|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$68.38 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$68.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.88
|
| Rate for Payer: Priority Health Narrow Network |
$16.70
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$87.35 |
| Rate for Payer: Aetna American Axle |
$20.55
|
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.55
|
| Rate for Payer: BCBS Complete |
$12.65
|
| Rate for Payer: BCBS Trust/PPO |
$87.35
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.88
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.79
|
| Rate for Payer: Priority Health Narrow Network |
$22.23
|
| Rate for Payer: Priority Health SBD |
$19.92
|
| Rate for Payer: UMR Bronson Commercial |
$11.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna American Axle |
$20.55
|
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.55
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.88
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: Priority Health SBD |
$19.92
|
| Rate for Payer: UMR Bronson Commercial |
$13.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
63600126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$34.19 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$34.19
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.44
|
| Rate for Payer: Priority Health Narrow Network |
$8.35
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
63600126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$71.84 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$71.84
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.35
|
| Rate for Payer: Priority Health Narrow Network |
$17.88
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
63600077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
63600077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$69.94 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$69.94
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.64
|
| Rate for Payer: Priority Health Narrow Network |
$17.31
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$53.92 |
| Rate for Payer: Aetna American Axle |
$15.91
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: BCBS Trust/PPO |
$53.92
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.77
|
| Rate for Payer: Priority Health Narrow Network |
$15.82
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: UMR Bronson Commercial |
$9.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna American Axle |
$15.91
|
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: UMR Bronson Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC INF PUMP PROGRAMMABLE LVL 6
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
27800141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.30 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna American Axle |
$448.50
|
| Rate for Payer: Aetna Commercial |
$586.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.50
|
| Rate for Payer: BCBS Complete |
$276.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Commercial |
$483.00
|
| Rate for Payer: Cofinity Commercial |
$593.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.00
|
| Rate for Payer: Healthscope Commercial |
$621.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$586.50
|
| Rate for Payer: PHP Commercial |
$586.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.00
|
| Rate for Payer: Priority Health SBD |
$434.70
|
| Rate for Payer: UMR Bronson Commercial |
$255.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.50
|
|
|
HC INF PUMP PROGRAMMABLE LVL 6
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
27800141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.60 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna American Axle |
$448.50
|
| Rate for Payer: Aetna Commercial |
$586.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.50
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Commercial |
$483.00
|
| Rate for Payer: Cofinity Commercial |
$593.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.00
|
| Rate for Payer: Healthscope Commercial |
$621.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$586.50
|
| Rate for Payer: PHP Commercial |
$586.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.00
|
| Rate for Payer: Priority Health SBD |
$434.70
|
| Rate for Payer: UMR Bronson Commercial |
$303.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.50
|
|
|
HC INFRARED THERAPY
|
Facility
|
OP
|
$57.48
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna American Axle |
$37.36
|
| Rate for Payer: Aetna Commercial |
$48.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.36
|
| Rate for Payer: BCBS Complete |
$22.99
|
| Rate for Payer: BCBS Trust/PPO |
$4.69
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cofinity Commercial |
$40.24
|
| Rate for Payer: Cofinity Commercial |
$49.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.98
|
| Rate for Payer: Healthscope Commercial |
$51.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.86
|
| Rate for Payer: PHP Commercial |
$48.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.00
|
| Rate for Payer: Priority Health Narrow Network |
$4.00
|
| Rate for Payer: Priority Health SBD |
$36.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.20
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$6.55
|
| Rate for Payer: UMR Bronson Commercial |
$21.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.11
|
|
|
HC INFRARED THERAPY
|
Facility
|
IP
|
$57.48
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.29 |
| Max. Negotiated Rate |
$51.73 |
| Rate for Payer: Aetna American Axle |
$37.36
|
| Rate for Payer: Aetna Commercial |
$48.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.36
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cofinity Commercial |
$49.43
|
| Rate for Payer: Cofinity Commercial |
$40.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.98
|
| Rate for Payer: Healthscope Commercial |
$51.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.86
|
| Rate for Payer: PHP Commercial |
$48.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.24
|
| Rate for Payer: Priority Health SBD |
$36.21
|
| Rate for Payer: UMR Bronson Commercial |
$25.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.11
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
OP
|
$157.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna American Axle |
$102.38
|
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.38
|
| Rate for Payer: BCBS Complete |
$63.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$110.25
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: Priority Health SBD |
$99.22
|
| Rate for Payer: UMR Bronson Commercial |
$58.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
IP
|
$157.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna American Axle |
$102.38
|
