|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
OP
|
$204.69
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.74 |
| Max. Negotiated Rate |
$184.22 |
| Rate for Payer: Aetna American Axle |
$133.05
|
| Rate for Payer: Aetna Commercial |
$173.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.05
|
| Rate for Payer: BCBS Complete |
$81.88
|
| Rate for Payer: BCBS Trust/PPO |
$119.91
|
| Rate for Payer: Cash Price |
$163.75
|
| Rate for Payer: Cash Price |
$163.75
|
| Rate for Payer: Cofinity Commercial |
$176.03
|
| Rate for Payer: Cofinity Commercial |
$143.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.75
|
| Rate for Payer: Healthscope Commercial |
$184.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.99
|
| Rate for Payer: PHP Commercial |
$173.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.28
|
| Rate for Payer: Priority Health SBD |
$128.95
|
| Rate for Payer: UMR Bronson Commercial |
$75.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.52
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
IP
|
$204.69
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.06 |
| Max. Negotiated Rate |
$184.22 |
| Rate for Payer: Aetna American Axle |
$133.05
|
| Rate for Payer: Aetna Commercial |
$173.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.05
|
| Rate for Payer: Cash Price |
$163.75
|
| Rate for Payer: Cofinity Commercial |
$143.28
|
| Rate for Payer: Cofinity Commercial |
$176.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.75
|
| Rate for Payer: Healthscope Commercial |
$184.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.99
|
| Rate for Payer: PHP Commercial |
$173.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.28
|
| Rate for Payer: Priority Health SBD |
$128.95
|
| Rate for Payer: UMR Bronson Commercial |
$90.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.52
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
OP
|
$1,084.60
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.27 |
| Max. Negotiated Rate |
$976.14 |
| Rate for Payer: Aetna American Axle |
$704.99
|
| Rate for Payer: Aetna Commercial |
$921.91
|
| Rate for Payer: Aetna Medicare |
$175.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$704.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.86
|
| Rate for Payer: BCBS Complete |
$96.90
|
| Rate for Payer: BCBS MAPPO |
$168.69
|
| Rate for Payer: BCBS Trust/PPO |
$600.12
|
| Rate for Payer: BCN Medicare Advantage |
$168.69
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cofinity Commercial |
$932.76
|
| Rate for Payer: Cofinity Commercial |
$759.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$867.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.69
|
| Rate for Payer: Healthscope Commercial |
$976.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$759.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$813.45
|
| Rate for Payer: Mclaren Medicaid |
$92.27
|
| Rate for Payer: Mclaren Medicare |
$168.69
|
| Rate for Payer: Meridian Medicaid |
$96.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$921.91
|
| Rate for Payer: PACE Medicare |
$160.26
|
| Rate for Payer: PACE SWMI |
$168.69
|
| Rate for Payer: PHP Commercial |
$921.91
|
| Rate for Payer: PHP Medicare Advantage |
$168.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$531.04
|
| Rate for Payer: Priority Health Medicare |
$168.69
|
| Rate for Payer: Priority Health Narrow Network |
$424.83
|
| Rate for Payer: Priority Health SBD |
$683.30
|
| Rate for Payer: Railroad Medicare Medicare |
$168.69
|
| Rate for Payer: UHC Core |
$446.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.69
|
| Rate for Payer: UHC Medicare Advantage |
$173.75
|
| Rate for Payer: UMR Bronson Commercial |
$401.30
|
| Rate for Payer: VA VA |
$168.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$813.45
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
IP
|
$1,084.60
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$477.22 |
| Max. Negotiated Rate |
$976.14 |
| Rate for Payer: Aetna American Axle |
$704.99
|
| Rate for Payer: Aetna Commercial |
$921.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$704.99
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cofinity Commercial |
$759.22
|
| Rate for Payer: Cofinity Commercial |
$932.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$867.68
|
| Rate for Payer: Healthscope Commercial |
$976.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$759.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$813.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$921.91
|
| Rate for Payer: PHP Commercial |
$921.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.22
|
| Rate for Payer: Priority Health SBD |
$683.30
|
| Rate for Payer: UMR Bronson Commercial |
$477.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$813.45
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC REDTOP BENT GRASS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna American Axle |
$16.18
|
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.16
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$5.73
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.21
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna American Axle |
$5.85
|
| Rate for Payer: Aetna Commercial |
$7.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.85
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$6.30
|
| Rate for Payer: Cofinity Commercial |
