|
HC IV INFUSION CONCURRENT
|
Facility
|
OP
|
$170.26
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna American Axle |
$110.67
|
| Rate for Payer: Aetna Commercial |
$144.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.67
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS Trust/PPO |
$105.72
|
| Rate for Payer: Cash Price |
$136.21
|
| Rate for Payer: Cash Price |
$136.21
|
| Rate for Payer: Cofinity Commercial |
$146.42
|
| Rate for Payer: Cofinity Commercial |
$119.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.21
|
| Rate for Payer: Healthscope Commercial |
$153.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.72
|
| Rate for Payer: PHP Commercial |
$144.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.18
|
| Rate for Payer: Priority Health SBD |
$107.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.25
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Exchange |
$19.32
|
| Rate for Payer: UMR Bronson Commercial |
$63.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.70
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
IP
|
$170.26
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$153.23 |
| Rate for Payer: Aetna American Axle |
$110.67
|
| Rate for Payer: Aetna Commercial |
$144.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.67
|
| Rate for Payer: Cash Price |
$136.21
|
| Rate for Payer: Cofinity Commercial |
$119.18
|
| Rate for Payer: Cofinity Commercial |
$146.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.21
|
| Rate for Payer: Healthscope Commercial |
$153.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.72
|
| Rate for Payer: PHP Commercial |
$144.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.18
|
| Rate for Payer: Priority Health SBD |
$107.26
|
| Rate for Payer: UMR Bronson Commercial |
$74.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.70
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
IP
|
$190.73
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.92 |
| Max. Negotiated Rate |
$171.66 |
| Rate for Payer: Aetna American Axle |
$123.97
|
| Rate for Payer: Aetna Commercial |
$162.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.97
|
| Rate for Payer: Cash Price |
$152.58
|
| Rate for Payer: Cofinity Commercial |
$133.51
|
| Rate for Payer: Cofinity Commercial |
$164.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.58
|
| Rate for Payer: Healthscope Commercial |
$171.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.12
|
| Rate for Payer: PHP Commercial |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.51
|
| Rate for Payer: Priority Health SBD |
$120.16
|
| Rate for Payer: UMR Bronson Commercial |
$83.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.05
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
OP
|
$190.73
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna American Axle |
$123.97
|
| Rate for Payer: Aetna Commercial |
$162.12
|
| Rate for Payer: Aetna Medicare |
$43.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.97
|
| 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 |
$109.32
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$152.58
|
| Rate for Payer: Cash Price |
$152.58
|
| Rate for Payer: Cofinity Commercial |
$164.03
|
| Rate for Payer: Cofinity Commercial |
$133.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$171.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.05
|
| 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 |
$162.12
|
| Rate for Payer: PACE Medicare |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$162.12
|
| 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 |
$133.51
|
| 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 |
$120.16
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.22
|
| Rate for Payer: UHC Exchange |
$19.97
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: UMR Bronson Commercial |
$70.57
|
| Rate for Payer: VA VA |
$42.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.05
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
OP
|
$524.29
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$599.77 |
| Rate for Payer: Aetna American Axle |
$340.79
|
| Rate for Payer: Aetna Commercial |
$445.65
|
| Rate for Payer: Aetna Medicare |
$198.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.79
|
| 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 |
$419.43
|
| Rate for Payer: Cash Price |
$419.43
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$471.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.22
|
| 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 |
$445.65
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$445.65
|
| 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 |
$367.00
|
| 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 |
$330.30
|
| 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 |
$193.99
|
| Rate for Payer: VA VA |
$190.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.22
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
IP
|
$524.29
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$230.69 |
| Max. Negotiated Rate |
$471.86 |
| Rate for Payer: Aetna American Axle |
$340.79
|
| Rate for Payer: Aetna Commercial |
$445.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.79
|
| Rate for Payer: Cash Price |
$419.43
|