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.38
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$110.25
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.00
|
| Rate for Payer: Healthscope Commercial |
$141.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.88
|
| Rate for Payer: PHP Commercial |
$133.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.25
|
| Rate for Payer: Priority Health SBD |
$99.22
|
| Rate for Payer: UMR Bronson Commercial |
$69.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.12
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
OP
|
$237.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.73 |
| Max. Negotiated Rate |
$213.41 |
| Rate for Payer: Aetna American Axle |
$154.13
|
| Rate for Payer: Aetna Commercial |
$201.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.13
|
| Rate for Payer: BCBS Complete |
$94.85
|
| Rate for Payer: Cash Price |
$189.70
|
| Rate for Payer: Cofinity Commercial |
$165.98
|
| Rate for Payer: Cofinity Commercial |
$203.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.70
|
| Rate for Payer: Healthscope Commercial |
$213.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.55
|
| Rate for Payer: PHP Commercial |
$201.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.98
|
| Rate for Payer: Priority Health SBD |
$149.39
|
| Rate for Payer: UMR Bronson Commercial |
$87.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.84
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
IP
|
$237.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.33 |
| Max. Negotiated Rate |
$213.41 |
| Rate for Payer: Aetna American Axle |
$154.13
|
| Rate for Payer: Aetna Commercial |
$201.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.13
|
| Rate for Payer: Cash Price |
$189.70
|
| Rate for Payer: Cofinity Commercial |
$165.98
|
| Rate for Payer: Cofinity Commercial |
$203.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.70
|
| Rate for Payer: Healthscope Commercial |
$213.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.55
|
| Rate for Payer: PHP Commercial |
$201.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.98
|
| Rate for Payer: Priority Health SBD |
$149.39
|
| Rate for Payer: UMR Bronson Commercial |
$104.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.84
|
|
|
HC INFUSION CATHETER LVL 3
|
Facility
|
IP
|
$396.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.64 |
| Max. Negotiated Rate |
$357.21 |
| Rate for Payer: Aetna American Axle |
$257.98
|
| Rate for Payer: Aetna Commercial |
$337.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.98
|
| Rate for Payer: Cash Price |
$317.52
|
| Rate for Payer: Cofinity Commercial |
$277.83
|
| Rate for Payer: Cofinity Commercial |
$341.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.52
|
| Rate for Payer: Healthscope Commercial |
$357.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$337.36
|
| Rate for Payer: PHP Commercial |
$337.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.83
|
| Rate for Payer: Priority Health SBD |
$250.05
|
| Rate for Payer: UMR Bronson Commercial |
$174.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.68
|
|
|
HC INFUSION CATHETER LVL 3
|
Facility
|
OP
|
$396.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.85 |
| Max. Negotiated Rate |
$357.21 |
| Rate for Payer: Aetna American Axle |
$257.98
|
| Rate for Payer: Aetna Commercial |
$337.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.98
|
| Rate for Payer: BCBS Complete |
$158.76
|
| Rate for Payer: Cash Price |
$317.52
|
| Rate for Payer: Cofinity Commercial |
$277.83
|
| Rate for Payer: Cofinity Commercial |
$341.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.52
|
| Rate for Payer: Healthscope Commercial |
$357.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$337.36
|
| Rate for Payer: PHP Commercial |
$337.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.83
|
| Rate for Payer: Priority Health SBD |
$250.05
|
| Rate for Payer: UMR Bronson Commercial |
$146.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.68
|
|
|
HC INFUSION CATHETER LVL 6
|
Facility
|
OP
|
$662.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.26 |
| Max. Negotiated Rate |
$596.57 |
| Rate for Payer: Aetna American Axle |
$430.86
|
| Rate for Payer: Aetna Commercial |
$563.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.86
|
| Rate for Payer: BCBS Complete |
$265.14
|
| Rate for Payer: Cash Price |
$530.29
|
| Rate for Payer: Cofinity Commercial |
$464.00
|
| Rate for Payer: Cofinity Commercial |
$570.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.29
|
| Rate for Payer: Healthscope Commercial |
$596.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$464.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.43
|
| Rate for Payer: PHP Commercial |
$563.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.00
|
| Rate for Payer: Priority Health SBD |
$417.60
|
| Rate for Payer: UMR Bronson Commercial |
$245.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.14
|
|
|
HC INFUSION CATHETER LVL 6
|
Facility
|
IP
|
$662.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$291.66 |
| Max. Negotiated Rate |
$596.57 |
| Rate for Payer: Aetna American Axle |
$430.86
|
| Rate for Payer: Aetna Commercial |
$563.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.86
|
| Rate for Payer: Cash Price |
$530.29
|
| Rate for Payer: Cofinity Commercial |
$464.00
|
| Rate for Payer: Cofinity Commercial |
$570.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.29
|
| Rate for Payer: Healthscope Commercial |
$596.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$464.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.43
|
| Rate for Payer: PHP Commercial |
$563.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.00
|
| Rate for Payer: Priority Health SBD |
$417.60
|
| Rate for Payer: UMR Bronson Commercial |
$291.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.14
|
|
|
HC INFUSION CATHETER LVL 7
|
Facility
|
OP
|
$740.38
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$273.94 |
| Max. Negotiated Rate |
$666.34 |
| Rate for Payer: Aetna American Axle |
$481.25
|
| Rate for Payer: Aetna Commercial |
$629.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.25
|
| Rate for Payer: BCBS Complete |
$296.15
|
| Rate for Payer: Cash Price |
$592.30
|
| Rate for Payer: Cofinity Commercial |
$518.27
|
| Rate for Payer: Cofinity Commercial |
$636.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.30
|
| Rate for Payer: Healthscope Commercial |
$666.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$518.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.32
|
| Rate for Payer: PHP Commercial |
$629.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.27
|
| Rate for Payer: Priority Health SBD |
$466.44
|
| Rate for Payer: UMR Bronson Commercial |
$273.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.28
|
|