$7.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.65
|
| Rate for Payer: PHP Commercial |
$7.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.30
|
| Rate for Payer: Priority Health SBD |
$5.67
|
| Rate for Payer: UMR Bronson Commercial |
$3.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.75
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna American Axle |
$5.85
|
| Rate for Payer: Aetna Commercial |
$7.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.85
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$6.30
|
| Rate for Payer: Cofinity Commercial |
$7.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.65
|
| Rate for Payer: PHP Commercial |
$7.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.30
|
| Rate for Payer: Priority Health SBD |
$5.67
|
| Rate for Payer: UMR Bronson Commercial |
$3.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.75
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
IP
|
$430.05
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$189.22 |
| Max. Negotiated Rate |
$387.04 |
| Rate for Payer: Aetna American Axle |
$279.53
|
| Rate for Payer: Aetna American Axle |
$227.63
|
| Rate for Payer: Aetna Commercial |
$297.67
|
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.53
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cash Price |
$280.16
|
| Rate for Payer: Cofinity Commercial |
$301.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Cofinity Commercial |
$245.14
|
| Rate for Payer: Cofinity Commercial |
$301.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.16
|
| Rate for Payer: Healthscope Commercial |
$387.04
|
| Rate for Payer: Healthscope Commercial |
$315.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.67
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: PHP Commercial |
$297.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.14
|
| Rate for Payer: Priority Health SBD |
$270.93
|
| Rate for Payer: Priority Health SBD |
$220.63
|
| Rate for Payer: UMR Bronson Commercial |
$154.09
|
| Rate for Payer: UMR Bronson Commercial |
$189.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
OP
|
$350.20
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$623.58 |
| Rate for Payer: Aetna American Axle |
$227.63
|
| Rate for Payer: Aetna American Axle |
$279.53
|
| Rate for Payer: Aetna Commercial |
$297.67
|
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: Aetna Medicare |
$198.14
|
| Rate for Payer: Aetna Medicare |
$198.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$623.58
|
| Rate for Payer: BCBS Trust/PPO |
$623.58
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cash Price |
$280.16
|
| Rate for Payer: Cash Price |
$280.16
|
| Rate for Payer: Cofinity Commercial |
$301.17
|
| Rate for Payer: Cofinity Commercial |
$245.14
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Cofinity Commercial |
$301.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$387.04
|
| Rate for Payer: Healthscope Commercial |
$315.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.67
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: PHP Commercial |
$297.67
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.77
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$479.82
|
| Rate for Payer: Priority Health Narrow Network |
$479.82
|
| Rate for Payer: Priority Health SBD |
$270.93
|
| Rate for Payer: Priority Health SBD |
$220.63
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.15
|
| Rate for Payer: UHC Core |
$284.00
|
| Rate for Payer: UHC Core |
$284.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.52
|
| Rate for Payer: UHC Exchange |
$115.59
|
| Rate for Payer: UHC Exchange |
$115.59
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: UMR Bronson Commercial |
$159.12
|
| Rate for Payer: UMR Bronson Commercial |
$129.57
|
| Rate for Payer: VA VA |
$190.52
|
| Rate for Payer: VA VA |
$190.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
IP
|
$350.20
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$154.09 |
| Max. Negotiated Rate |
$315.18 |
| Rate for Payer: Aetna American Axle |
$227.63
|
| Rate for Payer: Aetna American Axle |
$562.06
|
| Rate for Payer: Aetna Commercial |
$297.67
|
| Rate for Payer: Aetna Commercial |
$735.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.63
|
| Rate for Payer: Cash Price |
$691.76
|
| Rate for Payer: Cash Price |
$280.16
|
| Rate for Payer: Cofinity Commercial |
$743.64
|
| Rate for Payer: Cofinity Commercial |
$301.17
|
| Rate for Payer: Cofinity Commercial |
$245.14
|
| Rate for Payer: Cofinity Commercial |
$605.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.76
|
| Rate for Payer: Healthscope Commercial |
$778.23
|
| Rate for Payer: Healthscope Commercial |
$315.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$735.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.67
|
| Rate for Payer: PHP Commercial |
$735.00
|
| Rate for Payer: PHP Commercial |
$297.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$605.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.14
|
| Rate for Payer: Priority Health SBD |
$544.76
|
| Rate for Payer: Priority Health SBD |
$220.63
|
| Rate for Payer: UMR Bronson Commercial |
$154.09
|
| Rate for Payer: UMR Bronson Commercial |
$380.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.65
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
OP
|
$864.70
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$778.23 |
| Rate for Payer: Aetna American Axle |
