|
HC THORACIC FASCIAL PLANE BLOCK UNILAT INJ
|
Facility
|
OP
|
$741.19
|
|
|
Service Code
|
CPT 64466
|
| Hospital Charge Code |
37000021
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$274.24 |
| Max. Negotiated Rate |
$667.07 |
| Rate for Payer: Aetna American Axle |
$481.77
|
| Rate for Payer: Aetna Commercial |
$630.01
|
| Rate for Payer: Aetna Medicare |
$370.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.77
|
| Rate for Payer: BCBS Complete |
$296.48
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cofinity Advantage |
$518.83
|
| Rate for Payer: Cofinity Commercial |
$637.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.95
|
| Rate for Payer: Healthscope Commercial |
$667.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$518.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$592.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.89
|
| Rate for Payer: PHP Commercial |
$630.01
|
| Rate for Payer: Priority Health SBD |
$466.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$481.77
|
| Rate for Payer: UHC Core |
$386.16
|
| Rate for Payer: UHC Exchange |
$291.29
|
| Rate for Payer: UMR Bronson Commercial |
$274.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.89
|
|
|
HC THORACIC FASCIAL PLANE BLOCK UNILAT INJ
|
Facility
|
IP
|
$741.19
|
|
|
Service Code
|
CPT 64466
|
| Hospital Charge Code |
37000021
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$326.12 |
| Max. Negotiated Rate |
$667.07 |
| Rate for Payer: Aetna American Axle |
$481.77
|
| Rate for Payer: Aetna Commercial |
$630.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.77
|
| Rate for Payer: Cash Price |
$592.95
|
| Rate for Payer: Cofinity Advantage |
$518.83
|
| Rate for Payer: Cofinity Commercial |
$637.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.95
|
| Rate for Payer: Healthscope Commercial |
$667.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$518.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.89
|
| Rate for Payer: PHP Commercial |
$630.01
|
| Rate for Payer: Priority Health SBD |
$466.95
|
| Rate for Payer: UMR Bronson Commercial |
$326.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.89
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$1,202.41 |
| Rate for Payer: Aetna American Axle |
$467.35
|
| Rate for Payer: Aetna Commercial |
$611.15
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$190.20
|
| Rate for Payer: BCN Commercial |
$190.20
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Advantage |
$503.30
|
| Rate for Payer: Cofinity Commercial |
$618.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$647.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$503.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$539.25
|
| Rate for Payer: Mclaren Medicaid |
$371.82
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.15
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.25
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$611.15
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$452.97
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.35
|
| Rate for Payer: UHC Core |
$374.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$282.57
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: UMR Bronson Commercial |
$266.03
|
| Rate for Payer: VA VA |
$371.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$539.25
|
|
|
HC THORACIC GAS/RAW
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
46000015
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$316.36 |
| Max. Negotiated Rate |
$647.10 |
| Rate for Payer: Aetna American Axle |
$467.35
|
| Rate for Payer: Aetna Commercial |
$611.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.35
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Advantage |
$503.30
|
| Rate for Payer: Cofinity Commercial |
$618.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.20
|
| Rate for Payer: Healthscope Commercial |
$647.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$503.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$539.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$539.25
|
| Rate for Payer: PHP Commercial |
$611.15
|
| Rate for Payer: Priority Health SBD |
$452.97
|
| Rate for Payer: UMR Bronson Commercial |
$316.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$539.25
|
|
|
HC THORACOTOMY
|
Facility
|
OP
|
$2,133.72
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$789.48 |
| Max. Negotiated Rate |
$1,920.35 |
| Rate for Payer: Aetna American Axle |
$1,386.92
|
| Rate for Payer: Aetna Commercial |
$1,813.66
|
| Rate for Payer: Aetna Medicare |
$1,066.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,386.92
|
| Rate for Payer: BCBS Complete |
$853.49
|
| Rate for Payer: Cash Price |
$1,706.98
|
| Rate for Payer: Cofinity Advantage |
$1,493.60
|
| Rate for Payer: Cofinity Commercial |
$1,835.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.98
|
| Rate for Payer: Healthscope Commercial |
$1,920.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,493.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,600.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,706.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,813.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,600.29
|
| Rate for Payer: PHP Commercial |
$1,813.66
|
| Rate for Payer: Priority Health SBD |
$1,344.24
|
| Rate for Payer: UMR Bronson Commercial |
