|
HC POUCH WOUND 1 X 1
|
Facility
|
OP
|
$30.45
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000623
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$51.92 |
| Rate for Payer: Aetna American Axle |
$19.79
|
| Rate for Payer: Aetna Commercial |
$25.88
|
| Rate for Payer: Aetna Medicare |
$15.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.79
|
| Rate for Payer: BCBS Complete |
$12.18
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$27.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.88
|
| Rate for Payer: PHP Commercial |
$25.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.79
|
| Rate for Payer: Priority Health SBD |
$19.18
|
| Rate for Payer: UMR Bronson Commercial |
$11.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.84
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna American Axle |
$25.87
|
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.87
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$27.86
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.87
|
| Rate for Payer: Priority Health SBD |
$25.07
|
| Rate for Payer: UMR Bronson Commercial |
$17.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.85
|
|
|
HC POUCH WOUND 2 X 3
|
Facility
|
OP
|
$39.80
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000622
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$51.92 |
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: Aetna American Axle |
$25.87
|
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: Aetna Medicare |
$19.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.87
|
| Rate for Payer: BCBS Complete |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$27.86
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.87
|
| Rate for Payer: Priority Health SBD |
$25.07
|
| Rate for Payer: UMR Bronson Commercial |
$14.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.85
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
IP
|
$56.73
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$51.06 |
| Rate for Payer: Aetna American Axle |
$36.87
|
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.87
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Cofinity Commercial |
$39.71
|
| Rate for Payer: Cofinity Commercial |
$48.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.38
|
| Rate for Payer: Healthscope Commercial |
$51.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.22
|
| Rate for Payer: PHP Commercial |
$48.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.87
|
| Rate for Payer: Priority Health SBD |
$35.74
|
| Rate for Payer: UMR Bronson Commercial |
$24.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.55
|
|
|
HC POUCH WOUND 6 X 4
|
Facility
|
OP
|
$56.73
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$51.92 |
| Rate for Payer: Aetna American Axle |
$36.87
|
| Rate for Payer: Aetna Commercial |
$48.22
|
| Rate for Payer: Aetna Medicare |
$28.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.87
|
| Rate for Payer: BCBS Complete |
$22.69
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Cofinity Commercial |
$39.71
|
| Rate for Payer: Cofinity Commercial |
$48.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.38
|
| Rate for Payer: Healthscope Commercial |
$51.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.22
|
| Rate for Payer: PHP Commercial |
$48.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.87
|
| Rate for Payer: Priority Health SBD |
$35.74
|
| Rate for Payer: UMR Bronson Commercial |
$20.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.55
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
IP
|
$102.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.14 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Aetna American Axle |
$66.69
|
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.69
|
| Rate for Payer: Cash Price |
$82.08
|
| Rate for Payer: Cofinity Commercial |
$71.82
|
| Rate for Payer: Cofinity Commercial |
$88.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.08
|
| Rate for Payer: Healthscope Commercial |
$92.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.21
|
| Rate for Payer: PHP Commercial |
$87.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.69
|
| Rate for Payer: Priority Health SBD |
$64.64
|
| Rate for Payer: UMR Bronson Commercial |
$45.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.95
|
|
|
HC POUCH WOUND 9 X 6
|
Facility
|
OP
|
$102.60
|
|
|
Service Code
|
HCPCS A6154
|
| Hospital Charge Code |
27000620
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$92.34 |
| Rate for Payer: Cash Price |
$82.08
|
| Rate for Payer: Cash Price |
$82.08
|
| Rate for Payer: Cofinity Commercial |
$71.82
|
| Rate for Payer: Cofinity Commercial |
$88.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.82
|
| Rate for Payer: Aetna American Axle |
$66.69
|
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: Aetna Medicare |
$51.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.69
|
| Rate for Payer: BCBS Complete |
$41.04