$562.06
|
| Rate for Payer: Aetna American Axle |
$227.63
|
| Rate for Payer: Aetna Commercial |
$297.67
|
| Rate for Payer: Aetna Commercial |
$735.00
|
| Rate for Payer: Aetna Medicare |
$198.14
|
| Rate for Payer: Aetna Medicare |
$198.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$238.15
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS Complete |
$109.43
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS MAPPO |
$190.52
|
| Rate for Payer: BCBS Trust/PPO |
$675.54
|
| Rate for Payer: BCBS Trust/PPO |
$675.54
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: BCN Medicare Advantage |
$190.52
|
| Rate for Payer: Cash Price |
$691.76
|
| Rate for Payer: Cash Price |
$691.76
|
| Rate for Payer: Cash Price |
$280.16
|
| Rate for Payer: Cash Price |
$280.16
|
| Rate for Payer: Cofinity Commercial |
$743.64
|
| Rate for Payer: Cofinity Commercial |
$245.14
|
| Rate for Payer: Cofinity Commercial |
$301.17
|
| Rate for Payer: Cofinity Commercial |
$605.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.52
|
| Rate for Payer: Healthscope Commercial |
$315.18
|
| Rate for Payer: Healthscope Commercial |
$778.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.52
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicaid |
$104.21
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Mclaren Medicare |
$190.52
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Medicaid |
$109.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$200.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$735.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.67
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE Medicare |
$180.99
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PACE SWMI |
$190.52
|
| Rate for Payer: PHP Commercial |
$735.00
|
| Rate for Payer: PHP Commercial |
$297.67
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: PHP Medicare Advantage |
$190.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$605.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.77
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Medicare |
$190.52
|
| Rate for Payer: Priority Health Narrow Network |
$479.82
|
| Rate for Payer: Priority Health Narrow Network |
$479.82
|
| Rate for Payer: Priority Health SBD |
$544.76
|
| Rate for Payer: Priority Health SBD |
$220.63
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: Railroad Medicare Medicare |
$190.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.99
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.52
|
| Rate for Payer: UHC Exchange |
$121.81
|
| Rate for Payer: UHC Exchange |
$121.81
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: UHC Medicare Advantage |
$196.24
|
| Rate for Payer: UMR Bronson Commercial |
$129.57
|
| Rate for Payer: UMR Bronson Commercial |
$319.94
|
| Rate for Payer: VA VA |
$190.52
|
| Rate for Payer: VA VA |
$190.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.52
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
OP
|
$413.30
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$835.79 |
| Rate for Payer: Aetna American Axle |
$268.64
|
| Rate for Payer: Aetna Commercial |
$351.30
|
| Rate for Payer: Aetna Medicare |
$276.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$331.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$331.88
|
| Rate for Payer: BCBS Complete |
$152.50
|
| Rate for Payer: BCBS MAPPO |
$265.50
|
| Rate for Payer: BCBS Trust/PPO |
$295.85
|
| Rate for Payer: BCN Medicare Advantage |
$265.50
|
| Rate for Payer: Cash Price |
$330.64
|
| Rate for Payer: Cash Price |
$330.64
|
| Rate for Payer: Cofinity Commercial |
$289.31
|
| Rate for Payer: Cofinity Commercial |
$355.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.50
|
| Rate for Payer: Healthscope Commercial |
$371.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.98
|
| Rate for Payer: Mclaren Medicaid |
$145.23
|
| Rate for Payer: Mclaren Medicare |
$265.50
|
| Rate for Payer: Meridian Medicaid |
$152.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$278.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$305.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.30
|
| Rate for Payer: PACE Medicare |
$252.22
|
| Rate for Payer: PACE SWMI |
$265.50
|
| Rate for Payer: PHP Commercial |
$351.30
|
| Rate for Payer: PHP Medicare Advantage |
$265.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$835.79
|
| Rate for Payer: Priority Health Medicare |
$265.50
|
| Rate for Payer: Priority Health Narrow Network |
$668.63
|
| Rate for Payer: Priority Health SBD |
$260.38
|
| Rate for Payer: Railroad Medicare Medicare |
$265.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.98
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$265.50
|
| Rate for Payer: UHC Exchange |
$44.53
|
| Rate for Payer: UHC Medicare Advantage |
$273.46
|
| Rate for Payer: UMR Bronson Commercial |
$152.92
|
| Rate for Payer: VA VA |
$265.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.98
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
IP
|
$413.30
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$181.85 |
| Max. Negotiated Rate |
$371.97 |
| Rate for Payer: Aetna American Axle |
$268.64
|
| Rate for Payer: Aetna Commercial |
$351.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.64
|
| Rate for Payer: Cash Price |
$330.64
|
| Rate for Payer: Cofinity Commercial |
$289.31
|
| Rate for Payer: Cofinity Commercial |
