|
HC PLACEMENT SELECTIVE ART ABOVE ARCH 3RD ORDER
|
Facility
|
IP
|
$845.54
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
36100108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$372.04 |
| Max. Negotiated Rate |
$760.99 |
| Rate for Payer: Aetna American Axle |
$549.60
|
| Rate for Payer: Aetna Commercial |
$718.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.60
|
| Rate for Payer: Cash Price |
$676.43
|
| Rate for Payer: Cofinity Commercial |
$591.88
|
| Rate for Payer: Cofinity Commercial |
$727.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$591.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.43
|
| Rate for Payer: Healthscope Commercial |
$760.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$591.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.71
|
| Rate for Payer: PHP Commercial |
$718.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.60
|
| Rate for Payer: Priority Health SBD |
$532.69
|
| Rate for Payer: UMR Bronson Commercial |
$372.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.15
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
IP
|
$1,122.86
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
36100109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$494.06 |
| Max. Negotiated Rate |
$1,010.57 |
| Rate for Payer: Aetna American Axle |
$729.86
|
| Rate for Payer: Aetna Commercial |
$954.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.86
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$786.00
|
| Rate for Payer: Cofinity Commercial |
$965.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$786.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Healthscope Commercial |
$1,010.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$786.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: PHP Commercial |
$954.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: Priority Health SBD |
$707.40
|
| Rate for Payer: UMR Bronson Commercial |
$494.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.14
|
|
|
HC PLACEMENT SELECTIVE ART ABOVE ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
OP
|
$1,122.86
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
36100109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$415.46 |
| Max. Negotiated Rate |
$1,010.57 |
| Rate for Payer: Aetna American Axle |
$729.86
|
| Rate for Payer: Aetna Commercial |
$954.43
|
| Rate for Payer: Aetna Medicare |
$561.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.86
|
| Rate for Payer: BCBS Complete |
$449.14
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$786.00
|
| Rate for Payer: Cofinity Commercial |
$965.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$786.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Healthscope Commercial |
$1,010.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$786.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: PHP Commercial |
$954.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: Priority Health SBD |
$707.40
|
| Rate for Payer: UMR Bronson Commercial |
$415.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.14
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH 3RD ORDER
|
Facility
|
IP
|
$10,446.83
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
36100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,596.61 |
| Max. Negotiated Rate |
$9,402.15 |
| Rate for Payer: Aetna American Axle |
$6,790.44
|
| Rate for Payer: Aetna Commercial |
$8,879.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,790.44
|
| Rate for Payer: Cash Price |
$8,357.46
|
| Rate for Payer: Cofinity Commercial |
$7,312.78
|
| Rate for Payer: Cofinity Commercial |
$8,984.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,312.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,357.46
|
| Rate for Payer: Healthscope Commercial |
$9,402.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,312.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,835.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,879.81
|
| Rate for Payer: PHP Commercial |
$8,879.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,790.44
|
| Rate for Payer: Priority Health SBD |
$6,581.50
|
| Rate for Payer: UMR Bronson Commercial |
$4,596.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,835.12
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH 3RD ORDER
|
Facility
|
OP
|
$10,446.83
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
36100112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,865.33 |
| Max. Negotiated Rate |
$9,402.15 |
| Rate for Payer: Aetna American Axle |
$6,790.44
|
| Rate for Payer: Aetna Commercial |
$8,879.81
|
| Rate for Payer: Aetna Medicare |
$5,223.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,790.44
|
| Rate for Payer: BCBS Complete |
$4,178.73
|
| Rate for Payer: Cash Price |
$8,357.46
|
| Rate for Payer: Cofinity Commercial |
$7,312.78
|
| Rate for Payer: Cofinity Commercial |
$8,984.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,312.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,357.46
|
| Rate for Payer: Healthscope Commercial |
$9,402.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,312.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,835.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,879.81
|
| Rate for Payer: PHP Commercial |
$8,879.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,790.44
|
| Rate for Payer: Priority Health SBD |
$6,581.50
|
| Rate for Payer: UMR Bronson Commercial |
$3,865.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,835.12
