|
HC INFUSION CATHETER LVL 7
|
Facility
|
IP
|
$740.38
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.77 |
| 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: 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 |
$325.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.28
|
|
|
HC INFUSION CATHETER LVL 9
|
Facility
|
IP
|
$904.18
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$397.84 |
| Max. Negotiated Rate |
$813.76 |
| Rate for Payer: Aetna American Axle |
$587.72
|
| Rate for Payer: Aetna Commercial |
$768.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.72
|
| Rate for Payer: Cash Price |
$723.34
|
| Rate for Payer: Cofinity Commercial |
$632.93
|
| Rate for Payer: Cofinity Commercial |
$777.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.34
|
| Rate for Payer: Healthscope Commercial |
$813.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$632.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$678.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.55
|
| Rate for Payer: PHP Commercial |
$768.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.93
|
| Rate for Payer: Priority Health SBD |
$569.63
|
| Rate for Payer: UMR Bronson Commercial |
$397.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$678.14
|
|
|
HC INFUSION CATHETER LVL 9
|
Facility
|
OP
|
$904.18
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.55 |
| Max. Negotiated Rate |
$813.76 |
| Rate for Payer: Aetna American Axle |
$587.72
|
| Rate for Payer: Aetna Commercial |
$768.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.72
|
| Rate for Payer: BCBS Complete |
$361.67
|
| Rate for Payer: Cash Price |
$723.34
|
| Rate for Payer: Cofinity Commercial |
$632.93
|
| Rate for Payer: Cofinity Commercial |
$777.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.34
|
| Rate for Payer: Healthscope Commercial |
$813.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$632.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$678.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.55
|
| Rate for Payer: PHP Commercial |
$768.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.93
|
| Rate for Payer: Priority Health SBD |
$569.63
|
| Rate for Payer: UMR Bronson Commercial |
$334.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$678.14
|
|
|
HC INFUSION CATH LVL 10
|
Facility
|
IP
|
$1,006.71
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.95 |
| Max. Negotiated Rate |
$906.04 |
| Rate for Payer: Aetna American Axle |
$654.36
|
| Rate for Payer: Aetna Commercial |
$855.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.36
|
| Rate for Payer: Cash Price |
$805.37
|
| Rate for Payer: Cofinity Commercial |
$704.70
|
| Rate for Payer: Cofinity Commercial |
$865.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$805.37
|
| Rate for Payer: Healthscope Commercial |
$906.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$704.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$755.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$855.70
|
| Rate for Payer: PHP Commercial |
$855.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$704.70
|
| Rate for Payer: Priority Health SBD |
$634.23
|
| Rate for Payer: UMR Bronson Commercial |
$442.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$755.03
|
|
|
HC INFUSION CATH LVL 10
|
Facility
|
OP
|
$1,006.71
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.48 |
| Max. Negotiated Rate |
$906.04 |
| Rate for Payer: Aetna American Axle |
$654.36
|
| Rate for Payer: Aetna Commercial |
$855.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.36
|
| Rate for Payer: BCBS Complete |
$402.68
|
| Rate for Payer: Cash Price |
$805.37
|
| Rate for Payer: Cofinity Commercial |
$704.70
|
| Rate for Payer: Cofinity Commercial |
$865.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$805.37
|
| Rate for Payer: Healthscope Commercial |
$906.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$704.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$755.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$855.70
|
| Rate for Payer: PHP Commercial |
$855.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$704.70
|
| Rate for Payer: Priority Health SBD |
$634.23
|
| Rate for Payer: UMR Bronson Commercial |
$372.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$755.03
|
|
|
HC INFUSION CATH LVL 11
|
Facility
|
IP
|
$1,120.87
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.18 |
| Max. Negotiated Rate |
$1,008.78 |
| Rate for Payer: Aetna American Axle |
$728.57
|
| Rate for Payer: Aetna Commercial |
$952.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.57
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cofinity Commercial |
$784.61
|
| Rate for Payer: Cofinity Commercial |
$963.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.70
|
| Rate for Payer: Healthscope Commercial |
$1,008.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$784.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$840.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$952.74
|
| Rate for Payer: PHP Commercial |
$952.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$784.61
|
| Rate for Payer: Priority Health SBD |
$706.15
|
| Rate for Payer: UMR Bronson Commercial |
$493.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$840.65
|
|
|
HC INFUSION CATH LVL 11
|
Facility
|
OP
|
$1,120.87
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.72 |
| Max. Negotiated Rate |
$1,008.78 |
| Rate for Payer: Aetna American Axle |
$728.57
|
| Rate for Payer: Aetna Commercial |
$952.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.57
|
| Rate for Payer: BCBS Complete |
$448.35
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cofinity Commercial |
$784.61
|
| Rate for Payer: Cofinity Commercial |