$355.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.64
|
| Rate for Payer: Healthscope Commercial |
$371.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.30
|
| Rate for Payer: PHP Commercial |
$351.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.31
|
| Rate for Payer: Priority Health SBD |
$260.38
|
| Rate for Payer: UMR Bronson Commercial |
$181.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.98
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
OP
|
$151.98
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$136.78 |
| Rate for Payer: Aetna American Axle |
$98.79
|
| Rate for Payer: Aetna Commercial |
$129.18
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$11.57
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$121.58
|
| Rate for Payer: Cash Price |
$121.58
|
| Rate for Payer: Cofinity Commercial |
$130.70
|
| Rate for Payer: Cofinity Commercial |
$106.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$136.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.98
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.18
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$129.18
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.66
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$14.13
|
| Rate for Payer: Priority Health SBD |
$95.75
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$21.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Exchange |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: UMR Bronson Commercial |
$56.23
|
| Rate for Payer: VA VA |
$12.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.98
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
IP
|
$151.98
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$66.87 |
| Max. Negotiated Rate |
$136.78 |
| Rate for Payer: Aetna American Axle |
$98.79
|
| Rate for Payer: Aetna Commercial |
$129.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.79
|
| Rate for Payer: Cash Price |
$121.58
|
| Rate for Payer: Cofinity Commercial |
$106.39
|
| Rate for Payer: Cofinity Commercial |
$130.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.58
|
| Rate for Payer: Healthscope Commercial |
$136.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.18
|
| Rate for Payer: PHP Commercial |
$129.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.39
|
| Rate for Payer: Priority Health SBD |
$95.75
|
| Rate for Payer: UMR Bronson Commercial |
$66.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.98
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
OP
|
$314.16
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$282.74 |
| Rate for Payer: Aetna American Axle |
$204.20
|
| Rate for Payer: Aetna Commercial |
$267.04
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$11.57
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$251.33
|
| Rate for Payer: Cash Price |
$251.33
|
| Rate for Payer: Cofinity Commercial |
$219.91
|
| Rate for Payer: Cofinity Commercial |
$270.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$282.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.62
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.04
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$267.04
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.66
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$14.13
|
| Rate for Payer: Priority Health SBD |
$197.92
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$21.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Exchange |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: UMR Bronson Commercial |
$116.24
|
| Rate for Payer: VA VA |
$12.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.62
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
IP
|
$314.16
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$138.23 |
| Max. Negotiated Rate |
$282.74 |
| Rate for Payer: Aetna American Axle |
$204.20
|
| Rate for Payer: Aetna Commercial |
$267.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.20
|
| Rate for Payer: Cash Price |
$251.33
|
| Rate for Payer: Cofinity Commercial |
$219.91
|
| Rate for Payer: Cofinity Commercial |
$270.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.33
|
| Rate for Payer: Healthscope Commercial |
$282.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.04
|
| Rate for Payer: PHP Commercial |
$267.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.91
|
| Rate for Payer: Priority Health SBD |
$197.92
|
| Rate for Payer: UMR Bronson Commercial |
$138.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.62
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
IP
|
$115.47
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$50.81 |
| Max. Negotiated Rate |
$103.92 |
| Rate for Payer: Aetna American Axle |
$75.06
|
| Rate for Payer: Aetna Commercial |
$98.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.06
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Commercial |
$80.83
|
| Rate for Payer: Cofinity Commercial |
$99.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Healthscope Commercial |
$103.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.15
|
| Rate for Payer: PHP Commercial |
$98.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.83
|
| Rate for Payer: Priority Health SBD |
$72.75
|
| Rate for Payer: UMR Bronson Commercial |
$50.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.60
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
OP
|
$115.47
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$103.92 |
