|
HC THORACOTOMY
|
Facility
|
OP
|
$2,091.88
|
|
| Hospital Charge Code |
27000156
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$774.00 |
| Max. Negotiated Rate |
$1,882.69 |
| Rate for Payer: Aetna American Axle |
$1,359.72
|
| Rate for Payer: Aetna Commercial |
$1,778.10
|
| Rate for Payer: Aetna Medicare |
$1,045.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.72
|
| Rate for Payer: BCBS Complete |
$836.75
|
| Rate for Payer: Cash Price |
$1,673.50
|
| Rate for Payer: Cofinity Commercial |
$1,464.32
|
| Rate for Payer: Cofinity Commercial |
$1,799.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,464.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,673.50
|
| Rate for Payer: Healthscope Commercial |
$1,882.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,464.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,568.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,778.10
|
| Rate for Payer: PHP Commercial |
$1,778.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.72
|
| Rate for Payer: Priority Health SBD |
$1,317.88
|
| Rate for Payer: UMR Bronson Commercial |
$774.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,568.91
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
IP
|
$4,968.12
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,185.97 |
| Max. Negotiated Rate |
$4,471.31 |
| Rate for Payer: Aetna American Axle |
$3,229.28
|
| Rate for Payer: Aetna Commercial |
$4,222.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,229.28
|
| Rate for Payer: Cash Price |
$3,974.50
|
| Rate for Payer: Cofinity Commercial |
$3,477.68
|
| Rate for Payer: Cofinity Commercial |
$4,272.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,477.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,974.50
|
| Rate for Payer: Healthscope Commercial |
$4,471.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,477.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,726.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,222.90
|
| Rate for Payer: PHP Commercial |
$4,222.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,229.28
|
| Rate for Payer: Priority Health SBD |
$3,129.92
|
| Rate for Payer: UMR Bronson Commercial |
$2,185.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,726.09
|
|
|
HC THROMBECTOMY MECH AND OR THROMBOLYSIS ARTERIAL INTRACRANIAL
|
Facility
|
OP
|
$4,968.12
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
36100513
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$830.48 |
| Max. Negotiated Rate |
$4,471.31 |
| Rate for Payer: Aetna American Axle |
$3,229.28
|
| Rate for Payer: Aetna Commercial |
$4,222.90
|
| Rate for Payer: Aetna Medicare |
$2,484.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,229.28
|
| Rate for Payer: BCBS Complete |
$1,987.25
|
| Rate for Payer: BCBS Trust/PPO |
$3,295.01
|
| Rate for Payer: BCN Commercial |
$3,295.01
|
| Rate for Payer: Cash Price |
$3,974.50
|
| Rate for Payer: Cash Price |
$3,974.50
|
| Rate for Payer: Cash Price |
$3,974.50
|
| Rate for Payer: Cofinity Commercial |
$4,272.58
|
| Rate for Payer: Cofinity Commercial |
$3,477.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,477.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,974.50
|
| Rate for Payer: Healthscope Commercial |
$4,471.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,477.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,726.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,222.90
|
| Rate for Payer: PHP Commercial |
$4,222.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,229.28
|
| Rate for Payer: Priority Health SBD |
$3,129.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$913.53
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$830.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,838.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,726.09
|
|
|
HC THROMBIN TIME
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna American Axle |
$49.37
|
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.37
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$53.16
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health SBD |
$47.85
|
| Rate for Payer: UMR Bronson Commercial |
$33.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
HC THROMBIN TIME
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
30500062
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna American Axle |
$49.37
|
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.37
|
| 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 |
$3.25
|
| Rate for Payer: BCBS MAPPO |
$5.77
|
| Rate for Payer: BCBS Trust/PPO |
$5.56
|
| Rate for Payer: BCN Commercial |
$5.56
|
| Rate for Payer: BCN Medicare Advantage |
$5.77
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Cofinity Commercial |
$53.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.77
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| 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 |
$3.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$8.66
|
| Rate for Payer: PACE Medicare |
$5.48
|
| Rate for Payer: PACE SWMI |
$5.77
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: PHP Medicare Advantage |
$5.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.93
|
| Rate for Payer: Priority Health Medicare |
$5.77
|
| Rate for Payer: Priority Health Narrow Network |
$4.74
|
| Rate for Payer: Priority Health SBD |
$47.85
|
| Rate for Payer: Railroad Medicare Medicare |
$5.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.77
|
| Rate for Payer: UHC Exchange |
$5.77
|
| Rate for Payer: UHC Medicare Advantage |
$5.77
|
| Rate for Payer: UHCCP Medicaid |
$3.09
|
| Rate for Payer: UMR Bronson Commercial |
$28.10
|
| Rate for Payer: VA VA |
$5.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
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: Cofinity Commercial |
$73.49
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.49
|