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
36100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$449.14 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna American Axle |
$663.51
|
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.51
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$714.55
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$714.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health SBD |
$643.09
|
| Rate for Payer: UMR Bronson Commercial |
$449.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
HC PLACEMENT SELECTIVE ART BELOW ARCH ADDL 2ND OR 3RD ORDER
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
36100113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$377.69 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna American Axle |
$663.51
|
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna Medicare |
$510.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.51
|
| Rate for Payer: BCBS Complete |
$408.31
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$714.55
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$714.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health SBD |
$643.09
|
| Rate for Payer: UMR Bronson Commercial |
$377.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
HC PLACEMENT SELECTIVE PULMONARY
|
Facility
|
IP
|
$930.40
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
36100100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.38 |
| Max. Negotiated Rate |
$837.36 |
| Rate for Payer: Aetna American Axle |
$604.76
|
| Rate for Payer: Aetna Commercial |
$790.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.76
|
| Rate for Payer: Cash Price |
$744.32
|
| Rate for Payer: Cofinity Commercial |
$651.28
|
| Rate for Payer: Cofinity Commercial |
$800.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$651.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$744.32
|
| Rate for Payer: Healthscope Commercial |
$837.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$651.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$697.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.84
|
| Rate for Payer: PHP Commercial |
$790.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.76
|
| Rate for Payer: Priority Health SBD |
$586.15
|
| Rate for Payer: UMR Bronson Commercial |
$409.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$697.80
|
|
|
HC PLACEMENT SELECTIVE PULMONARY
|
Facility
|
OP
|
$930.40
|
|
|
Service Code
|
CPT 36014
|
| Hospital Charge Code |
36100100
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$344.25 |
| Max. Negotiated Rate |
$837.36 |
| Rate for Payer: Aetna American Axle |
$604.76
|
| Rate for Payer: Aetna Commercial |
$790.84
|
| Rate for Payer: Aetna Medicare |
$465.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$604.76
|
| Rate for Payer: BCBS Complete |
$372.16
|
| Rate for Payer: Cash Price |
$744.32
|
| Rate for Payer: Cofinity Commercial |
$651.28
|
| Rate for Payer: Cofinity Commercial |
$800.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$651.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$744.32
|
| Rate for Payer: Healthscope Commercial |
$837.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$651.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$697.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.84
|
| Rate for Payer: PHP Commercial |
$790.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.76
|
| Rate for Payer: Priority Health SBD |
$586.15
|
| Rate for Payer: UMR Bronson Commercial |
$344.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$697.80
|
|
|
HC PLACEMENT SELECTIVE VENOUS 1ST ORDER
|
Facility
|
OP
|
$6,639.46
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
36100097
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,456.60 |
| Max. Negotiated Rate |
$5,975.51 |
| Rate for Payer: Aetna American Axle |
$4,315.65
|
| Rate for Payer: Aetna Commercial |
$5,643.54
|
| Rate for Payer: Aetna Medicare |
$3,319.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,315.65
|
| Rate for Payer: BCBS Complete |
$2,655.78
|
| Rate for Payer: Cash Price |
$5,311.57
|
| Rate for Payer: Cofinity Commercial |
$4,647.62
|
| Rate for Payer: Cofinity Commercial |
$5,709.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,647.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,311.57
|
| Rate for Payer: Healthscope Commercial |
$5,975.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,647.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,979.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,643.54
|
| Rate for Payer: PHP Commercial |
$5,643.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,315.65
|
| Rate for Payer: Priority Health SBD |
$4,182.86
|
| Rate for Payer: UMR Bronson Commercial |
$2,456.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,979.60
|
|
|
HC PLACEMENT SELECTIVE VENOUS 1ST ORDER
|
Facility
|
IP
|
$6,639.46
|
|
|
Service Code
|
CPT 36011
|
| Hospital Charge Code |
36100097
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,921.36 |
| Max. Negotiated Rate |
$5,975.51 |
| Rate for Payer: Aetna American Axle |
$4,315.65
|
| Rate for Payer: Aetna Commercial |
$5,643.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,315.65
|
| Rate for Payer: Cash Price |
$5,311.57
|
| Rate for Payer: Cofinity Commercial |
$4,647.62
|
| Rate for Payer: Cofinity Commercial |
$5,709.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,647.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,311.57
