|
HC ISOVUE 300M PER ML
|
Facility
|
IP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna American Axle |
$1.24
|
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.24
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.33
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.52
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.20
|
| Rate for Payer: UMR Bronson Commercial |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna American Axle |
$1.07
|
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cofinity Commercial |
$1.15
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.31
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.39
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.15
|
| Rate for Payer: Priority Health SBD |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.23
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna American Axle |
$1.07
|
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cofinity Commercial |
$1.15
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.31
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.39
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.15
|
| Rate for Payer: Priority Health SBD |
$1.03
|
| Rate for Payer: UMR Bronson Commercial |
$0.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.23
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna American Axle |
$1.21
|
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.21
|
| Rate for Payer: BCBS Complete |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.14
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cofinity Commercial |
$1.30
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.49
|
| Rate for Payer: Healthscope Commercial |
$1.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.58
|
| Rate for Payer: PHP Commercial |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health SBD |
$1.17
|
| Rate for Payer: UMR Bronson Commercial |
$0.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.40
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna American Axle |
$1.21
|
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.21
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cofinity Commercial |
$1.30
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.49
|
| Rate for Payer: Healthscope Commercial |
$1.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.58
|
| Rate for Payer: PHP Commercial |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health SBD |
$1.17
|
| Rate for Payer: UMR Bronson Commercial |
$0.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.40
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$307.84
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.45 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna American Axle |
$200.10
|
| Rate for Payer: Aetna Commercial |
$261.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.10
|
| Rate for Payer: Cash Price |
$246.27
|
| Rate for Payer: Cofinity Commercial |
$215.49
|
| Rate for Payer: Cofinity Commercial |
$264.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.27
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.66
|
| Rate for Payer: PHP Commercial |
$261.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.49
|
| Rate for Payer: Priority Health SBD |
$193.94
|
| Rate for Payer: UMR Bronson Commercial |
$135.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.88
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$307.84
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.83 |
| Max. Negotiated Rate |
$897.69 |
| Rate for Payer: Aetna American Axle |
$200.10
|
| Rate for Payer: Aetna Commercial |
$261.66
|
| Rate for Payer: Aetna Medicare |
$296.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.45
|
| Rate for Payer: BCBS Complete |
$163.80
|
| Rate for Payer: BCBS MAPPO |
$285.16
|
| Rate for Payer: BCBS Trust/PPO |
$166.47
|
| Rate for Payer: BCN Medicare Advantage |
$285.16
|
| Rate for Payer: Cash Price |
$246.27
|
| Rate for Payer: Cash Price |
$246.27
|
| Rate for Payer: Cofinity Commercial |
$264.74
|
| Rate for Payer: Cofinity Commercial |
$215.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.16
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.88
|
| Rate for Payer: Mclaren Medicaid |
$155.98
|
| Rate for Payer: Mclaren Medicare |
$285.16
|
| Rate for Payer: Meridian Medicaid |
$163.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.66
|
| Rate for Payer: PACE Medicare |
$270.90
|
| Rate for Payer: PACE SWMI |
$285.16
|
| Rate for Payer: PHP Commercial |
$261.66
|
| Rate for Payer: PHP Medicare Advantage |
$285.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.69
|
| Rate for Payer: Priority Health Medicare |
$285.16
|
| Rate for Payer: Priority Health Narrow Network |
$718.15
|
| Rate for Payer: Priority Health SBD |
$193.94
|
| Rate for Payer: Railroad Medicare Medicare |
$285.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.16
|
| Rate for Payer: UHC Exchange |
$64.83
|
| Rate for Payer: UHC Medicare Advantage |
$293.71
|
| Rate for Payer: UMR Bronson Commercial |
$113.90
|
| Rate for Payer: VA VA |
$285.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.88
|
|
|
HC IUPC ASSIST
|
Facility
|
IP
|
$117.37
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.64 |
| Max. Negotiated Rate |
$105.63 |
| Rate for Payer: Aetna American Axle |
$76.29
|
| Rate for Payer: Aetna Commercial |
$99.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.29
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cofinity Commercial |
$100.94
|
| Rate for Payer: Cofinity Commercial |