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCN Commercial |
$51.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.08
|
| Rate for Payer: Healthscope Commercial |
$92.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.21
|
| Rate for Payer: PHP Commercial |
$87.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.69
|
| Rate for Payer: Priority Health SBD |
$64.64
|
| Rate for Payer: UMR Bronson Commercial |
$37.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.95
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
IP
|
$19.99
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Cofinity Commercial |
$13.99
|
| Rate for Payer: Cofinity Commercial |
$17.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.99
|
| Rate for Payer: Aetna American Axle |
$12.99
|
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.99
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.99
|
| Rate for Payer: Healthscope Commercial |
$17.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.99
|
| Rate for Payer: PHP Commercial |
$16.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health SBD |
$12.59
|
| Rate for Payer: UMR Bronson Commercial |
$8.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.99
|
|
|
HC POWDER MICANOZOLE
|
Facility
|
OP
|
$19.99
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Aetna American Axle |
$12.99
|
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.99
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$13.99
|
| Rate for Payer: Cofinity Commercial |
$17.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.99
|
| Rate for Payer: Healthscope Commercial |
$17.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.99
|
| Rate for Payer: PHP Commercial |
$16.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health SBD |
$12.59
|
| Rate for Payer: UMR Bronson Commercial |
$7.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.99
|
|
|
HC POWDER OSTOMY
|
Facility
|
IP
|
$25.68
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Aetna American Axle |
$16.69
|
| Rate for Payer: Aetna Commercial |
$21.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.69
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$23.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.83
|
| Rate for Payer: PHP Commercial |
$21.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: Priority Health SBD |
$16.18
|
| Rate for Payer: UMR Bronson Commercial |
$11.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.26
|
|
|
HC POWDER OSTOMY
|
Facility
|
OP
|
$25.68
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$23.11 |
| Rate for Payer: Aetna American Axle |
$16.69
|
| Rate for Payer: Aetna Commercial |
$21.83
|
| Rate for Payer: Aetna Medicare |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.69
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Commercial |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$23.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.83
|
| Rate for Payer: PHP Commercial |
$21.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.69
|
| Rate for Payer: Priority Health SBD |
$16.18
|
| Rate for Payer: UMR Bronson Commercial |
$9.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.26
|
|
|
HC POWER CVC
|
Facility
|
IP
|
$552.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.19 |
| Max. Negotiated Rate |
$497.43 |
| Rate for Payer: Aetna American Axle |
$359.26
|
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.26
|
| Rate for Payer: Cash Price |
$442.16
|
| Rate for Payer: Cofinity Commercial |
$386.89
|
| Rate for Payer: Cofinity Commercial |
$475.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$386.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.16
|
| Rate for Payer: Healthscope Commercial |
$497.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$386.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.80
|
| Rate for Payer: PHP Commercial |
$469.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.26
|
| Rate for Payer: Priority Health SBD |
$348.20
|
| Rate for Payer: UMR Bronson Commercial |
$243.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.52
|
|
|
HC POWER CVC
|
Facility
|
OP
|
$552.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.50 |
| Max. Negotiated Rate |
$497.43 |
| Rate for Payer: Aetna American Axle |
$359.26
|
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna Medicare |
$276.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.26
|
| Rate for Payer: BCBS Complete |
$221.08
|
| Rate for Payer: Cash Price |
$442.16
|
| Rate for Payer: Cofinity Commercial |
$386.89
|
| Rate for Payer: Cofinity Commercial |
$475.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$386.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.16
|
| Rate for Payer: Healthscope Commercial |
$497.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$386.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.80
|
| Rate for Payer: PHP Commercial |
$469.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.26