$963.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.70
|
| Rate for Payer: Healthscope Commercial |
$1,008.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$784.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$840.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$952.74
|
| Rate for Payer: PHP Commercial |
$952.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$784.61
|
| Rate for Payer: Priority Health SBD |
$706.15
|
| Rate for Payer: UMR Bronson Commercial |
$414.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$840.65
|
|
|
HC INFUSION CATH LVL 12
|
Facility
|
IP
|
$1,247.97
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.11 |
| Max. Negotiated Rate |
$1,123.17 |
| Rate for Payer: Aetna American Axle |
$811.18
|
| Rate for Payer: Aetna Commercial |
$1,060.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$811.18
|
| Rate for Payer: Cash Price |
$998.38
|
| Rate for Payer: Cofinity Commercial |
$1,073.25
|
| Rate for Payer: Cofinity Commercial |
$873.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$998.38
|
| Rate for Payer: Healthscope Commercial |
$1,123.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$873.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$935.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,060.77
|
| Rate for Payer: PHP Commercial |
$1,060.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$873.58
|
| Rate for Payer: Priority Health SBD |
$786.22
|
| Rate for Payer: UMR Bronson Commercial |
$549.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$935.98
|
|
|
HC INFUSION CATH LVL 12
|
Facility
|
OP
|
$1,247.97
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.75 |
| Max. Negotiated Rate |
$1,123.17 |
| Rate for Payer: Aetna American Axle |
$811.18
|
| Rate for Payer: Aetna Commercial |
$1,060.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$811.18
|
| Rate for Payer: BCBS Complete |
$499.19
|
| Rate for Payer: Cash Price |
$998.38
|
| Rate for Payer: Cofinity Commercial |
$1,073.25
|
| Rate for Payer: Cofinity Commercial |
$873.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$998.38
|
| Rate for Payer: Healthscope Commercial |
$1,123.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$873.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$935.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,060.77
|
| Rate for Payer: PHP Commercial |
$1,060.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$873.58
|
| Rate for Payer: Priority Health SBD |
$786.22
|
| Rate for Payer: UMR Bronson Commercial |
$461.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$935.98
|
|
|
HC INFUSION CATH LVL 13
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$500.61 |
| Max. Negotiated Rate |
$1,217.70 |
| Rate for Payer: Aetna American Axle |
$879.45
|
| Rate for Payer: Aetna Commercial |
$1,150.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.45
|
| Rate for Payer: BCBS Complete |
$541.20
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cofinity Commercial |
$1,163.58
|
| Rate for Payer: Cofinity Commercial |
$947.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.40
|
| Rate for Payer: Healthscope Commercial |
$1,217.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$947.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,014.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.05
|
| Rate for Payer: PHP Commercial |
$1,150.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.10
|
| Rate for Payer: Priority Health SBD |
$852.39
|
| Rate for Payer: UMR Bronson Commercial |
$500.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,014.75
|
|
|
HC INFUSION CATH LVL 13
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.32 |
| Max. Negotiated Rate |
$1,217.70 |
| Rate for Payer: Aetna American Axle |
$879.45
|
| Rate for Payer: Aetna Commercial |
$1,150.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$879.45
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cofinity Commercial |
$1,163.58
|
| Rate for Payer: Cofinity Commercial |
$947.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.40
|
| Rate for Payer: Healthscope Commercial |
$1,217.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$947.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,014.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,150.05
|
| Rate for Payer: PHP Commercial |
$1,150.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$947.10
|
| Rate for Payer: Priority Health SBD |
$852.39
|
| Rate for Payer: UMR Bronson Commercial |
$595.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,014.75
|
|
|
HC INFUSION CATH LVL 14
|
Facility
|
OP
|
$1,446.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.35 |
| Max. Negotiated Rate |
$1,302.21 |
| Rate for Payer: Aetna American Axle |
$940.48
|
| Rate for Payer: Aetna Commercial |
$1,229.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.48
|
| Rate for Payer: BCBS Complete |
$578.76
|
| Rate for Payer: Cash Price |
$1,157.52
|
| Rate for Payer: Cofinity Commercial |
$1,012.83
|
| Rate for Payer: Cofinity Commercial |
$1,244.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.52
|
| Rate for Payer: Healthscope Commercial |
$1,302.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,012.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,229.86
|
| Rate for Payer: PHP Commercial |
$1,229.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.83
|
| Rate for Payer: Priority Health SBD |
$911.55
|
| Rate for Payer: UMR Bronson Commercial |
$535.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.18
|
|
|
HC INFUSION CATH LVL 14
|
Facility
|
IP
|
$1,446.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$636.64 |
| Max. Negotiated Rate |
$1,302.21 |
| Rate for Payer: Aetna American Axle |
$940.48
|
| Rate for Payer: Aetna Commercial |