| Rate for Payer: Cofinity Commercial |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.43
|
| Rate for Payer: Healthscope Commercial |
$471.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.65
|
| Rate for Payer: PHP Commercial |
$445.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health SBD |
$330.30
|
| Rate for Payer: UMR Bronson Commercial |
$230.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.22
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
OP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.34 |
| 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: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: Cash Price |
$66.99
|
| 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 LACTATED RINGERS 1000
|
Facility
|
IP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
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 NORMAL SALINE 500 ML
|
Facility
|
OP
|
$85.72
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$77.15 |
| Rate for Payer: Aetna American Axle |
$55.72
|
| Rate for Payer: Aetna Commercial |
$72.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.72
|
| Rate for Payer: BCBS Complete |
$34.29
|
| Rate for Payer: BCBS Trust/PPO |
$4.35
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$73.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$77.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.86
|
| Rate for Payer: PHP Commercial |
$72.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.00
|
| Rate for Payer: Priority Health SBD |
$54.00
|
| Rate for Payer: UMR Bronson Commercial |
$31.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.29
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
IP
|
$85.72
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.72 |
| Max. Negotiated Rate |
$77.15 |
| Rate for Payer: Aetna American Axle |
$55.72
|
| Rate for Payer: Aetna Commercial |
$72.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.72
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$73.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$77.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.86
|
| Rate for Payer: PHP Commercial |
$72.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.00
|
| Rate for Payer: Priority Health SBD |
$54.00
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.29
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
OP
|
$164.43
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$147.99 |
| Rate for Payer: Aetna American Axle |
$106.88
|
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Aetna Medicare |
$43.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.88
|
| 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 |
$82.42
|
| Rate for Payer: BCN Medicare Advantage |
$42.22
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$115.10
|
| Rate for Payer: Cofinity Commercial |
$141.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.22
|
| Rate for Payer: Healthscope Commercial |
$147.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.32
|
| 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 |
$139.77
|
| Rate for Payer: PACE Medicare |
$40.11
|
| Rate for Payer: PACE SWMI |
$42.22
|
| Rate for Payer: PHP Commercial |
$139.77
|
| 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 |
$115.10
|
| 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 |
$103.59
|
| Rate for Payer: Railroad Medicare Medicare |
$42.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.22
|
| Rate for Payer: UHC Exchange |
$15.06
|
| Rate for Payer: UHC Medicare Advantage |
$43.49
|
| Rate for Payer: UMR Bronson Commercial |
$60.84
|
| Rate for Payer: VA VA |
$42.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.32
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
IP
|
$164.43
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.35 |
| Max. Negotiated Rate |
$147.99 |
| Rate for Payer: Aetna American Axle |
$106.88
|
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.88
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$115.10
|
| Rate for Payer: Cofinity Commercial |
$141.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.54
|
| Rate for Payer: Healthscope Commercial |
$147.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.77
|
| Rate for Payer: PHP Commercial |
$139.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.10
|
| Rate for Payer: Priority Health SBD |
$103.59
|
| Rate for Payer: UMR Bronson Commercial |
$72.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.32
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
OP
|
$151.79
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.31 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna American Axle |
$98.66
|
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.66
|
| Rate for Payer: BCBS Complete |
$60.72
|
| Rate for Payer: BCBS Trust/PPO |
$41.31
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.02
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.25
|
| Rate for Payer: Priority Health SBD |
$95.63
|
| Rate for Payer: UMR Bronson Commercial |
$56.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.84
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
IP
|
$151.79
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.79 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna American Axle |
$98.66
|
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.66
