|
HC DIALYSIS CATH LVL 13 LONG TERM
|
Facility
|
OP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$510.62 |
| Max. Negotiated Rate |
$1,242.05 |
| Rate for Payer: Aetna American Axle |
$897.04
|
| Rate for Payer: Aetna Commercial |
$1,173.05
|
| Rate for Payer: Aetna Medicare |
$690.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.04
|
| Rate for Payer: BCBS Complete |
$552.02
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,186.85
|
| Rate for Payer: Cofinity Commercial |
$966.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$966.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Healthscope Commercial |
$1,242.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$966.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: PHP Commercial |
$1,173.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.04
|
| Rate for Payer: Priority Health SBD |
$869.44
|
| Rate for Payer: UMR Bronson Commercial |
$510.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.04
|
|
|
HC DIALYSIS CATH LVL 13 LONG TERM
|
Facility
|
IP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200266
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$607.23 |
| Max. Negotiated Rate |
$1,242.05 |
| Rate for Payer: Aetna American Axle |
$897.04
|
| Rate for Payer: Aetna Commercial |
$1,173.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.04
|
| Rate for Payer: Cash Price |
$1,104.05
|
| Rate for Payer: Cofinity Commercial |
$1,186.85
|
| Rate for Payer: Cofinity Commercial |
$966.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$966.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.05
|
| Rate for Payer: Healthscope Commercial |
$1,242.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$966.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,035.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: PHP Commercial |
$1,173.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.04
|
| Rate for Payer: Priority Health SBD |
$869.44
|
| Rate for Payer: UMR Bronson Commercial |
$607.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.04
|
|
|
HC DIALYSIS CATH LVL 2 SHORT TERM
|
Facility
|
OP
|
$208.07
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$187.26 |
| Rate for Payer: Aetna American Axle |
$135.25
|
| Rate for Payer: Aetna Commercial |
$176.86
|
| Rate for Payer: Aetna Medicare |
$104.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.25
|
| Rate for Payer: BCBS Complete |
$83.23
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$145.65
|
| Rate for Payer: Cofinity Commercial |
$178.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$187.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.86
|
| Rate for Payer: PHP Commercial |
$176.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.25
|
| Rate for Payer: Priority Health SBD |
$131.08
|
| Rate for Payer: UMR Bronson Commercial |
$76.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.05
|
|
|
HC DIALYSIS CATH LVL 2 SHORT TERM
|
Facility
|
IP
|
$208.07
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.55 |
| Max. Negotiated Rate |
$187.26 |
| Rate for Payer: Aetna American Axle |
$135.25
|
| Rate for Payer: Aetna Commercial |
$176.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.25
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$145.65
|
| Rate for Payer: Cofinity Commercial |
$178.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$187.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.86
|
| Rate for Payer: PHP Commercial |
$176.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.25
|
| Rate for Payer: Priority Health SBD |
$131.08
|
| Rate for Payer: UMR Bronson Commercial |
$91.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.05
|
|
|
HC DIALYSIS CATH LVL 3 SHORT TERM
|
Facility
|
IP
|
$315.17
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$283.65 |
| Rate for Payer: Aetna American Axle |
$204.86
|
| Rate for Payer: Aetna Commercial |
$267.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.86
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cofinity Commercial |
$220.62
|
| Rate for Payer: Cofinity Commercial |
$271.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.14
|
| Rate for Payer: Healthscope Commercial |
$283.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: PHP Commercial |
$267.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.86
|
| Rate for Payer: Priority Health SBD |
$198.56
|
| Rate for Payer: UMR Bronson Commercial |
$138.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.38
|
|
|
HC DIALYSIS CATH LVL 3 SHORT TERM
|
Facility
|
OP
|
$315.17
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.61 |
| Max. Negotiated Rate |
$283.65 |
| Rate for Payer: Aetna American Axle |
$204.86
|
| Rate for Payer: Aetna Commercial |
$267.89
|
| Rate for Payer: Aetna Medicare |
$157.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.86
|
| Rate for Payer: BCBS Complete |
$126.07
|
| Rate for Payer: Cash Price |
$252.14
|
| Rate for Payer: Cofinity Commercial |
$220.62
|