$789.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,600.29
|
|
|
HC THORACOTOMY
|
Facility
|
IP
|
$2,133.72
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$938.84 |
| Max. Negotiated Rate |
$1,920.35 |
| Rate for Payer: Aetna American Axle |
$1,386.92
|
| Rate for Payer: Aetna Commercial |
$1,813.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,386.92
|
| Rate for Payer: Cash Price |
$1,706.98
|
| Rate for Payer: Cofinity Advantage |
$1,493.60
|
| Rate for Payer: Cofinity Commercial |
$1,835.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,706.98
|
| Rate for Payer: Healthscope Commercial |
$1,920.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,493.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,600.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,813.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,600.29
|
| Rate for Payer: PHP Commercial |
$1,813.66
|
| Rate for Payer: Priority Health SBD |
$1,344.24
|
| Rate for Payer: UMR Bronson Commercial |
$938.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,600.29
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
OP
|
$5,067.48
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,874.97 |
| Max. Negotiated Rate |
$4,560.73 |
| Rate for Payer: Aetna American Axle |
$3,293.86
|
| Rate for Payer: Aetna Commercial |
$4,307.36
|
| Rate for Payer: Aetna Medicare |
$2,533.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,293.86
|
| Rate for Payer: BCBS Complete |
$2,026.99
|
| Rate for Payer: BCBS Trust/PPO |
$3,475.59
|
| Rate for Payer: BCN Commercial |
$3,475.59
|
| Rate for Payer: Cash Price |
$4,053.98
|
| Rate for Payer: Cash Price |
$4,053.98
|
| Rate for Payer: Cash Price |
$4,053.98
|
| Rate for Payer: Cofinity Advantage |
$3,547.24
|
| Rate for Payer: Cofinity Commercial |
$4,358.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,053.98
|
| Rate for Payer: Healthscope Commercial |
$4,560.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,547.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,800.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,053.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,307.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,800.61
|
| Rate for Payer: PHP Commercial |
$4,307.36
|
| Rate for Payer: Priority Health SBD |
$3,192.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,874.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,800.61
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
IP
|
$5,067.48
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,229.69 |
| Max. Negotiated Rate |
$4,560.73 |
| Rate for Payer: Aetna American Axle |
$3,293.86
|
| Rate for Payer: Aetna Commercial |
$4,307.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,293.86
|
| Rate for Payer: Cash Price |
$4,053.98
|
| Rate for Payer: Cofinity Advantage |
$3,547.24
|
| Rate for Payer: Cofinity Commercial |
$4,358.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,053.98
|
| Rate for Payer: Healthscope Commercial |
$4,560.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,547.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,800.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,307.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,800.61
|
| Rate for Payer: PHP Commercial |
$4,307.36
|
| Rate for Payer: Priority Health SBD |
$3,192.51
|
| Rate for Payer: UMR Bronson Commercial |
$2,229.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,800.61
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$77.47
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.21
|
| Rate for Payer: BCBS Complete |
$3.17
|
| Rate for Payer: BCBS MAPPO |
$5.77
|
| Rate for Payer: BCBS Trust/PPO |
$6.67
|
| Rate for Payer: BCN Commercial |
$6.67
|
| Rate for Payer: BCN Medicare Advantage |
$5.77
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Advantage |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.77
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.10
|
| Rate for Payer: Mclaren Medicaid |
$5.77
|
| Rate for Payer: Mclaren Medicare |
$5.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.06
|
| Rate for Payer: Meridian Medicaid |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$8.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PACE Medicare |
$5.48
|
| Rate for Payer: PACE SWMI |
$5.77
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: PHP Medicare Advantage |
$5.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.77
|
| Rate for Payer: Priority Health Medicare |
$5.77
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: Priority Health Tiered Network |
$4.62
|
| Rate for Payer: Railroad Medicare Medicare |
$5.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.66
|
| Rate for Payer: UHC Core |
$8.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.77
|
| Rate for Payer: UHC Exchange |
$8.66
|
| Rate for Payer: UHC Medicaid |
$3.02
|
| Rate for Payer: UHCCP Medicaid |
$3.02
|
| Rate for Payer: UMR Bronson Commercial |
$28.66
|
| Rate for Payer: VA VA |
$5.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.10
|
|
|
HC THROMBIN TIME
|
Facility
|
IP
|
$77.47
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Advantage |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: UMR Bronson Commercial |
$34.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.10
|
|