$82.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.90
|
| Rate for Payer: Healthscope Commercial |
$105.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.76
|
| Rate for Payer: PHP Commercial |
$99.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.16
|
| Rate for Payer: Priority Health SBD |
$73.94
|
| Rate for Payer: UMR Bronson Commercial |
$51.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.03
|
|
|
HC IUPC ASSIST
|
Facility
|
OP
|
$117.37
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.43 |
| Max. Negotiated Rate |
$105.63 |
| Rate for Payer: Aetna American Axle |
$76.29
|
| Rate for Payer: Aetna Commercial |
$99.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.29
|
| Rate for Payer: BCBS Complete |
$46.95
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cofinity Commercial |
$100.94
|
| Rate for Payer: Cofinity Commercial |
$82.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.90
|
| Rate for Payer: Healthscope Commercial |
$105.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.76
|
| Rate for Payer: PHP Commercial |
$99.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.16
|
| Rate for Payer: Priority Health SBD |
$73.94
|
| Rate for Payer: UMR Bronson Commercial |
$43.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.03
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
OP
|
$83.74
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna American Axle |
$54.43
|
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.43
|
| Rate for Payer: BCBS Complete |
$33.50
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$58.62
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: Priority Health SBD |
$52.76
|
| Rate for Payer: UMR Bronson Commercial |
$30.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.80
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
IP
|
$83.74
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna American Axle |
$54.43
|
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.43
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$58.62
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: Priority Health SBD |
$52.76
|
| Rate for Payer: UMR Bronson Commercial |
$36.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.80
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
IP
|
$199.58
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$87.82 |
| Max. Negotiated Rate |
$179.62 |
| Rate for Payer: Aetna American Axle |
$129.73
|
| Rate for Payer: Aetna Commercial |
$169.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.73
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cofinity Commercial |
$139.71
|
| Rate for Payer: Cofinity Commercial |
$171.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.66
|
| Rate for Payer: Healthscope Commercial |
$179.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.64
|
| Rate for Payer: PHP Commercial |
$169.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.71
|
| Rate for Payer: Priority Health SBD |
$125.74
|
| Rate for Payer: UMR Bronson Commercial |
$87.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.68
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
OP
|
$199.58
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna American Axle |
$129.73
|
| Rate for Payer: Aetna Commercial |
$169.64
|
| Rate for Payer: Aetna Medicare |
$43.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.78
|
| Rate for Payer: BCBS Complete |
$24.25
|
| Rate for Payer: BCBS MAPPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$68.11
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cofinity Commercial |
$139.71
|
| Rate for Payer: Cofinity Commercial |
$171.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$179.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.68
|
| Rate for Payer: Mclaren Medicaid |
$23.09
|
| Rate for Payer: Mclaren Medicare |
$42.22
|
| Rate for Payer: Meridian Medicaid |
$24.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.64
|
| Rate for Payer: PACE Medicare |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$169.64
|
| Rate for Payer: PHP Medicare Advantage |
$42.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.91
|
| Rate for Payer: Priority Health Medicare |
$42.22
|
| Rate for Payer: Priority Health Narrow Network |
$106.33
|
| Rate for Payer: Priority Health SBD |
$125.74
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.22
|
| Rate for Payer: UHC Exchange |
$12.12
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: UMR Bronson Commercial |
$73.84
|
| Rate for Payer: VA VA |
$42.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.68
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
OP
|
$500.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$599.77 |
| Rate for Payer: Aetna American Axle |
$325.16
|
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: Aetna Medicare |
$198.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$173.83
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cofinity Commercial |
$350.17
|
| Rate for Payer: Cofinity Commercial |
$430.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$450.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.18
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.20
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$425.20
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.77
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$479.82
|
| Rate for Payer: Priority Health SBD |
$315.15
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.94
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.52
|
| Rate for Payer: UHC Exchange |
$31.76