| Rate for Payer: Cofinity Commercial |
$271.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$220.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.14
|
| Rate for Payer: Healthscope Commercial |
$283.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.89
|
| Rate for Payer: PHP Commercial |
$267.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.86
|
| Rate for Payer: Priority Health SBD |
$198.56
|
| Rate for Payer: UMR Bronson Commercial |
$116.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.38
|
|
|
HC DIALYSIS CATH LVL 4 SHORT TERM
|
Facility
|
OP
|
$422.27
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.24 |
| Max. Negotiated Rate |
$380.04 |
| Rate for Payer: Aetna American Axle |
$274.48
|
| Rate for Payer: Aetna Commercial |
$358.93
|
| Rate for Payer: Aetna Medicare |
$211.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.48
|
| Rate for Payer: BCBS Complete |
$168.91
|
| Rate for Payer: Cash Price |
$337.82
|
| Rate for Payer: Cofinity Commercial |
$295.59
|
| Rate for Payer: Cofinity Commercial |
$363.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.82
|
| Rate for Payer: Healthscope Commercial |
$380.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.93
|
| Rate for Payer: PHP Commercial |
$358.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.48
|
| Rate for Payer: Priority Health SBD |
$266.03
|
| Rate for Payer: UMR Bronson Commercial |
$156.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.70
|
|
|
HC DIALYSIS CATH LVL 4 SHORT TERM
|
Facility
|
IP
|
$422.27
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$185.80 |
| Max. Negotiated Rate |
$380.04 |
| Rate for Payer: Aetna American Axle |
$274.48
|
| Rate for Payer: Aetna Commercial |
$358.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.48
|
| Rate for Payer: Cash Price |
$337.82
|
| Rate for Payer: Cofinity Commercial |
$295.59
|
| Rate for Payer: Cofinity Commercial |
$363.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$295.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.82
|
| Rate for Payer: Healthscope Commercial |
$380.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.93
|
| Rate for Payer: PHP Commercial |
$358.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.48
|
| Rate for Payer: Priority Health SBD |
$266.03
|
| Rate for Payer: UMR Bronson Commercial |
$185.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.70
|
|
|
HC DIALYSIS CATH LVL 5 SHORT TERM
|
Facility
|
OP
|
$529.37
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.87 |
| Max. Negotiated Rate |
$476.43 |
| Rate for Payer: Aetna American Axle |
$344.09
|
| Rate for Payer: Aetna Commercial |
$449.96
|
| Rate for Payer: Aetna Medicare |
$264.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.09
|
| Rate for Payer: BCBS Complete |
$211.75
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cofinity Commercial |
$370.56
|
| Rate for Payer: Cofinity Commercial |
$455.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.50
|
| Rate for Payer: Healthscope Commercial |
$476.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.96
|
| Rate for Payer: PHP Commercial |
$449.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.09
|
| Rate for Payer: Priority Health SBD |
$333.50
|
| Rate for Payer: UMR Bronson Commercial |
$195.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.03
|
|
|
HC DIALYSIS CATH LVL 5 SHORT TERM
|
Facility
|
IP
|
$529.37
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.92 |
| Max. Negotiated Rate |
$476.43 |
| Rate for Payer: Aetna American Axle |
$344.09
|
| Rate for Payer: Aetna Commercial |
$449.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.09
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Cofinity Commercial |
$370.56
|
| Rate for Payer: Cofinity Commercial |
$455.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$370.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$423.50
|
| Rate for Payer: Healthscope Commercial |
$476.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$370.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.96
|
| Rate for Payer: PHP Commercial |
$449.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.09
|
| Rate for Payer: Priority Health SBD |
$333.50
|
| Rate for Payer: UMR Bronson Commercial |
$232.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.03
|
|
|
HC DIALYSIS CATH LVL 7 LONG TERM
|
Facility
|
OP
|
$743.57
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
27200319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$669.21 |
| Rate for Payer: Aetna American Axle |
$483.32
|
| Rate for Payer: Aetna Commercial |
$632.03
|
| Rate for Payer: Aetna Medicare |
$371.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.32
|
| Rate for Payer: BCBS Complete |
$297.43
|
| Rate for Payer: Cash Price |
$594.86
|
| Rate for Payer: Cofinity Commercial |
$520.50
|
| Rate for Payer: Cofinity Commercial |
$639.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$520.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.86