|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
IP
|
$104.99
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$94.49 |
| Rate for Payer: Aetna American Axle |
$68.24
|
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.24
|
| Rate for Payer: Cash Price |
$83.99
|
| Rate for Payer: Cofinity Advantage |
$73.49
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.99
|
| Rate for Payer: Healthscope Commercial |
$94.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.74
|
| Rate for Payer: PHP Commercial |
$89.24
|
| Rate for Payer: Priority Health SBD |
$66.14
|
| Rate for Payer: UMR Bronson Commercial |
$46.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.74
|
|
|
HC THROMBO EMBO CATHETER LVL 1
|
Facility
|
OP
|
$104.99
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$94.49 |
| Rate for Payer: Aetna American Axle |
$68.24
|
| Rate for Payer: Aetna Commercial |
$89.24
|
| Rate for Payer: Aetna Medicare |
$52.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.24
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$83.99
|
| Rate for Payer: Cofinity Advantage |
$73.49
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.99
|
| Rate for Payer: Healthscope Commercial |
$94.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.74
|
| Rate for Payer: PHP Commercial |
$89.24
|
| Rate for Payer: Priority Health SBD |
$66.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.24
|
| Rate for Payer: UHC Core |
$54.70
|
| Rate for Payer: UHC Exchange |
$41.26
|
| Rate for Payer: UMR Bronson Commercial |
$38.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.74
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
OP
|
$1,044.23
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.37 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna American Axle |
$678.75
|
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: Aetna Medicare |
$522.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.75
|
| Rate for Payer: BCBS Complete |
$417.69
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Advantage |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$730.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$835.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.17
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health SBD |
$657.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.75
|
| Rate for Payer: UHC Core |
$544.04
|
| Rate for Payer: UHC Exchange |
$410.38
|
| Rate for Payer: UMR Bronson Commercial |
$386.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.17
|
|
|
HC THROMBO EMBO CATHETER LVL 10
|
Facility
|
IP
|
$1,044.23
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$459.46 |
| Max. Negotiated Rate |
$939.81 |
| Rate for Payer: Aetna American Axle |
$678.75
|
| Rate for Payer: Aetna Commercial |
$887.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.75
|
| Rate for Payer: Cash Price |
$835.38
|
| Rate for Payer: Cofinity Advantage |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.38
|
| Rate for Payer: Healthscope Commercial |
$939.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$730.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$887.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$783.17
|
| Rate for Payer: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health SBD |
$657.86
|
| Rate for Payer: UMR Bronson Commercial |
$459.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.17
|
|
|
HC THROMBO EMBO CATHETER LVL 13
|
Facility
|
OP
|
$1,365.80
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.35 |
| Max. Negotiated Rate |
$1,229.22 |
| Rate for Payer: Aetna American Axle |
$887.77
|
| Rate for Payer: Aetna Commercial |
$1,160.93
|
| Rate for Payer: Aetna Medicare |
$682.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.77
|
| Rate for Payer: BCBS Complete |
$546.32
|
| Rate for Payer: Cash Price |
$1,092.64
|
| Rate for Payer: Cofinity Advantage |
$956.06
|
| Rate for Payer: Cofinity Commercial |
$1,174.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,092.64
|
| Rate for Payer: Healthscope Commercial |
$1,229.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$956.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,024.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,092.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,160.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,024.35
|
| Rate for Payer: PHP Commercial |
$1,160.93
|
| Rate for Payer: Priority Health SBD |
$860.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$887.77
|
| Rate for Payer: UHC Core |
$711.58
|
| Rate for Payer: UHC Exchange |
$536.76
|
| Rate for Payer: UMR Bronson Commercial |
$505.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,024.35
|
|
|
HC THROMBO EMBO CATHETER LVL 13
|
Facility
|
IP
|
$1,365.80
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.95 |
| Max. Negotiated Rate |
$1,229.22 |
| Rate for Payer: Aetna American Axle |
$887.77
|
| Rate for Payer: Aetna Commercial |
$1,160.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.77
|
| Rate for Payer: Cash Price |
$1,092.64
|
| Rate for Payer: Cofinity Advantage |
$956.06
|
| Rate for Payer: Cofinity Commercial |
$1,174.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,092.64
|
| Rate for Payer: Healthscope Commercial |