|
| Rate for Payer: Healthscope Commercial |
$5,975.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,647.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,979.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,643.54
|
| Rate for Payer: PHP Commercial |
$5,643.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,315.65
|
| Rate for Payer: Priority Health SBD |
$4,182.86
|
| Rate for Payer: UMR Bronson Commercial |
$2,921.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,979.60
|
|
|
HC PLACEMENT SELECTIVE VENOUS 2ND ORDER
|
Facility
|
IP
|
$5,517.84
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
36100098
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,427.85 |
| Max. Negotiated Rate |
$4,966.06 |
| Rate for Payer: Aetna American Axle |
$3,586.60
|
| Rate for Payer: Aetna Commercial |
$4,690.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,586.60
|
| Rate for Payer: Cash Price |
$4,414.27
|
| Rate for Payer: Cofinity Commercial |
$3,862.49
|
| Rate for Payer: Cofinity Commercial |
$4,745.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,862.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,414.27
|
| Rate for Payer: Healthscope Commercial |
$4,966.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,862.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,138.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,690.16
|
| Rate for Payer: PHP Commercial |
$4,690.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,586.60
|
| Rate for Payer: Priority Health SBD |
$3,476.24
|
| Rate for Payer: UMR Bronson Commercial |
$2,427.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,138.38
|
|
|
HC PLACEMENT SELECTIVE VENOUS 2ND ORDER
|
Facility
|
OP
|
$5,517.84
|
|
|
Service Code
|
CPT 36012
|
| Hospital Charge Code |
36100098
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,041.60 |
| Max. Negotiated Rate |
$4,966.06 |
| Rate for Payer: Aetna American Axle |
$3,586.60
|
| Rate for Payer: Aetna Commercial |
$4,690.16
|
| Rate for Payer: Aetna Medicare |
$2,758.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,586.60
|
| Rate for Payer: BCBS Complete |
$2,207.14
|
| Rate for Payer: Cash Price |
$4,414.27
|
| Rate for Payer: Cofinity Commercial |
$3,862.49
|
| Rate for Payer: Cofinity Commercial |
$4,745.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,862.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,414.27
|
| Rate for Payer: Healthscope Commercial |
$4,966.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,862.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,138.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,690.16
|
| Rate for Payer: PHP Commercial |
$4,690.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,586.60
|
| Rate for Payer: Priority Health SBD |
$3,476.24
|
| Rate for Payer: UMR Bronson Commercial |
$2,041.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,138.38
|
|
|
HC PLACE NEPHROSTOMY CATHETER
|
Facility
|
IP
|
$3,348.21
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
36100504
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,473.21 |
| Max. Negotiated Rate |
$3,013.39 |
| Rate for Payer: Aetna American Axle |
$2,176.34
|
| Rate for Payer: Aetna Commercial |
$2,845.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,176.34
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cofinity Commercial |
$2,343.75
|
| Rate for Payer: Cofinity Commercial |
$2,879.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,343.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.57
|
| Rate for Payer: Healthscope Commercial |
$3,013.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,343.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,511.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,845.98
|
| Rate for Payer: PHP Commercial |
$2,845.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.34
|
| Rate for Payer: Priority Health SBD |
$2,109.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,473.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,511.16
|
|
|
HC PLACE NEPHROSTOMY CATHETER
|
Facility
|
OP
|
$3,348.21
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
36100504
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna American Axle |
$2,176.34
|
| Rate for Payer: Aetna Commercial |
$2,845.98
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,176.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cofinity Commercial |
$2,879.46
|
| Rate for Payer: Cofinity Commercial |
$2,343.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,343.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$3,013.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,343.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,511.16
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,845.98
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,845.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.34
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$2,109.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,818.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,238.84
|
| Rate for Payer: VA VA |
$1,997.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,511.16
|
|
|
HC PLACE NEPHROURETERAL CATHETER
|
Facility
|
IP
|
$3,348.21
|
|
|
Service Code
|
CPT 50433
|
| Hospital Charge Code |
36100505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,473.21 |
| Max. Negotiated Rate |
$3,013.39 |
| Rate for Payer: Aetna American Axle |
$2,176.34
|
| Rate for Payer: Aetna Commercial |
