healthscope Commercial |
$1,591.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,238.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,326.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,503.38
|
| Rate for Payer: PHP Commercial |
$1,503.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.64
|
| Rate for Payer: Priority Health SBD |
$1,114.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.52
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$238.65
|
| Rate for Payer: UMR Bronson Commercial |
$654.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,326.51
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
OP
|
$443.03
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.50 |
| Max. Negotiated Rate |
$748.94 |
| Rate for Payer: Aetna American Axle |
$287.97
|
| Rate for Payer: Aetna Commercial |
$376.58
|
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$435.28
|
| Rate for Payer: BCN Commercial |
$435.28
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cofinity Commercial |
$381.01
|
| Rate for Payer: Cofinity Commercial |
$310.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$398.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.27
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.58
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$376.58
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Priority Health SBD |
$279.11
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.15
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$36.50
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$127.72
|
| Rate for Payer: UMR Bronson Commercial |
$163.92
|
| Rate for Payer: VA VA |
$238.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.27
|
|
|
HC PERQ REPLACE GTUBE NOT REQ REV GSTRST TRACT
|
Facility
|
IP
|
$443.03
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
76100320
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.93 |
| Max. Negotiated Rate |
$398.73 |
| Rate for Payer: Aetna American Axle |
$287.97
|
| Rate for Payer: Aetna Commercial |
$376.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.97
|
| Rate for Payer: Cash Price |
$354.42
|
| Rate for Payer: Cofinity Commercial |
$310.12
|
| Rate for Payer: Cofinity Commercial |
$381.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.42
|
| Rate for Payer: Healthscope Commercial |
$398.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.58
|
| Rate for Payer: PHP Commercial |
$376.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.97
|
| Rate for Payer: Priority Health SBD |
$279.11
|
| Rate for Payer: UMR Bronson Commercial |
$194.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.27
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
OP
|
$15,697.20
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$566.62 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna American Axle |
$10,203.18
|
| Rate for Payer: Aetna Commercial |
$13,342.62
|
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,203.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$566.62
|
| Rate for Payer: BCN Commercial |
$566.62
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cofinity Commercial |
$13,499.59
|
| Rate for Payer: Cofinity Commercial |
$10,988.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,988.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,557.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Healthscope Commercial |
$14,127.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,988.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,772.90
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,342.62
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Commercial |
$13,342.62
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,203.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Priority Health SBD |
$9,889.24
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.58
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$606.89
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$5,955.64
|
| Rate for Payer: UMR Bronson Commercial |
$5,807.96
|
| Rate for Payer: VA VA |
$11,111.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,772.90
|
|
|
HC PERQ TRLUML ANGIO/ATHERECT ONE ART/BRANCH
|
Facility
|
IP
|
$15,697.20
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,906.77 |
| Max. Negotiated Rate |
$14,127.48 |
| Rate for Payer: Aetna American Axle |
$10,203.18
|
| Rate for Payer: Aetna Commercial |
$13,342.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,203.18
|
| Rate for Payer: Cash Price |
$12,557.76
|
| Rate for Payer: Cofinity Commercial |
$10,988.04
|
| Rate for Payer: Cofinity Commercial |
$13,499.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,988.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,557.76
|
| Rate for Payer: Healthscope Commercial |
$14,127.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,988.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,772.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,342.62
|
| Rate for Payer: PHP Commercial |
$13,342.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,203.18
|
| Rate for Payer: Priority Health SBD |
$9,889.24
|
| Rate for Payer: UMR Bronson Commercial |
$6,906.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,772.90
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
IP
|
$16,989.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$7,475.16 |
| Max. Negotiated Rate |
$15,290.10 |
| Rate for Payer: Aetna American Axle |
$11,042.85
|
| Rate for Payer: Aetna Commercial |
$14,440.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,042.85
|
| Rate for Payer: Cash Price |
$13,591.20
|
| Rate for Payer: Cofinity Commercial |
$11,892.30
|
| Rate for Payer: Cofinity Commercial |
$14,610.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,892.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,591.20
|
| Rate for Payer: Healthscope Commercial |
$15,290.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,892.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,741.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,440.65
|
| Rate for Payer: PHP Commercial |
$14,440.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,042.85
|
| Rate for Payer: Priority Health SBD |
$10,703.07
|
| Rate for Payer: UMR Bronson Commercial |
$7,475.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,741.75
|
|
|
HC PERQ TRLUML CORONRY LITHOTRIPSY
|
Facility
|
OP
|
$16,989.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
48000402
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$138.47 |
| Max. Negotiated Rate |
$15,290.10 |
| Rate for Payer: Aetna American Axle |
$11,042.85
|
| Rate for Payer: Aetna Commercial |
$14,440.65
|
| Rate for Payer: Aetna Medicare |
$8,494.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,042.85
|
| Rate for Payer: BCBS Complete |
$6,795.60
|
| Rate for Payer: Cash Price |
$13,591.20
|
| Rate for Payer: Cash Price |
$13,591.20
|
| Rate for Payer: Cash Price |
$13,591.20
|
| Rate for Payer: Cofinity Commercial |
$14,610.54
|
| Rate for Payer: Cofinity Commercial |
$11,892.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,892.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,591.20
|
| Rate for Payer: Healthscope Commercial |
$15,290.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,892.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,741.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,440.65
|
| Rate for Payer: PHP Commercial |
$14,440.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,042.85
|
| Rate for Payer: Priority Health SBD |
$10,703.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.32
|
| Rate for Payer: UHC Core |
$816.00
|
| Rate for Payer: UHC Exchange |
$138.47
|
| Rate for Payer: UMR Bronson Commercial |
$6,285.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,741.75
|
|