$1,229.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$956.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,024.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,160.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,024.35
|
| Rate for Payer: PHP Commercial |
$1,160.93
|
| Rate for Payer: Priority Health SBD |
$860.45
|
| Rate for Payer: UMR Bronson Commercial |
$600.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,024.35
|
|
|
HC THROMBO EMBO CATHETER LVL 14
|
Facility
|
IP
|
$1,485.84
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$653.77 |
| Max. Negotiated Rate |
$1,337.26 |
| Rate for Payer: Aetna American Axle |
$965.80
|
| Rate for Payer: Aetna Commercial |
$1,262.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$965.80
|
| Rate for Payer: Cash Price |
$1,188.67
|
| Rate for Payer: Cofinity Advantage |
$1,040.09
|
| Rate for Payer: Cofinity Commercial |
$1,277.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,188.67
|
| Rate for Payer: Healthscope Commercial |
$1,337.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,040.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,114.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,114.38
|
| Rate for Payer: PHP Commercial |
$1,262.96
|
| Rate for Payer: Priority Health SBD |
$936.08
|
| Rate for Payer: UMR Bronson Commercial |
$653.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,114.38
|
|
|
HC THROMBO EMBO CATHETER LVL 14
|
Facility
|
OP
|
$1,485.84
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.76 |
| Max. Negotiated Rate |
$1,337.26 |
| Rate for Payer: Aetna American Axle |
$965.80
|
| Rate for Payer: Aetna Commercial |
$1,262.96
|
| Rate for Payer: Aetna Medicare |
$742.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$965.80
|
| Rate for Payer: BCBS Complete |
$594.34
|
| Rate for Payer: Cash Price |
$1,188.67
|
| Rate for Payer: Cofinity Advantage |
$1,040.09
|
| Rate for Payer: Cofinity Commercial |
$1,277.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,188.67
|
| Rate for Payer: Healthscope Commercial |
$1,337.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,040.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,114.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,188.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,114.38
|
| Rate for Payer: PHP Commercial |
$1,262.96
|
| Rate for Payer: Priority Health SBD |
$936.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$965.80
|
| Rate for Payer: UHC Core |
$774.12
|
| Rate for Payer: UHC Exchange |
$583.94
|
| Rate for Payer: UMR Bronson Commercial |
$549.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,114.38
|
|
|
HC THROMBO EMBO CATHETER LVL 33
|
Facility
|
IP
|
$3,368.04
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,481.94 |
| Max. Negotiated Rate |
$3,031.24 |
| Rate for Payer: Aetna American Axle |
$2,189.23
|
| Rate for Payer: Aetna Commercial |
$2,862.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,189.23
|
| Rate for Payer: Cash Price |
$2,694.43
|
| Rate for Payer: Cofinity Advantage |
$2,357.63
|
| Rate for Payer: Cofinity Commercial |
$2,896.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,694.43
|
| Rate for Payer: Healthscope Commercial |
$3,031.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,357.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,526.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,862.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,526.03
|
| Rate for Payer: PHP Commercial |
$2,862.83
|
| Rate for Payer: Priority Health SBD |
$2,121.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,481.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,526.03
|
|
|
HC THROMBO EMBO CATHETER LVL 33
|
Facility
|
OP
|
$3,368.04
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,246.17 |
| Max. Negotiated Rate |
$3,031.24 |
| Rate for Payer: Aetna American Axle |
$2,189.23
|
| Rate for Payer: Aetna Commercial |
$2,862.83
|
| Rate for Payer: Aetna Medicare |
$1,684.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,189.23
|
| Rate for Payer: BCBS Complete |
$1,347.22
|
| Rate for Payer: Cash Price |
$2,694.43
|
| Rate for Payer: Cofinity Advantage |
$2,357.63
|
| Rate for Payer: Cofinity Commercial |
$2,896.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,694.43
|
| Rate for Payer: Healthscope Commercial |
$3,031.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,357.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,526.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,694.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,862.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,526.03
|
| Rate for Payer: PHP Commercial |
$2,862.83
|
| Rate for Payer: Priority Health SBD |
$2,121.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,189.23
|
| Rate for Payer: UHC Core |
$1,754.75
|
| Rate for Payer: UHC Exchange |
$1,323.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,246.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,526.03
|
|
|
HC THROMBO EMBO CATHETER LVL 46
|
Facility
|
IP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,028.40 |
| Max. Negotiated Rate |
$4,149.00 |
| Rate for Payer: Aetna American Axle |
$2,996.50
|
| Rate for Payer: Aetna Commercial |
$3,918.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,996.50
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cofinity Advantage |
$3,227.00
|
| Rate for Payer: Cofinity Commercial |