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.02
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.25
|
| Rate for Payer: Priority Health SBD |
$95.63
|
| Rate for Payer: UMR Bronson Commercial |
$66.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.84
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
IP
|
$365.26
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$160.71 |
| Max. Negotiated Rate |
$328.73 |
| Rate for Payer: Aetna American Axle |
$237.42
|
| Rate for Payer: Aetna Commercial |
$310.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.42
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cofinity Commercial |
$314.12
|
| Rate for Payer: Cofinity Commercial |
$255.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.21
|
| Rate for Payer: Healthscope Commercial |
$328.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.47
|
| Rate for Payer: PHP Commercial |
$310.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.68
|
| Rate for Payer: Priority Health SBD |
$230.11
|
| Rate for Payer: UMR Bronson Commercial |
$160.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.94
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
OP
|
$365.26
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$328.73 |
| Rate for Payer: Aetna American Axle |
$237.42
|
| Rate for Payer: Aetna Commercial |
$310.47
|
| Rate for Payer: Aetna Medicare |
$65.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.28
|
| Rate for Payer: BCBS Complete |
$35.97
|
| Rate for Payer: BCBS MAPPO |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$295.66
|
| Rate for Payer: BCN Medicare Advantage |
$62.62
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cofinity Commercial |
$255.68
|
| Rate for Payer: Cofinity Commercial |
$314.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.62
|
| Rate for Payer: Healthscope Commercial |
$328.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.94
|
| Rate for Payer: Mclaren Medicaid |
$34.25
|
| Rate for Payer: Mclaren Medicare |
$62.62
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.47
|
| Rate for Payer: PACE Medicare |
$59.49
|
| Rate for Payer: PACE SWMI |
$62.62
|
| Rate for Payer: PHP Commercial |
$310.47
|
| Rate for Payer: PHP Medicare Advantage |
$62.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.12
|
| Rate for Payer: Priority Health Medicare |
$62.62
|
| Rate for Payer: Priority Health Narrow Network |
$157.70
|
| Rate for Payer: Priority Health SBD |
$230.11
|
| Rate for Payer: Railroad Medicare Medicare |
$62.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.71
|
| Rate for Payer: UHC Core |
$284.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.62
|
| Rate for Payer: UHC Exchange |
$53.37
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: UMR Bronson Commercial |
$135.15
|
| Rate for Payer: VA VA |
$62.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.94
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
OP
|
$669.39
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$98.23 |
| Max. Negotiated Rate |
$947.66 |
| Rate for Payer: Aetna American Axle |
$435.10
|
| Rate for Payer: Aetna Commercial |
$568.98
|
| Rate for Payer: Aetna Medicare |
$313.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.29
|
| Rate for Payer: BCBS Complete |
$172.91
|
| Rate for Payer: BCBS MAPPO |
$301.03
|
| Rate for Payer: BCBS Trust/PPO |
$539.36
|
| Rate for Payer: BCN Medicare Advantage |
$301.03
|
| Rate for Payer: Cash Price |
$535.51
|
| Rate for Payer: Cash Price |
$535.51
|
| Rate for Payer: Cofinity Commercial |
$468.57
|
| Rate for Payer: Cofinity Commercial |
$575.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.03
|
| Rate for Payer: Healthscope Commercial |
$602.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.04
|
| Rate for Payer: Mclaren Medicaid |
$164.66
|
| Rate for Payer: Mclaren Medicare |
$301.03
|
| Rate for Payer: Meridian Medicaid |
$172.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.98
|
| Rate for Payer: PACE Medicare |
$285.98
|
| Rate for Payer: PACE SWMI |
$301.03
|
| Rate for Payer: PHP Commercial |
$568.98
|
| Rate for Payer: PHP Medicare Advantage |
$301.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$947.66
|
| Rate for Payer: Priority Health Medicare |
$301.03
|
| Rate for Payer: Priority Health Narrow Network |
$758.13
|
| Rate for Payer: Priority Health SBD |
$421.72
|
| Rate for Payer: Railroad Medicare Medicare |
$301.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.05
|
| Rate for Payer: UHC Core |
$284.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.03
|
| Rate for Payer: UHC Exchange |
$98.23
|
| Rate for Payer: UHC Medicare Advantage |
$310.06
|
| Rate for Payer: UMR Bronson Commercial |
$247.67
|
| Rate for Payer: VA VA |
$301.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.04
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
IP
|
$669.39
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$294.53 |
| Max. Negotiated Rate |
$602.45 |
| Rate for Payer: Aetna American Axle |
$435.10
|
| Rate for Payer: Aetna Commercial |
$568.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.10
|
| Rate for Payer: Cash Price |
$535.51
|
| Rate for Payer: Cofinity Commercial |
$468.57
|
| Rate for Payer: Cofinity Commercial |
$575.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.51