|
| Rate for Payer: Priority Health SBD |
$348.20
|
| Rate for Payer: UMR Bronson Commercial |
$204.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.52
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
IP
|
$38.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$34.84 |
| Rate for Payer: Aetna American Axle |
$25.16
|
| Rate for Payer: Aetna Commercial |
$32.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.16
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$27.10
|
| Rate for Payer: Cofinity Commercial |
$33.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Healthscope Commercial |
$34.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: PHP Commercial |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health SBD |
$24.39
|
| Rate for Payer: UMR Bronson Commercial |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.03
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
OP
|
$38.71
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$34.84 |
| Rate for Payer: Aetna American Axle |
$25.16
|
| Rate for Payer: Aetna Commercial |
$32.90
|
| Rate for Payer: Aetna Medicare |
$19.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.16
|
| Rate for Payer: BCBS Complete |
$15.48
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$27.10
|
| Rate for Payer: Cofinity Commercial |
$33.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Healthscope Commercial |
$34.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: PHP Commercial |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health SBD |
$24.39
|
| Rate for Payer: UMR Bronson Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.03
|
|
|
HC POWERWAND CATHETER
|
Facility
|
IP
|
$537.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.71 |
| Max. Negotiated Rate |
$484.18 |
| Rate for Payer: Aetna American Axle |
$349.69
|
| Rate for Payer: Aetna Commercial |
$457.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.69
|
| Rate for Payer: Cash Price |
$430.38
|
| Rate for Payer: Cofinity Commercial |
$376.59
|
| Rate for Payer: Cofinity Commercial |
$462.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$376.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.38
|
| Rate for Payer: Healthscope Commercial |
$484.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$376.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.28
|
| Rate for Payer: PHP Commercial |
$457.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.69
|
| Rate for Payer: Priority Health SBD |
$338.93
|
| Rate for Payer: UMR Bronson Commercial |
$236.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.48
|
|
|
HC POWERWAND CATHETER
|
Facility
|
OP
|
$537.98
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.05 |
| Max. Negotiated Rate |
$484.18 |
| Rate for Payer: Aetna American Axle |
$349.69
|
| Rate for Payer: Aetna Commercial |
$457.28
|
| Rate for Payer: Aetna Medicare |
$268.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.69
|
| Rate for Payer: BCBS Complete |
$215.19
|
| Rate for Payer: Cash Price |
$430.38
|
| Rate for Payer: Cofinity Commercial |
$376.59
|
| Rate for Payer: Cofinity Commercial |
$462.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$376.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.38
|
| Rate for Payer: Healthscope Commercial |
$484.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$376.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.28
|
| Rate for Payer: PHP Commercial |
$457.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$349.69
|
| Rate for Payer: Priority Health SBD |
$338.93
|
| Rate for Payer: UMR Bronson Commercial |
$199.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.48
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
IP
|
$11,873.09
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,224.16 |
| Max. Negotiated Rate |
$10,685.78 |
| Rate for Payer: Aetna American Axle |
$7,717.51
|
| Rate for Payer: Aetna Commercial |
$10,092.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,717.51
|
| Rate for Payer: Cash Price |
$9,498.47
|
| Rate for Payer: Cofinity Commercial |
$10,210.86
|
| Rate for Payer: Cofinity Commercial |
$8,311.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,311.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,498.47
|
| Rate for Payer: Healthscope Commercial |
$10,685.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,311.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,904.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,092.13
|
| Rate for Payer: PHP Commercial |
$10,092.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,717.51
|
| Rate for Payer: Priority Health SBD |
$7,480.05
|
| Rate for Payer: UMR Bronson Commercial |
$5,224.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,904.82
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
OP
|
$11,873.09
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$434.64 |
| Max. Negotiated Rate |
$32,227.28 |
| Rate for Payer: Aetna American Axle |
$7,717.51
|