$2,845.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,176.34
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cofinity Commercial |
$2,343.75
|
| Rate for Payer: Cofinity Commercial |
$2,879.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,343.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.57
|
| Rate for Payer: Healthscope Commercial |
$3,013.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,343.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,511.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,845.98
|
| Rate for Payer: PHP Commercial |
$2,845.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.34
|
| Rate for Payer: Priority Health SBD |
$2,109.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,473.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,511.16
|
|
|
HC PLACE NEPHROURETERAL CATHETER
|
Facility
|
OP
|
$3,348.21
|
|
|
Service Code
|
CPT 50433
|
| Hospital Charge Code |
36100505
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,238.84 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna American Axle |
$2,176.34
|
| Rate for Payer: Aetna Commercial |
$2,845.98
|
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,176.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cash Price |
$2,678.57
|
| Rate for Payer: Cofinity Commercial |
$2,879.46
|
| Rate for Payer: Cofinity Commercial |
$2,343.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,343.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,678.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Healthscope Commercial |
$3,013.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,343.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,511.16
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,845.98
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Commercial |
$2,845.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,176.34
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Priority Health SBD |
$2,109.37
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$6,428.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,238.84
|
| Rate for Payer: VA VA |
$3,363.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,511.16
|
|
|
HC PLACE SELECTIVE ART BELOW ARCH 1ST ORDER
|
Facility
|
IP
|
$8,589.97
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
36100474
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,779.59 |
| Max. Negotiated Rate |
$7,730.97 |
| Rate for Payer: Aetna American Axle |
$5,583.48
|
| Rate for Payer: Aetna Commercial |
$7,301.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,583.48
|
| Rate for Payer: Cash Price |
$6,871.98
|
| Rate for Payer: Cofinity Commercial |
$6,012.98
|
| Rate for Payer: Cofinity Commercial |
$7,387.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,012.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,871.98
|
| Rate for Payer: Healthscope Commercial |
$7,730.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,012.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,442.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,301.47
|
| Rate for Payer: PHP Commercial |
$7,301.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,583.48
|
| Rate for Payer: Priority Health SBD |
$5,411.68
|
| Rate for Payer: UMR Bronson Commercial |
$3,779.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,442.48
|
|
|
HC PLACE SELECTIVE ART BELOW ARCH 1ST ORDER
|
Facility
|
OP
|
$8,589.97
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
36100474
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,178.29 |
| Max. Negotiated Rate |
$7,730.97 |
| Rate for Payer: Aetna American Axle |
$5,583.48
|
| Rate for Payer: Aetna Commercial |
$7,301.47
|
| Rate for Payer: Aetna Medicare |
$4,294.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,583.48
|
| Rate for Payer: BCBS Complete |
$3,435.99
|
| Rate for Payer: Cash Price |
$6,871.98
|
| Rate for Payer: Cofinity Commercial |
$6,012.98
|
| Rate for Payer: Cofinity Commercial |
$7,387.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,012.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,871.98
|
| Rate for Payer: Healthscope Commercial |
$7,730.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,012.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,442.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,301.47
|
| Rate for Payer: PHP Commercial |
$7,301.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,583.48
|
| Rate for Payer: Priority Health SBD |
$5,411.68
|
| Rate for Payer: UMR Bronson Commercial |
$3,178.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,442.48
|
|
|
HC PLACE SELECTIVE ART BELOW ARCH 2ND ORDER
|
Facility
|
IP
|
$5,382.61
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
36100475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,368.35 |
| Max. Negotiated Rate |
$4,844.35 |
| Rate for Payer: Aetna American Axle |
$3,498.70
|
| Rate for Payer: Aetna Commercial |
$4,575.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,498.70
|
| Rate for Payer: Cash Price |
$4,306.09
|
| Rate for Payer: Cofinity Commercial |
$3,767.83
|
| Rate for Payer: Cofinity Commercial |
$4,629.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,767.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,306.09
|
| Rate for Payer: Healthscope Commercial |
$4,844.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,767.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,036.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,575.22
|
| Rate for Payer: PHP Commercial |