|
| Rate for Payer: Healthscope Commercial |
$669.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.03
|
| Rate for Payer: PHP Commercial |
$632.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.32
|
| Rate for Payer: Priority Health SBD |
$468.45
|
| Rate for Payer: UMR Bronson Commercial |
$275.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.68
|
|
|
HC DIALYSIS CATH LVL 7 LONG TERM
|
Facility
|
IP
|
$743.57
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
27200319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$327.17 |
| Max. Negotiated Rate |
$669.21 |
| Rate for Payer: Aetna American Axle |
$483.32
|
| Rate for Payer: Aetna Commercial |
$632.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.32
|
| Rate for Payer: Cash Price |
$594.86
|
| Rate for Payer: Cofinity Commercial |
$520.50
|
| Rate for Payer: Cofinity Commercial |
$639.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$520.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$594.86
|
| Rate for Payer: Healthscope Commercial |
$669.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.03
|
| Rate for Payer: PHP Commercial |
$632.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.32
|
| Rate for Payer: Priority Health SBD |
$468.45
|
| Rate for Payer: UMR Bronson Commercial |
$327.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.68
|
|
|
HC DIALYSIS CATH LVL 7 SHORT TERM
|
Facility
|
IP
|
$793.31
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$349.06 |
| Max. Negotiated Rate |
$713.98 |
| Rate for Payer: Aetna American Axle |
$515.65
|
| Rate for Payer: Aetna Commercial |
$674.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.65
|
| Rate for Payer: Cash Price |
$634.65
|
| Rate for Payer: Cofinity Commercial |
$555.32
|
| Rate for Payer: Cofinity Commercial |
$682.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$555.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.65
|
| Rate for Payer: Healthscope Commercial |
$713.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$555.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.31
|
| Rate for Payer: PHP Commercial |
$674.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.65
|
| Rate for Payer: Priority Health SBD |
$499.79
|
| Rate for Payer: UMR Bronson Commercial |
$349.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.98
|
|
|
HC DIALYSIS CATH LVL 7 SHORT TERM
|
Facility
|
OP
|
$793.31
|
|
|
Service Code
|
CPT C1752
|
| Hospital Charge Code |
27200347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$293.52 |
| Max. Negotiated Rate |
$713.98 |
| Rate for Payer: Aetna American Axle |
$515.65
|
| Rate for Payer: Aetna Commercial |
$674.31
|
| Rate for Payer: Aetna Medicare |
$396.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.65
|
| Rate for Payer: BCBS Complete |
$317.32
|
| Rate for Payer: Cash Price |
$634.65
|
| Rate for Payer: Cofinity Commercial |
$555.32
|
| Rate for Payer: Cofinity Commercial |
$682.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$555.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.65
|
| Rate for Payer: Healthscope Commercial |
$713.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$555.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.31
|
| Rate for Payer: PHP Commercial |
$674.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.65
|
| Rate for Payer: Priority Health SBD |
$499.79
|
| Rate for Payer: UMR Bronson Commercial |
$293.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.98
|
|
|
HC DIALYSIS CATH LVL 8 SHORT TERM
|
Facility
|
IP
|
$850.67
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.29 |
| Max. Negotiated Rate |
$765.60 |
| Rate for Payer: Aetna American Axle |
$552.94
|
| Rate for Payer: Aetna Commercial |
$723.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.94
|
| Rate for Payer: Cash Price |
$680.54
|
| Rate for Payer: Cofinity Commercial |
$595.47
|
| Rate for Payer: Cofinity Commercial |
$731.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$595.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.54
|
| Rate for Payer: Healthscope Commercial |
$765.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$595.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.07
|
| Rate for Payer: PHP Commercial |
$723.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.94
|
| Rate for Payer: Priority Health SBD |
$535.92
|
| Rate for Payer: UMR Bronson Commercial |
$374.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.00
|
|
|
HC DIALYSIS CATH LVL 8 SHORT TERM
|
Facility
|
OP
|
$850.67
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200175
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$314.75 |
| Max. Negotiated Rate |
$765.60 |
| Rate for Payer: Aetna American Axle |
$552.94
|
| Rate for Payer: Aetna Commercial |
$723.07
|
| Rate for Payer: Aetna Medicare |
$425.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.94
|
| Rate for Payer: BCBS Complete |
$340.27
|
| Rate for Payer: Cash Price |
$680.54
|
| Rate for Payer: Cofinity Commercial |