| Rate for Payer: Aetna Commercial |
$10,092.13
|
| Rate for Payer: Aetna Medicare |
$10,663.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,717.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,817.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,817.15
|
| Rate for Payer: BCBS Complete |
$5,770.79
|
| Rate for Payer: BCBS MAPPO |
$10,253.72
|
| Rate for Payer: BCBS Trust/PPO |
$14,037.77
|
| Rate for Payer: BCN Commercial |
$14,037.77
|
| Rate for Payer: BCN Medicare Advantage |
$10,253.72
|
| Rate for Payer: Cash Price |
$9,498.47
|
| Rate for Payer: Cash Price |
$9,498.47
|
| Rate for Payer: Cash Price |
$9,498.47
|
| Rate for Payer: Cofinity Commercial |
$8,311.16
|
| Rate for Payer: Cofinity Commercial |
$10,210.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,311.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,498.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,253.72
|
| Rate for Payer: Healthscope Commercial |
$10,685.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,311.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,904.82
|
| Rate for Payer: Mclaren Medicaid |
$5,495.99
|
| Rate for Payer: Mclaren Medicare |
$10,253.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,766.41
|
| Rate for Payer: Meridian Medicaid |
$5,770.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,791.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,092.13
|
| Rate for Payer: Nomi Health Commercial |
$21,532.81
|
| Rate for Payer: PACE Medicare |
$9,741.03
|
| Rate for Payer: PACE SWMI |
$10,253.72
|
| Rate for Payer: PHP Commercial |
$10,092.13
|
| Rate for Payer: PHP Medicare Advantage |
$10,253.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,495.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,717.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,227.28
|
| Rate for Payer: Priority Health Medicare |
$10,253.72
|
| Rate for Payer: Priority Health Narrow Network |
$25,781.82
|
| Rate for Payer: Priority Health SBD |
$7,480.05
|
| Rate for Payer: Railroad Medicare Medicare |
$10,253.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$478.10
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,253.72
|
| Rate for Payer: UHC Exchange |
$434.64
|
| Rate for Payer: UHC Medicare Advantage |
$10,253.72
|
| Rate for Payer: UHCCP Medicaid |
$5,495.99
|
| Rate for Payer: UMR Bronson Commercial |
$4,393.04
|
| Rate for Payer: VA VA |
$10,253.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,904.82
|
|
|
HC PPM SINGLE/V LEAD
|
Facility
|
OP
|
$13,060.39
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
36100058
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$458.22 |
| Max. Negotiated Rate |
$32,227.28 |
| Rate for Payer: Aetna American Axle |
$8,489.25
|
| Rate for Payer: Aetna Commercial |
$11,101.33
|
| Rate for Payer: Aetna Medicare |
$10,663.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,489.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,817.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,817.15
|
| Rate for Payer: BCBS Complete |
$5,770.79
|
| Rate for Payer: BCBS MAPPO |
$10,253.72
|
| Rate for Payer: BCBS Trust/PPO |
$12,923.87
|
| Rate for Payer: BCN Commercial |
$12,923.87
|
| Rate for Payer: BCN Medicare Advantage |
$10,253.72
|
| Rate for Payer: Cash Price |
$10,448.31
|
| Rate for Payer: Cash Price |
$10,448.31
|
| Rate for Payer: Cash Price |
$10,448.31
|
| Rate for Payer: Cofinity Commercial |
$9,142.27
|
| Rate for Payer: Cofinity Commercial |
$11,231.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,142.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,448.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,253.72
|
| Rate for Payer: Healthscope Commercial |
$11,754.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,142.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,795.29
|
| Rate for Payer: Mclaren Medicaid |
$5,495.99
|
| Rate for Payer: Mclaren Medicare |
$10,253.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,766.41
|
| Rate for Payer: Meridian Medicaid |
$5,770.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,791.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,101.33
|
| Rate for Payer: Nomi Health Commercial |
$21,532.81
|
| Rate for Payer: PACE Medicare |
$9,741.03
|
| Rate for Payer: PACE SWMI |
$10,253.72
|
| Rate for Payer: PHP Commercial |
$11,101.33
|
| Rate for Payer: PHP Medicare Advantage |
$10,253.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,495.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,489.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,227.28
|
| Rate for Payer: Priority Health Medicare |
$10,253.72
|
| Rate for Payer: Priority Health Narrow Network |
$25,781.82
|
| Rate for Payer: Priority Health SBD |
$8,228.05
|
| Rate for Payer: Railroad Medicare Medicare |
$10,253.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.04
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,253.72
|
| Rate for Payer: UHC Exchange |
$458.22
|