| 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: PHP Commercial |
$89.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.24
|
| 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
|
| 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
|
|
|
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 |
$52.50
|
| 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 Commercial |
$73.49
|
| Rate for Payer: Cofinity Commercial |
$90.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.49
|
| 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: PHP Commercial |
$89.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.24
|
| Rate for Payer: Priority Health SBD |
$66.14
|
| 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
|
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 Commercial |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$730.96
|
| 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: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.75
|
| 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 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 Commercial |
$730.96
|
| Rate for Payer: Cofinity Commercial |
$898.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$730.96
|
| 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: PHP Commercial |
$887.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.75
|
| Rate for Payer: Priority Health SBD |
$657.86
|
| Rate for Payer: UMR Bronson Commercial |
$386.37
|
| 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 Commercial |
$1,174.59
|
| Rate for Payer: Cofinity Commercial |
$956.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$956.06
|
| 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: PHP Commercial |
$1,160.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$887.77
|
| Rate for Payer: Priority Health SBD |
$860.45
|
| 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 Commercial |
$1,174.59
|
| Rate for Payer: Cofinity Commercial |
$956.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$956.06
|
| 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: PHP Commercial |
$1,160.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$887.77
|
| 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 Commercial |
$1,040.09
|
| Rate for Payer: Cofinity Commercial |
$1,277.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,040.09
|
| 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: PHP Commercial |
$1,262.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$965.80
|
| 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 Commercial |
$1,040.09
|
| Rate for Payer: Cofinity Commercial |
$1,277.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,040.09
|
| 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: PHP Commercial |
$1,262.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$965.80
|
| Rate for Payer: Priority Health SBD |
$936.08
|
| 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
|
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 Commercial |
$2,357.63
|
| Rate for Payer: Cofinity Commercial |
$2,896.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,357.63
|
| 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: PHP Commercial |
$2,862.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,189.23
|
| Rate for Payer: Priority Health SBD |
$2,121.87
|
| 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 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 Commercial |
$2,357.63
|
| Rate for Payer: Cofinity Commercial |
$2,896.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,357.63
|
| 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: PHP Commercial |
$2,862.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,189.23
|
| 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 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 Commercial |
$3,227.00
|
| Rate for Payer: Cofinity Commercial |
$3,964.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,227.00
|
| 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: PHP Commercial |
$3,918.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,996.50
|
| Rate for Payer: Priority Health SBD |
$2,904.30
|
| 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 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 Commercial |
$3,227.00
|
| Rate for Payer: Cofinity Commercial |
$3,964.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,227.00
|
| 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: PHP Commercial |
$3,918.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,996.50
|
| 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 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 |
$3,572.58
|
| 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 Commercial |
$5,001.60
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,001.60
|
| 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: PHP Commercial |
$6,073.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,644.35
|
| Rate for Payer: Priority Health SBD |
$4,501.44
|
| 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 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 Commercial |
$5,001.60
|
| Rate for Payer: Cofinity Commercial |
$6,144.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,001.60
|
| 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: PHP Commercial |
$6,073.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,644.35
|
| 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 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 Commercial |
$6,167.00
|
| Rate for Payer: Cofinity Commercial |
$7,576.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,167.00
|
| 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: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: PHP Commercial |
$7,488.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,726.50
|
| Rate for Payer: Priority Health SBD |
$5,550.30
|
| Rate for Payer: UMR Bronson Commercial |