$595.47
|
| Rate for Payer: Cofinity Commercial |
$731.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$595.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.54
|
| Rate for Payer: Healthscope Commercial |
$765.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$595.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.07
|
| Rate for Payer: PHP Commercial |
$723.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.94
|
| Rate for Payer: Priority Health SBD |
$535.92
|
| Rate for Payer: UMR Bronson Commercial |
$314.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.00
|
|
|
HC DIALYSIS CATH LVL 9 LONG TERM
|
Facility
|
IP
|
$957.77
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.42 |
| Max. Negotiated Rate |
$861.99 |
| Rate for Payer: Aetna American Axle |
$622.55
|
| Rate for Payer: Aetna Commercial |
$814.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.55
|
| Rate for Payer: Cash Price |
$766.22
|
| Rate for Payer: Cofinity Commercial |
$670.44
|
| Rate for Payer: Cofinity Commercial |
$823.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.22
|
| Rate for Payer: Healthscope Commercial |
$861.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$670.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.10
|
| Rate for Payer: PHP Commercial |
$814.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.55
|
| Rate for Payer: Priority Health SBD |
$603.40
|
| Rate for Payer: UMR Bronson Commercial |
$421.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.33
|
|
|
HC DIALYSIS CATH LVL 9 LONG TERM
|
Facility
|
OP
|
$957.77
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.37 |
| Max. Negotiated Rate |
$861.99 |
| Rate for Payer: Aetna American Axle |
$622.55
|
| Rate for Payer: Aetna Commercial |
$814.10
|
| Rate for Payer: Aetna Medicare |
$478.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.55
|
| Rate for Payer: BCBS Complete |
$383.11
|
| Rate for Payer: Cash Price |
$766.22
|
| Rate for Payer: Cofinity Commercial |
$670.44
|
| Rate for Payer: Cofinity Commercial |
$823.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$670.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.22
|
| Rate for Payer: Healthscope Commercial |
$861.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$670.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$718.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.10
|
| Rate for Payer: PHP Commercial |
$814.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.55
|
| Rate for Payer: Priority Health SBD |
$603.40
|
| Rate for Payer: UMR Bronson Commercial |
$354.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$718.33
|
|
|
HC DIFFUSION
|
Facility
|
OP
|
$396.56
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$51.44 |
| Max. Negotiated Rate |
$356.90 |
| Rate for Payer: Aetna American Axle |
$257.76
|
| Rate for Payer: Aetna Commercial |
$337.08
|
| Rate for Payer: Aetna Medicare |
$198.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.76
|
| Rate for Payer: BCBS Complete |
$158.62
|
| Rate for Payer: BCBS Trust/PPO |
$202.95
|
| Rate for Payer: BCN Commercial |
$202.95
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cofinity Commercial |
$341.04
|
| Rate for Payer: Cofinity Commercial |
$277.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.25
|
| Rate for Payer: Healthscope Commercial |
$356.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.08
|
| Rate for Payer: PHP Commercial |
$337.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.76
|
| Rate for Payer: Priority Health SBD |
$249.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.58
|
| Rate for Payer: UHC Core |
$294.00
|
| Rate for Payer: UHC Exchange |
$51.44
|
| Rate for Payer: UMR Bronson Commercial |
$146.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.42
|
|
|
HC DIFFUSION
|
Facility
|
IP
|
$396.56
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$174.49 |
| Max. Negotiated Rate |
$356.90 |
| Rate for Payer: Aetna American Axle |
$257.76
|
| Rate for Payer: Aetna Commercial |
$337.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.76
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cofinity Commercial |
$277.59
|
| Rate for Payer: Cofinity Commercial |
$341.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.25
|
| Rate for Payer: Healthscope Commercial |
$356.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.08
|
| Rate for Payer: PHP Commercial |
$337.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.76
|
| Rate for Payer: Priority Health SBD |
$249.83
|
| Rate for Payer: UMR Bronson Commercial |
$174.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.42
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
IP
|
$169.32
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.50 |
| Max. Negotiated Rate |
$152.39 |
| Rate for Payer: Aetna American Axle |
$110.06
|
| Rate for Payer: Aetna Commercial |
$143.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.06