$1,229.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.48
|
| Rate for Payer: Cash Price |
$1,157.52
|
| Rate for Payer: Cofinity Commercial |
$1,012.83
|
| Rate for Payer: Cofinity Commercial |
$1,244.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,157.52
|
| Rate for Payer: Healthscope Commercial |
$1,302.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,012.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,229.86
|
| Rate for Payer: PHP Commercial |
$1,229.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.83
|
| Rate for Payer: Priority Health SBD |
$911.55
|
| Rate for Payer: UMR Bronson Commercial |
$636.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.18
|
|
|
HC INFUSION CATH LVL 4
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna American Axle |
$292.50
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UMR Bronson Commercial |
$166.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC INFUSION CATH LVL 4
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna American Axle |
$292.50
|
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: UMR Bronson Commercial |
$198.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC INFUSION CATH LVL 5
|
Facility
|
OP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.28 |
| Max. Negotiated Rate |
$535.82 |
| Rate for Payer: Aetna American Axle |
$386.98
|
| Rate for Payer: Aetna Commercial |
$506.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.98
|
| Rate for Payer: BCBS Complete |
$238.14
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$416.74
|
| Rate for Payer: Cofinity Commercial |
$512.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Healthscope Commercial |
$535.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$416.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$506.05
|
| Rate for Payer: PHP Commercial |
$506.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.74
|
| Rate for Payer: Priority Health SBD |
$375.07
|
| Rate for Payer: UMR Bronson Commercial |
$220.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.51
|
|
|
HC INFUSION CATH LVL 5
|
Facility
|
IP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.95 |
| Max. Negotiated Rate |
$535.82 |
| Rate for Payer: Aetna American Axle |
$386.98
|
| Rate for Payer: Aetna Commercial |
$506.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.98
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$416.74
|
| Rate for Payer: Cofinity Commercial |
$512.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Healthscope Commercial |
$535.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$416.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$506.05
|
| Rate for Payer: PHP Commercial |
$506.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.74
|
| Rate for Payer: Priority Health SBD |
$375.07
|
| Rate for Payer: UMR Bronson Commercial |
$261.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.51
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
IP
|
$826.97
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.87 |
| Max. Negotiated Rate |
$744.27 |
| Rate for Payer: Aetna American Axle |
$537.53
|
| Rate for Payer: Aetna Commercial |
$702.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.53
|
| Rate for Payer: Cash Price |
$661.58
|
| Rate for Payer: Cofinity Commercial |
$578.88
|
| Rate for Payer: Cofinity Commercial |
$711.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.58
|
| Rate for Payer: Healthscope Commercial |
$744.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$578.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$620.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$702.92
|
| Rate for Payer: PHP Commercial |
$702.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.88
|
| Rate for Payer: Priority Health SBD |
$520.99
|
| Rate for Payer: UMR Bronson Commercial |
$363.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$620.23
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
OP
|
$826.97
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.98 |
| Max. Negotiated Rate |
$744.27 |
| Rate for Payer: Aetna American Axle |
$537.53
|
| Rate for Payer: Aetna Commercial |
$702.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.53
|
| Rate for Payer: BCBS Complete |
$330.79
|
| Rate for Payer: Cash Price |
$661.58
|
| Rate for Payer: Cofinity Commercial |
$578.88
|
| Rate for Payer: Cofinity Commercial |
$711.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.58
|
| Rate for Payer: Healthscope Commercial |
$744.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$578.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$620.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$702.92
|
| Rate for Payer: PHP Commercial |
$702.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.88
|
| Rate for Payer: Priority Health SBD |
$520.99
|
| Rate for Payer: UMR Bronson Commercial |
$305.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$620.23
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.82 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna American Axle |
$143.00
|
| Rate for Payer: Aetna Commercial |
$187.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.00
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: BCBS Trust/PPO |
$119.25
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$154.00
|
| Rate for Payer: Cofinity Commercial |
$189.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Healthscope Commercial |
$198.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.00
|
| Rate for Payer: PHP Commercial |
$187.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health SBD |
$138.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.40
|
| Rate for Payer: UHC Exchange |
$65.82
|
| Rate for Payer: UMR Bronson Commercial |