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: UMR Bronson Commercial |
$185.09
|
| Rate for Payer: VA VA |
$190.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.18
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
IP
|
$500.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$220.11 |
| Max. Negotiated Rate |
$450.22 |
| Rate for Payer: Aetna American Axle |
$325.16
|
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.16
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cofinity Commercial |
$350.17
|
| Rate for Payer: Cofinity Commercial |
$430.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Healthscope Commercial |
$450.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$350.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.20
|
| Rate for Payer: PHP Commercial |
$425.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.17
|
| Rate for Payer: Priority Health SBD |
$315.15
|
| Rate for Payer: UMR Bronson Commercial |
$220.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.18
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
IP
|
$126.49
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$55.66 |
| Max. Negotiated Rate |
$113.84 |
| Rate for Payer: Aetna American Axle |
$82.22
|
| Rate for Payer: Aetna Commercial |
$107.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.22
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cofinity Commercial |
$108.78
|
| Rate for Payer: Cofinity Commercial |
$88.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.19
|
| Rate for Payer: Healthscope Commercial |
$113.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.52
|
| Rate for Payer: PHP Commercial |
$107.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.54
|
| Rate for Payer: Priority Health SBD |
$79.69
|
| Rate for Payer: UMR Bronson Commercial |
$55.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.87
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
OP
|
$126.49
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna American Axle |
$82.22
|
| Rate for Payer: Aetna Commercial |
$107.52
|
| Rate for Payer: Aetna Medicare |
$43.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.78
|
| Rate for Payer: BCBS Complete |
$24.25
|
| Rate for Payer: BCBS MAPPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$68.11
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cofinity Commercial |
$108.78
|
| Rate for Payer: Cofinity Commercial |
$88.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$113.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.87
|
| Rate for Payer: Mclaren Medicaid |
$23.09
|
| Rate for Payer: Mclaren Medicare |
$42.22
|
| Rate for Payer: Meridian Medicaid |
$24.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.52
|
| Rate for Payer: PACE Medicare |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$107.52
|
| Rate for Payer: PHP Medicare Advantage |
$42.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.91
|
| Rate for Payer: Priority Health Medicare |
$42.22
|
| Rate for Payer: Priority Health Narrow Network |
$106.33
|
| Rate for Payer: Priority Health SBD |
$79.69
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.33
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.22
|
| Rate for Payer: UHC Exchange |
$12.12
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: UMR Bronson Commercial |
$46.80
|
| Rate for Payer: VA VA |
$42.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.87
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
IP
|
$265.62
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$116.87 |
| Max. Negotiated Rate |
$239.06 |
| Rate for Payer: Aetna American Axle |
$172.65
|
| Rate for Payer: Aetna Commercial |
$225.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.65
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Cofinity Commercial |
$228.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.50
|
| Rate for Payer: Healthscope Commercial |
$239.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.78
|
| Rate for Payer: PHP Commercial |
$225.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.93
|
| Rate for Payer: Priority Health SBD |
$167.34
|
| Rate for Payer: UMR Bronson Commercial |
$116.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.22
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
OP
|
$265.62
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$599.77 |
| Rate for Payer: Aetna American Axle |
$172.65
|
| Rate for Payer: Aetna Commercial |
$225.78
|
| Rate for Payer: Aetna Medicare |
$198.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$173.83
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cofinity Commercial |
$228.43
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$239.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.22
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.78
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$225.78
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.77
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$479.82
|
| Rate for Payer: Priority Health SBD |
$167.34
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.94
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.52
|
| Rate for Payer: UHC Exchange |
$31.76
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: UMR Bronson Commercial |
$98.28
|
| Rate for Payer: VA VA |
$190.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.22
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
OP
|
$674.68
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$607.21 |
| Rate for Payer: Aetna American Axle |
$438.54
|
| Rate for Payer: Aetna Commercial |