$4,575.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,498.70
|
| Rate for Payer: Priority Health SBD |
$3,391.04
|
| Rate for Payer: UMR Bronson Commercial |
$2,368.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,036.96
|
|
|
HC PLACE SELECTIVE ART BELOW ARCH 2ND ORDER
|
Facility
|
OP
|
$5,382.61
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
36100475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,991.57 |
| Max. Negotiated Rate |
$4,844.35 |
| Rate for Payer: Aetna American Axle |
$3,498.70
|
| Rate for Payer: Aetna Commercial |
$4,575.22
|
| Rate for Payer: Aetna Medicare |
$2,691.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,498.70
|
| Rate for Payer: BCBS Complete |
$2,153.04
|
| Rate for Payer: Cash Price |
$4,306.09
|
| Rate for Payer: Cofinity Commercial |
$3,767.83
|
| Rate for Payer: Cofinity Commercial |
$4,629.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,767.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,306.09
|
| Rate for Payer: Healthscope Commercial |
$4,844.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,767.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,036.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,575.22
|
| Rate for Payer: PHP Commercial |
$4,575.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,498.70
|
| Rate for Payer: Priority Health SBD |
$3,391.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,991.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,036.96
|
|
|
HC PLACE SOFT TISSUE LOCALIZATION DEVICE
|
Facility
|
IP
|
$740.52
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
36100486
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$325.83 |
| Max. Negotiated Rate |
$666.47 |
| Rate for Payer: Aetna American Axle |
$481.34
|
| Rate for Payer: Aetna Commercial |
$629.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.34
|
| Rate for Payer: Cash Price |
$592.42
|
| Rate for Payer: Cofinity Commercial |
$518.36
|
| Rate for Payer: Cofinity Commercial |
$636.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$518.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.42
|
| Rate for Payer: Healthscope Commercial |
$666.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$518.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.44
|
| Rate for Payer: PHP Commercial |
$629.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.34
|
| Rate for Payer: Priority Health SBD |
$466.53
|
| Rate for Payer: UMR Bronson Commercial |
$325.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.39
|
|
|
HC PLACE SOFT TISSUE LOCALIZATION DEVICE
|
Facility
|
OP
|
$740.52
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
36100486
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$273.99 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna American Axle |
$481.34
|
| Rate for Payer: Aetna Commercial |
$629.44
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$592.42
|
| Rate for Payer: Cash Price |
$592.42
|
| Rate for Payer: Cofinity Commercial |
$636.85
|
| Rate for Payer: Cofinity Commercial |
$518.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$518.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$666.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$518.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.39
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.44
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$629.44
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.34
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$466.53
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: UMR Bronson Commercial |
$273.99
|
| Rate for Payer: VA VA |
$686.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.39
|
|
|
HC PLACE SOFT TISSUE LOCALIZATION DEVICE EA ADDL LESION
|
Facility
|
IP
|
$421.54
|
|
|
Service Code
|
CPT 10036
|
| Hospital Charge Code |
36100487
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.48 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna American Axle |
$274.00
|
| Rate for Payer: Aetna Commercial |
$358.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.00
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$295.08
|
| Rate for Payer: Cofinity Commercial |
$362.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Healthscope Commercial |
$379.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: PHP Commercial |
$358.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: Priority Health SBD |
$265.57
|
| Rate for Payer: UMR Bronson Commercial |
$185.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.15
|
|
|
HC PLACE SOFT TISSUE LOCALIZATION DEVICE EA ADDL LESION
|
Facility
|
OP
|
$421.54
|
|
|
Service Code
|
CPT 10036
|
| Hospital Charge Code |
36100487
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.97 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna American Axle |
$274.00
|
| Rate for Payer: Aetna Commercial |
$358.31
|
| Rate for Payer: Aetna Medicare |
$210.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.00
|
| Rate for Payer: BCBS Complete |
$168.62
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$295.08
|
| Rate for Payer: Cofinity Commercial |
$362.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Healthscope Commercial |
$379.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: PHP Commercial |
$358.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: Priority Health SBD |
$265.57
|
| Rate for Payer: UMR Bronson Commercial |
$155.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.15
|
|