$81.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.00
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna American Axle |
$143.00
|
| Rate for Payer: Aetna Commercial |
$187.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$189.20
|
| Rate for Payer: Cofinity Commercial |
$154.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Healthscope Commercial |
$198.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.00
|
| Rate for Payer: PHP Commercial |
$187.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health SBD |
$138.60
|
| Rate for Payer: UMR Bronson Commercial |
$96.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.00
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
OP
|
$1,401.95
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.38 |
| Max. Negotiated Rate |
$1,499.80 |
| Rate for Payer: Aetna American Axle |
$911.27
|
| Rate for Payer: Aetna Commercial |
$1,191.66
|
| Rate for Payer: Aetna Medicare |
$495.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$171.04
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$1,121.56
|
| Rate for Payer: Cash Price |
$1,121.56
|
| Rate for Payer: Cofinity Commercial |
$981.36
|
| Rate for Payer: Cofinity Commercial |
$1,205.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$1,261.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$981.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,051.46
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,191.66
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$1,191.66
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,499.80
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,199.84
|
| Rate for Payer: Priority Health SBD |
$883.23
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.42
|
| Rate for Payer: UHC Exchange |
$71.38
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: UMR Bronson Commercial |
$518.72
|
| Rate for Payer: VA VA |
$476.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,051.46
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
IP
|
$1,401.95
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$616.86 |
| Max. Negotiated Rate |
$1,261.76 |
| Rate for Payer: Aetna American Axle |
$911.27
|
| Rate for Payer: Aetna Commercial |
$1,191.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.27
|
| Rate for Payer: Cash Price |
$1,121.56
|
| Rate for Payer: Cofinity Commercial |
$981.36
|
| Rate for Payer: Cofinity Commercial |
$1,205.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.56
|
| Rate for Payer: Healthscope Commercial |
$1,261.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$981.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,051.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,191.66
|
| Rate for Payer: PHP Commercial |
$1,191.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.36
|
| Rate for Payer: Priority Health SBD |
$883.23
|
| Rate for Payer: UMR Bronson Commercial |
$616.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,051.46
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
IP
|
$485.34
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$213.55 |
| Max. Negotiated Rate |
$436.81 |
| Rate for Payer: Aetna American Axle |
$315.47
|
| Rate for Payer: Aetna Commercial |
$412.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.47
|
| Rate for Payer: Cash Price |
$388.27
|
| Rate for Payer: Cofinity Commercial |
$339.74
|
| Rate for Payer: Cofinity Commercial |
$417.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.27
|
| Rate for Payer: Healthscope Commercial |
$436.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$412.54
|
| Rate for Payer: PHP Commercial |
$412.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.74
|
| Rate for Payer: Priority Health SBD |
$305.76
|
| Rate for Payer: UMR Bronson Commercial |
$213.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.00
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
OP
|
$485.34
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.38 |
| Max. Negotiated Rate |
$1,499.80 |
| Rate for Payer: Aetna American Axle |
$315.47
|
| Rate for Payer: Aetna Commercial |
$412.54
|
| Rate for Payer: Aetna Medicare |
$495.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.52
|
| Rate for Payer: BCBS Complete |
$273.66
|
| Rate for Payer: BCBS MAPPO |
$476.42
|
| Rate for Payer: BCBS Trust/PPO |
$48.94
|
| Rate for Payer: BCN Medicare Advantage |
$476.42
|
| Rate for Payer: Cash Price |
$388.27
|
| Rate for Payer: Cash Price |
$388.27
|
| Rate for Payer: Cash Price |
$388.27
|
| Rate for Payer: Cofinity Commercial |
$417.39
|
| Rate for Payer: Cofinity Commercial |
$339.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.42
|
| Rate for Payer: Healthscope Commercial |
$436.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.00
|
| Rate for Payer: Mclaren Medicaid |
$260.60
|
| Rate for Payer: Mclaren Medicare |
$476.42
|
| Rate for Payer: Meridian Medicaid |
$273.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$412.54
|
| Rate for Payer: PACE Medicare |
$452.60
|
| Rate for Payer: PACE SWMI |
$476.42
|
| Rate for Payer: PHP Commercial |
$412.54
|
| Rate for Payer: PHP Medicare Advantage |
$476.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,499.80
|
| Rate for Payer: Priority Health Medicare |
$476.42
|
| Rate for Payer: Priority Health Narrow Network |
$1,199.84
|
| Rate for Payer: Priority Health SBD |
$305.76
|
| Rate for Payer: Railroad Medicare Medicare |
$476.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.82
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.42
|
| Rate for Payer: UHC Exchange |
$34.38
|
| Rate for Payer: UHC Medicare Advantage |
$490.71
|
| Rate for Payer: UMR Bronson Commercial |
$179.58
|
| Rate for Payer: VA VA |
$476.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.00
|
|