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cofinity Commercial |
$118.52
|
| Rate for Payer: Cofinity Commercial |
$145.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Healthscope Commercial |
$152.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.92
|
| Rate for Payer: PHP Commercial |
$143.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.06
|
| Rate for Payer: Priority Health SBD |
$106.67
|
| Rate for Payer: UMR Bronson Commercial |
$74.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.99
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
OP
|
$169.32
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$152.39 |
| Rate for Payer: Aetna American Axle |
$110.06
|
| Rate for Payer: Aetna Commercial |
$143.92
|
| Rate for Payer: Aetna Medicare |
$36.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.51
|
| Rate for Payer: BCBS Complete |
$19.59
|
| Rate for Payer: BCBS MAPPO |
$34.81
|
| Rate for Payer: BCBS Trust/PPO |
$33.54
|
| Rate for Payer: BCN Commercial |
$33.54
|
| Rate for Payer: BCN Medicare Advantage |
$34.81
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cofinity Commercial |
$145.62
|
| Rate for Payer: Cofinity Commercial |
$118.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$152.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.99
|
| Rate for Payer: Mclaren Medicaid |
$18.66
|
| Rate for Payer: Mclaren Medicare |
$34.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.55
|
| Rate for Payer: Meridian Medicaid |
$19.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.92
|
| Rate for Payer: Nomi Health Commercial |
$52.22
|
| Rate for Payer: PACE Medicare |
$33.07
|
| Rate for Payer: PACE SWMI |
$34.81
|
| Rate for Payer: PHP Commercial |
$143.92
|
| Rate for Payer: PHP Medicare Advantage |
$34.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.81
|
| Rate for Payer: Priority Health Medicare |
$34.81
|
| Rate for Payer: Priority Health Narrow Network |
$27.85
|
| Rate for Payer: Priority Health SBD |
$106.67
|
| Rate for Payer: Railroad Medicare Medicare |
$34.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.81
|
| Rate for Payer: UHC Exchange |
$34.81
|
| Rate for Payer: UHC Medicare Advantage |
$34.81
|
| Rate for Payer: UHCCP Medicaid |
$18.66
|
| Rate for Payer: UMR Bronson Commercial |
$62.65
|
| Rate for Payer: VA VA |
$34.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.99
|
|
|
HC DIGOXIN LVL
|
Facility
|
IP
|
$91.87
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.42 |
| Max. Negotiated Rate |
$82.68 |
| Rate for Payer: Aetna American Axle |
$59.72
|
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.72
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$64.31
|
| Rate for Payer: Cofinity Commercial |
$79.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.50
|
| Rate for Payer: Healthscope Commercial |
$82.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: PHP Commercial |
$78.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: Priority Health SBD |
$57.88
|
| Rate for Payer: UMR Bronson Commercial |
$40.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.90
|
|
|
HC DIGOXIN LVL
|
Facility
|
OP
|
$91.87
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$82.68 |
| Rate for Payer: Aetna American Axle |
$59.72
|
| Rate for Payer: Aetna Commercial |
$78.09
|
| Rate for Payer: Aetna Medicare |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.60
|
| Rate for Payer: BCBS Complete |
$7.47
|
| Rate for Payer: BCBS MAPPO |
$13.28
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: BCN Medicare Advantage |
$13.28
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$79.01
|
| Rate for Payer: Cofinity Commercial |
$64.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$82.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.90
|
| Rate for Payer: Mclaren Medicaid |
$7.12
|
| Rate for Payer: Mclaren Medicare |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.94
|
| Rate for Payer: Meridian Medicaid |
$7.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.09
|
| Rate for Payer: Nomi Health Commercial |
$19.92
|
| Rate for Payer: PACE Medicare |
$12.62
|
| Rate for Payer: PACE SWMI |
$13.28
|
| Rate for Payer: PHP Commercial |
$78.09
|
| Rate for Payer: PHP Medicare Advantage |
$13.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.66
|
| Rate for Payer: Priority Health Medicare |
$13.28
|
| Rate for Payer: Priority Health Narrow Network |
$10.93
|
| Rate for Payer: Priority Health SBD |
$57.88
|
| Rate for Payer: Railroad Medicare Medicare |
$13.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.28
|
| Rate for Payer: UHC Exchange |
$13.28
|
| Rate for Payer: UHC Medicare Advantage |
$13.28
|
| Rate for Payer: UHCCP Medicaid |
$7.12
|
| Rate for Payer: UMR Bronson Commercial |
$33.99
|
| Rate for Payer: VA VA |
$13.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.90
|
|
|
HC DILANTIN LEVEL
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: UMR Bronson Commercial |
$16.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