$3,259.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,607.50
|
|
|
HC THROMBO EMBO CATHETER LVL 88
|
Facility
|
IP
|
$8,810.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27200383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,876.40 |
| 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 New Business (MI Preferred) |
$5,726.50
|
| Rate for Payer: Cash Price |
$7,048.00
|
| Rate for Payer: Cofinity Commercial |
$6,167.00
|
| Rate for Payer: Cofinity Commercial |
$7,576.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,167.00
|
| 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: Multiplan/Beech St/PHCS Commercial |
$7,488.50
|
| Rate for Payer: PHP Commercial |
$7,488.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,726.50
|
| Rate for Payer: Priority Health SBD |
$5,550.30
|
| Rate for Payer: UMR Bronson Commercial |
$3,876.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,607.50
|
|
|
HC THROMBO EMBO LVL 141
|
Facility
|
OP
|
$14,159.85
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
27200225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,239.14 |
| Max. Negotiated Rate |
$12,743.86 |
| Rate for Payer: Aetna American Axle |
$9,203.90
|
| Rate for Payer: Aetna Commercial |
$12,035.87
|
| Rate for Payer: Aetna Medicare |
$7,079.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,203.90
|
| Rate for Payer: BCBS Complete |
$5,663.94
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Commercial |
$12,177.47
|
| Rate for Payer: Cofinity Commercial |
$9,911.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,911.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Healthscope Commercial |
$12,743.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,911.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,619.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,035.87
|
| Rate for Payer: PHP Commercial |
$12,035.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,203.90
|
| Rate for Payer: Priority Health SBD |
$8,920.71
|
| Rate for Payer: UMR Bronson Commercial |
$5,239.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,619.89
|
|
|
HC THROMBO EMBO LVL 141
|
Facility
|
IP
|
$14,159.85
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
27200225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,230.33 |
| Max. Negotiated Rate |
$12,743.86 |
| Rate for Payer: Aetna American Axle |
$9,203.90
|
| Rate for Payer: Aetna Commercial |
$12,035.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,203.90
|
| Rate for Payer: Cash Price |
$11,327.88
|
| Rate for Payer: Cofinity Commercial |
$12,177.47
|
| Rate for Payer: Cofinity Commercial |
$9,911.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,911.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,327.88
|
| Rate for Payer: Healthscope Commercial |
$12,743.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,911.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,619.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,035.87
|
| Rate for Payer: PHP Commercial |
$12,035.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,203.90
|
| Rate for Payer: Priority Health SBD |
$8,920.71
|
| Rate for Payer: UMR Bronson Commercial |
$6,230.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,619.89
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
OP
|
$519.80
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.19 |
| Max. Negotiated Rate |
$1,021.42 |
| Rate for Payer: Aetna American Axle |
$337.87
|
| Rate for Payer: Aetna Commercial |
$441.83
|
| Rate for Payer: Aetna Medicare |
$337.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$261.01
|
| Rate for Payer: BCN Commercial |
$261.01
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cofinity Commercial |
$447.03
|
| Rate for Payer: Cofinity Commercial |
$363.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$363.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$467.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$363.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.85
|
| Rate for Payer: Mclaren Medicaid |
$174.19
|
| Rate for Payer: Mclaren Medicare |
$324.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.23
|
| Rate for Payer: Meridian Medicaid |
$182.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.83
|
| Rate for Payer: Nomi Health Commercial |
$682.46
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Commercial |
$441.83
|
| Rate for Payer: PHP Medicare Advantage |
$324.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.42
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$817.14
|
| Rate for Payer: Priority Health SBD |
$327.47
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$914.79
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$621.07
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$174.19
|
| Rate for Payer: UMR Bronson Commercial |
$192.33
|
| Rate for Payer: VA VA |
$324.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.85
|
|
|
HC THROMBOLYSIS CEREBRAL IV INFUSION
|
Facility
|
IP
|
$519.80
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$228.71 |
| Max. Negotiated Rate |
$467.82 |
| Rate for Payer: Aetna American Axle |
$337.87
|
| Rate for Payer: Aetna Commercial |
$441.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.87
|
| Rate for Payer: Cash Price |
$415.84
|
| Rate for Payer: Cofinity Commercial |
$363.86
|
| Rate for Payer: Cofinity Commercial |
$447.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$363.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.84
|
| Rate for Payer: Healthscope Commercial |
$467.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$363.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$441.83
|
| Rate for Payer: PHP Commercial |
$441.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.87
|
| Rate for Payer: Priority Health SBD |
$327.47
|
| Rate for Payer: UMR Bronson Commercial |
$228.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.85
|
|