$3,964.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,688.00
|
| Rate for Payer: Healthscope Commercial |
$4,149.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,227.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,457.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,918.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,457.50
|
| Rate for Payer: PHP Commercial |
$3,918.50
|
| Rate for Payer: Priority Health SBD |
$2,904.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,028.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,457.50
|
|
|
HC THROMBO EMBO CATHETER LVL 46
|
Facility
|
OP
|
$4,610.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,705.70 |
| Max. Negotiated Rate |
$4,149.00 |
| Rate for Payer: Aetna American Axle |
$2,996.50
|
| Rate for Payer: Aetna Commercial |
$3,918.50
|
| Rate for Payer: Aetna Medicare |
$2,305.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,996.50
|
| Rate for Payer: BCBS Complete |
$1,844.00
|
| Rate for Payer: Cash Price |
$3,688.00
|
| Rate for Payer: Cofinity Advantage |
$3,227.00
|
| Rate for Payer: Cofinity Commercial |
$3,964.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,688.00
|
| Rate for Payer: Healthscope Commercial |
$4,149.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,227.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,457.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,688.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,918.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,457.50
|
| Rate for Payer: PHP Commercial |
$3,918.50
|
| Rate for Payer: Priority Health SBD |
$2,904.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,996.50
|
| Rate for Payer: UHC Core |
$2,401.81
|
| Rate for Payer: UHC Exchange |
$1,811.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,705.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,457.50
|
|
|
HC THROMBO EMBO CATHETER LVL 71
|
Facility
|
IP
|
$7,145.15
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,143.87 |
| Max. Negotiated Rate |
$6,430.64 |
| Rate for Payer: Aetna American Axle |
$4,644.35
|
| Rate for Payer: Aetna Commercial |
$6,073.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,644.35
|
| Rate for Payer: Cash Price |
$5,716.12
|
| Rate for Payer: Cofinity Advantage |
$5,001.60
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,716.12
|
| Rate for Payer: Healthscope Commercial |
$6,430.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,001.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,358.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,073.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,358.86
|
| Rate for Payer: PHP Commercial |
$6,073.38
|
| Rate for Payer: Priority Health SBD |
$4,501.44
|
| Rate for Payer: UMR Bronson Commercial |
$3,143.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,358.86
|
|
|
HC THROMBO EMBO CATHETER LVL 71
|
Facility
|
OP
|
$7,145.15
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,643.71 |
| Max. Negotiated Rate |
$6,430.64 |
| Rate for Payer: Aetna American Axle |
$4,644.35
|
| Rate for Payer: Aetna Commercial |
$6,073.38
|
| Rate for Payer: Aetna Medicare |
$3,572.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,644.35
|
| Rate for Payer: BCBS Complete |
$2,858.06
|
| Rate for Payer: Cash Price |
$5,716.12
|
| Rate for Payer: Cofinity Advantage |
$5,001.60
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,716.12
|
| Rate for Payer: Healthscope Commercial |
$6,430.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,001.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,358.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,716.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,073.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,358.86
|
| Rate for Payer: PHP Commercial |
$6,073.38
|
| Rate for Payer: Priority Health SBD |
$4,501.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,644.35
|
| Rate for Payer: UHC Core |
$3,722.62
|
| Rate for Payer: UHC Exchange |
$2,808.04
|
| Rate for Payer: UMR Bronson Commercial |
$2,643.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,358.86
|
|
|
HC THROMBO EMBO CATHETER LVL 88
|
Facility
|
OP
|
$8,810.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,259.70 |
| Max. Negotiated Rate |
$7,929.00 |
| Rate for Payer: Aetna American Axle |
$5,726.50
|
| Rate for Payer: Aetna Commercial |
$7,488.50
|
| Rate for Payer: Aetna Medicare |
$4,405.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,726.50
|
| Rate for Payer: BCBS Complete |
$3,524.00
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cofinity Advantage |
$6,167.00
|
| Rate for Payer: Cofinity Commercial |
$7,576.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,048.00
|
| Rate for Payer: Healthscope Commercial |
$7,929.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,167.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,607.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,048.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,607.50
|
| Rate for Payer: PHP Commercial |
$7,488.50
|
| Rate for Payer: Priority Health SBD |
$5,550.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,726.50
|
| Rate for Payer: UHC Core |
$4,590.01
|
| Rate for Payer: UHC Exchange |
$3,462.33
|
| Rate for Payer: UMR Bronson Commercial |
$3,259.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,607.50
|
|