|
| Rate for Payer: Healthscope Commercial |
$602.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.98
|
| Rate for Payer: PHP Commercial |
$568.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.57
|
| Rate for Payer: Priority Health SBD |
$421.72
|
| Rate for Payer: UMR Bronson Commercial |
$294.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.04
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
IP
|
$277.09
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.92 |
| Max. Negotiated Rate |
$249.38 |
| Rate for Payer: Aetna American Axle |
$180.11
|
| Rate for Payer: Aetna Commercial |
$235.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.11
|
| Rate for Payer: Cash Price |
$221.67
|
| Rate for Payer: Cofinity Commercial |
$193.96
|
| Rate for Payer: Cofinity Commercial |
$238.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.67
|
| Rate for Payer: Healthscope Commercial |
$249.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.53
|
| Rate for Payer: PHP Commercial |
$235.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.96
|
| Rate for Payer: Priority Health SBD |
$174.57
|
| Rate for Payer: UMR Bronson Commercial |
$121.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.82
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
OP
|
$277.09
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$599.77 |
| Rate for Payer: Aetna American Axle |
$180.11
|
| Rate for Payer: Aetna Commercial |
$235.53
|
| Rate for Payer: Aetna Medicare |
$198.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.11
|
| 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 |
$198.90
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$221.67
|
| Rate for Payer: Cash Price |
$221.67
|
| Rate for Payer: Cofinity Commercial |
$193.96
|
| Rate for Payer: Cofinity Commercial |
$238.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$249.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.82
|
| 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 |
$235.53
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$235.53
|
| 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 |
$193.96
|
| 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 |
$174.57
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.52
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: UMR Bronson Commercial |
$102.52
|
| Rate for Payer: VA VA |
$190.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.82
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
IP
|
$217.88
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$95.87 |
| Max. Negotiated Rate |
$196.09 |
| Rate for Payer: Aetna American Axle |
$141.62
|
| Rate for Payer: Aetna Commercial |
$185.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.62
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$152.52
|
| Rate for Payer: Cofinity Commercial |
$187.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$196.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.20
|
| Rate for Payer: PHP Commercial |
$185.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health SBD |
$137.26
|
| Rate for Payer: UMR Bronson Commercial |
$95.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.41
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
OP
|
$217.88
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$27.83 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna American Axle |
$141.62
|
| Rate for Payer: Aetna Commercial |
$185.20
|
| Rate for Payer: Aetna Medicare |
$65.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.28
|
| Rate for Payer: BCBS Complete |
$35.97
|
| Rate for Payer: BCBS MAPPO |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$154.09
|
| Rate for Payer: BCN Medicare Advantage |
$62.62
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$152.52
|
| Rate for Payer: Cofinity Commercial |
$187.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.62
|
| Rate for Payer: Healthscope Commercial |
$196.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.41
|
| Rate for Payer: Mclaren Medicaid |
$34.25
|
| Rate for Payer: Mclaren Medicare |
$62.62
|
| Rate for Payer: Meridian Medicaid |
$35.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.20
|
| Rate for Payer: PACE Medicare |
$59.49
|
| Rate for Payer: PACE SWMI |
$62.62
|
| Rate for Payer: PHP Commercial |
$185.20
|
| Rate for Payer: PHP Medicare Advantage |
$62.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.12
|
| Rate for Payer: Priority Health Medicare |
$62.62
|
| Rate for Payer: Priority Health Narrow Network |
$157.70
|
| Rate for Payer: Priority Health SBD |
$137.26
|
| Rate for Payer: Railroad Medicare Medicare |
$62.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.61
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.62
|
| Rate for Payer: UHC Exchange |
$27.83
|
| Rate for Payer: UHC Medicare Advantage |
$64.50
|
| Rate for Payer: UMR Bronson Commercial |
$80.62
|
| Rate for Payer: VA VA |
$62.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.41
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
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 |
$367.00
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| 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/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
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
|
|