$573.48
|
| Rate for Payer: Aetna Medicare |
$198.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$342.27
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$539.74
|
| Rate for Payer: Cash Price |
$539.74
|
| Rate for Payer: Cofinity Commercial |
$580.22
|
| Rate for Payer: Cofinity Commercial |
$472.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$607.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$472.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.01
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.48
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$573.48
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.77
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$479.82
|
| Rate for Payer: Priority Health SBD |
$425.05
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.72
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.52
|
| Rate for Payer: UHC Exchange |
$61.56
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: UMR Bronson Commercial |
$249.63
|
| Rate for Payer: VA VA |
$190.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.01
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
IP
|
$674.68
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$296.86 |
| Max. Negotiated Rate |
$607.21 |
| Rate for Payer: Aetna American Axle |
$438.54
|
| Rate for Payer: Aetna Commercial |
$573.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.54
|
| Rate for Payer: Cash Price |
$539.74
|
| Rate for Payer: Cofinity Commercial |
$472.28
|
| Rate for Payer: Cofinity Commercial |
$580.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.74
|
| Rate for Payer: Healthscope Commercial |
$607.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$472.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.48
|
| Rate for Payer: PHP Commercial |
$573.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.28
|
| Rate for Payer: Priority Health SBD |
$425.05
|
| Rate for Payer: UMR Bronson Commercial |
$296.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.01
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$230.68 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna American Axle |
$340.78
|
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health SBD |
$330.30
|
| Rate for Payer: UMR Bronson Commercial |
$230.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.21
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Aetna American Axle |
$340.78
|
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna Medicare |
$437.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$525.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$525.35
|
| Rate for Payer: BCBS Complete |
$241.41
|
| Rate for Payer: BCBS MAPPO |
$420.28
|
| Rate for Payer: BCN Medicare Advantage |
$420.28
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.28
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.21
|
| Rate for Payer: Mclaren Medicaid |
$229.89
|
| Rate for Payer: Mclaren Medicare |
$420.28
|
| Rate for Payer: Meridian Medicaid |
$241.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Medicare |
$399.27
|
| Rate for Payer: PACE SWMI |
$420.28
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: PHP Medicare Advantage |
$420.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.50
|
| Rate for Payer: Priority Health Medicare |
$420.28
|
| Rate for Payer: Priority Health Narrow Network |
$360.40
|
| Rate for Payer: Priority Health SBD |
$330.30
|
| Rate for Payer: Railroad Medicare Medicare |
$420.28
|
| Rate for Payer: UHC Core |
$47.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.28
|
| Rate for Payer: UHC Medicare Advantage |
$432.89
|
| Rate for Payer: UMR Bronson Commercial |
$193.98
|
| Rate for Payer: VA VA |
$420.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.21
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Aetna American Axle |
$340.78
|
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna Medicare |
$437.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$525.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$525.35
|
| Rate for Payer: BCBS Complete |
$241.41
|
| Rate for Payer: BCBS MAPPO |
$420.28
|
| Rate for Payer: BCN Medicare Advantage |
$420.28
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.28
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.21
|
| Rate for Payer: Mclaren Medicaid |
$229.89
|
| Rate for Payer: Mclaren Medicare |
$420.28
|
| Rate for Payer: Meridian Medicaid |
$241.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$483.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Medicare |
$399.27
|
| Rate for Payer: PACE SWMI |
$420.28
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: PHP Medicare Advantage |
$420.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.50
|
| Rate for Payer: Priority Health Medicare |
$420.28
|
| Rate for Payer: Priority Health Narrow Network |
$360.40
|
| Rate for Payer: Priority Health SBD |
$330.30
|
| Rate for Payer: Railroad Medicare Medicare |
$420.28
|
| Rate for Payer: UHC Core |
$47.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.28
|
| Rate for Payer: UHC Medicare Advantage |
$432.89
|
| Rate for Payer: UMR Bronson Commercial |
$193.98
|
| Rate for Payer: VA VA |
$420.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.21
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$230.68 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna American Axle |
$340.78
|
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health SBD |
$330.30
|
| Rate for Payer: UMR Bronson Commercial |
$230.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.21
|
|