| Rate for Payer: Aetna American Axle |
$75.06
|
| Rate for Payer: Aetna Commercial |
$98.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.06
|
| Rate for Payer: BCBS Complete |
$46.19
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Commercial |
$80.83
|
| Rate for Payer: Cofinity Commercial |
$99.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Healthscope Commercial |
$103.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.15
|
| Rate for Payer: PHP Commercial |
$98.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.83
|
| Rate for Payer: Priority Health SBD |
$72.75
|
| Rate for Payer: UMR Bronson Commercial |
$42.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.60
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
OP
|
$584.10
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$216.12 |
| Max. Negotiated Rate |
$525.69 |
| Rate for Payer: Aetna American Axle |
$379.66
|
| Rate for Payer: Aetna Commercial |
$496.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.66
|
| Rate for Payer: BCBS Complete |
$233.64
|
| Rate for Payer: Cash Price |
$467.28
|
| Rate for Payer: Cofinity Commercial |
$408.87
|
| Rate for Payer: Cofinity Commercial |
$502.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.28
|
| Rate for Payer: Healthscope Commercial |
$525.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$408.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.48
|
| Rate for Payer: PHP Commercial |
$496.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.87
|
| Rate for Payer: Priority Health SBD |
$367.98
|
| Rate for Payer: UMR Bronson Commercial |
$216.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.08
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
IP
|
$584.10
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$257.00 |
| Max. Negotiated Rate |
$525.69 |
| Rate for Payer: Aetna American Axle |
$379.66
|
| Rate for Payer: Aetna Commercial |
$496.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.66
|
| Rate for Payer: Cash Price |
$467.28
|
| Rate for Payer: Cofinity Commercial |
$408.87
|
| Rate for Payer: Cofinity Commercial |
$502.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.28
|
| Rate for Payer: Healthscope Commercial |
$525.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$408.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.48
|
| Rate for Payer: PHP Commercial |
$496.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.87
|
| Rate for Payer: Priority Health SBD |
$367.98
|
| Rate for Payer: UMR Bronson Commercial |
$257.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.08
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$246.31 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$34.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.90
|
| Rate for Payer: BCBS Complete |
$19.25
|
| Rate for Payer: BCBS MAPPO |
$33.52
|
| Rate for Payer: BCBS Trust/PPO |
$246.31
|
| Rate for Payer: BCN Medicare Advantage |
$33.52
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Mclaren Medicaid |
$18.34
|
| Rate for Payer: Mclaren Medicare |
$33.52
|
| Rate for Payer: Meridian Medicaid |
$19.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Medicare |
$31.84
|
| Rate for Payer: PACE SWMI |
$33.52
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$33.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.53
|
| Rate for Payer: Priority Health Medicare |
$33.52
|
| Rate for Payer: Priority Health Narrow Network |
$84.42
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: Railroad Medicare Medicare |
$33.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.52
|
| Rate for Payer: UHC Exchange |
$46.50
|
| Rate for Payer: UHC Medicare Advantage |
$34.53
|
| Rate for Payer: UMR Bronson Commercial |
$38.85
|
| Rate for Payer: VA VA |
$33.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST DEV SUPPLY EA 30 D
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: UMR Bronson Commercial |
$46.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
51000111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$369.91 |
| Rate for Payer: Aetna American Axle |
$221.00
|
| Rate for Payer: Aetna Commercial |
$289.00
|
| Rate for Payer: Aetna Medicare |
$122.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.88
|
| Rate for Payer: BCBS Complete |
$67.49
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCBS Trust/PPO |
$92.17
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$238.00
|
| Rate for Payer: Cofinity Commercial |
$292.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$306.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.00
|
| Rate for Payer: Mclaren Medicaid |
$64.27
|
| Rate for Payer: Mclaren Medicare |
$117.50
|
| Rate for Payer: Meridian Medicaid |
$67.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.00
|
| Rate for Payer: PACE Medicare |
$111.62
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Commercial |
$289.00
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.91
|
| Rate for Payer: Priority Health Medicare |
$117.50
|
| Rate for Payer: Priority Health Narrow Network |
$295.93
|
| Rate for Payer: Priority Health SBD |
$214.20
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.50
|
| Rate for Payer: UHC Exchange |
$19.65
|
| Rate for Payer: UHC Medicare Advantage |
$121.02
|
| Rate for Payer: UMR Bronson Commercial |
$125.80
|
| Rate for Payer: VA VA |
$117.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.00
|
|