| Rate for Payer: UHC Medicare Advantage |
$10,253.72
|
| Rate for Payer: UHCCP Medicaid |
$5,495.99
|
| Rate for Payer: UMR Bronson Commercial |
$4,832.34
|
| Rate for Payer: VA VA |
$10,253.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,795.29
|
|
|
HC PPM SINGLE/V LEAD
|
Facility
|
IP
|
$13,060.39
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
36100058
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,746.57 |
| Max. Negotiated Rate |
$11,754.35 |
| Rate for Payer: Aetna American Axle |
$8,489.25
|
| Rate for Payer: Aetna Commercial |
$11,101.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,489.25
|
| Rate for Payer: Cash Price |
$10,448.31
|
| Rate for Payer: Cofinity Commercial |
$11,231.94
|
| Rate for Payer: Cofinity Commercial |
$9,142.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,142.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,448.31
|
| Rate for Payer: Healthscope Commercial |
$11,754.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,142.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,795.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,101.33
|
| Rate for Payer: PHP Commercial |
$11,101.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,489.25
|
| Rate for Payer: Priority Health SBD |
$8,228.05
|
| Rate for Payer: UMR Bronson Commercial |
$5,746.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,795.29
|
|
|
HC PPU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$4,092.00 |
| Rate for Payer: Aetna American Axle |
$94.30
|
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$103.16
|
| Rate for Payer: BCN Commercial |
$103.16
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
| Rate for Payer: UHC Core |
$4,092.00
|
| Rate for Payer: UMR Bronson Commercial |
$53.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC PPU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna American Axle |
$94.30
|
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
| Rate for Payer: UMR Bronson Commercial |
$63.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC PRADER WILLI MOL ANALYSIS
|
Facility
|
IP
|
$438.60
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
31000103
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$192.98 |
| Max. Negotiated Rate |
$394.74 |
| Rate for Payer: Aetna American Axle |
$285.09
|
| Rate for Payer: Aetna Commercial |
$372.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.09
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cofinity Commercial |
$307.02
|
| Rate for Payer: Cofinity Commercial |
$377.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.88
|
| Rate for Payer: Healthscope Commercial |
$394.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.81
|
| Rate for Payer: PHP Commercial |
$372.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.09
|
| Rate for Payer: Priority Health SBD |
$276.32
|
| Rate for Payer: UMR Bronson Commercial |
$192.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.95
|
|
|
HC PRADER WILLI MOL ANALYSIS
|
Facility
|
OP
|
$438.60
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
31000103
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$394.74 |
| Rate for Payer: Aetna American Axle |
$285.09
|
| Rate for Payer: Aetna Commercial |
$372.81
|
| Rate for Payer: Aetna Medicare |
$53.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.84
|
| Rate for Payer: BCBS Complete |
$28.74
|
| Rate for Payer: BCBS MAPPO |
$51.07
|
| Rate for Payer: BCBS Trust/PPO |
$49.20
|
| Rate for Payer: BCN Commercial |
$49.20
|
| Rate for Payer: BCN Medicare Advantage |
$51.07
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cofinity Commercial |
$377.20
|
| Rate for Payer: Cofinity Commercial |
$307.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$394.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.95
|
| Rate for Payer: Mclaren Medicaid |
$27.37
|
| Rate for Payer: Mclaren Medicare |
$51.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.62
|
| Rate for Payer: Meridian Medicaid |
$28.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.81
|
| Rate for Payer: Nomi Health Commercial |
$153.21
|
| Rate for Payer: PACE Medicare |
$48.52
|
| Rate for Payer: PACE SWMI |
$51.07
|
| Rate for Payer: PHP Commercial |
$372.81
|
| Rate for Payer: PHP Medicare Advantage |
$51.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.07
|
| Rate for Payer: Priority Health Medicare |
$51.07
|
| Rate for Payer: Priority Health Narrow Network |
$40.86
|
| Rate for Payer: Priority Health SBD |
$276.32
|
| Rate for Payer: Railroad Medicare Medicare |
$51.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.28
|
| Rate for Payer: UHC Core |
$199.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.07
|
| Rate for Payer: UHC Exchange |
$51.07
|
| Rate for Payer: UHC Medicare Advantage |
$51.07
|
| Rate for Payer: UHCCP Medicaid |
$27.37
|
| Rate for Payer: UMR Bronson Commercial |
$162.28
|
| Rate for Payer: VA VA |
$51.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.95
|
|
