|
HC INFLUENZA VIRUS VAC, TRIVALENT (RIV3), PF IM
|
Facility
|
OP
|
$111.18
|
|
|
Service Code
|
CPT 90673
|
| Hospital Charge Code |
63600249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$274.44 |
| Rate for Payer: Aetna American Axle |
$72.27
|
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Medicare |
$55.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.27
|
| Rate for Payer: BCBS Complete |
$44.47
|
| Rate for Payer: BCBS Trust/PPO |
$274.44
|
| Rate for Payer: BCN Commercial |
$274.44
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cofinity Advantage |
$77.83
|
| Rate for Payer: Cofinity Commercial |
$95.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.94
|
| Rate for Payer: Healthscope Commercial |
$100.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.39
|
| Rate for Payer: PHP Commercial |
$94.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$98.16
|
| Rate for Payer: Priority Health SBD |
$70.04
|
| Rate for Payer: Priority Health Tiered Network |
$78.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.96
|
| Rate for Payer: UHC Core |
$161.96
|
| Rate for Payer: UHC Exchange |
$161.96
|
| Rate for Payer: UMR Bronson Commercial |
$41.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.39
|
|
|
HC INF PUMP PROGRAMMABLE LVL 6
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
27800141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.30 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna American Axle |
$448.50
|
| Rate for Payer: Aetna Commercial |
$586.50
|
| Rate for Payer: Aetna Medicare |
$345.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.50
|
| Rate for Payer: BCBS Complete |
$276.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Advantage |
$483.00
|
| Rate for Payer: Cofinity Commercial |
$593.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.00
|
| Rate for Payer: Healthscope Commercial |
$621.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$552.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.50
|
| Rate for Payer: PHP Commercial |
$586.50
|
| Rate for Payer: Priority Health SBD |
$434.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.50
|
| Rate for Payer: UHC Core |
$359.49
|
| Rate for Payer: UHC Exchange |
$271.17
|
| Rate for Payer: UMR Bronson Commercial |
$255.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.50
|
|
|
HC INF PUMP PROGRAMMABLE LVL 6
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
27800141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.60 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna American Axle |
$448.50
|
| Rate for Payer: Aetna Commercial |
$586.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.50
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Advantage |
$483.00
|
| Rate for Payer: Cofinity Commercial |
$593.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.00
|
| Rate for Payer: Healthscope Commercial |
$621.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$483.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.50
|
| Rate for Payer: PHP Commercial |
$586.50
|
| Rate for Payer: Priority Health SBD |
$434.70
|
| Rate for Payer: UMR Bronson Commercial |
$303.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.50
|
|
|
HC INFRARED THERAPY
|
Facility
|
OP
|
$59.80
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna American Axle |
$38.87
|
| Rate for Payer: Aetna Commercial |
$50.83
|
| Rate for Payer: Aetna Medicare |
$29.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.87
|
| Rate for Payer: BCBS Complete |
$23.92
|
| Rate for Payer: BCBS Trust/PPO |
$6.35
|
| Rate for Payer: BCN Commercial |
$6.35
|
| Rate for Payer: Cash Price |
$47.84
|
| Rate for Payer: Cash Price |
$47.84
|
| Rate for Payer: Cash Price |
$47.84
|
| Rate for Payer: Cofinity Advantage |
$41.86
|
| Rate for Payer: Cofinity Commercial |
$51.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.84
|
| Rate for Payer: Healthscope Commercial |
$53.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.83
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.85
|
| Rate for Payer: PHP Commercial |
$50.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.00
|
| Rate for Payer: Priority Health SBD |
$37.67
|
| Rate for Payer: Priority Health Tiered Network |
$4.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.87
|
| Rate for Payer: UHC Core |
$31.16
|
| Rate for Payer: UHC Exchange |
$23.50
|
| Rate for Payer: UMR Bronson Commercial |
$22.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.85
|
|
|
HC INFRARED THERAPY
|
Facility
|
IP
|
$59.80
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$53.82 |
| Rate for Payer: Aetna American Axle |
$38.87
|
| Rate for Payer: Aetna Commercial |
$50.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.87
|
| Rate for Payer: Cash Price |
$47.84
|
| Rate for Payer: Cofinity Advantage |
$41.86
|
| Rate for Payer: Cofinity Commercial |
$51.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.84
|
| Rate for Payer: Healthscope Commercial |
$53.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.85
|
| Rate for Payer: PHP Commercial |
$50.83
|
| Rate for Payer: Priority Health SBD |
$37.67
|
| Rate for Payer: UMR Bronson Commercial |
$26.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.85
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
IP
|
$160.65
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.69 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Aetna American Axle |
$104.42
|
| Rate for Payer: Aetna Commercial |
$136.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.42
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Cofinity Advantage |
$112.45
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Healthscope Commercial |
$144.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.49
|
| Rate for Payer: PHP Commercial |
$136.55
|
| Rate for Payer: Priority Health SBD |
$101.21
|
| Rate for Payer: UMR Bronson Commercial |
$70.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.49
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
OP
|
$160.65
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Aetna American Axle |
$104.42
|
| Rate for Payer: Aetna Commercial |
$136.55
|
| Rate for Payer: Aetna Medicare |
$80.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.42
|
| Rate for Payer: BCBS Complete |
$64.26
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Cofinity Advantage |
$112.45
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Healthscope Commercial |
$144.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.49
|
| Rate for Payer: PHP Commercial |
$136.55
|
| Rate for Payer: Priority Health SBD |
$101.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.42
|
| Rate for Payer: UHC Core |
$83.70
|
| Rate for Payer: UHC Exchange |
$63.14
|
| Rate for Payer: UMR Bronson Commercial |
$59.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.49
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
IP
|
$241.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.42 |
| Max. Negotiated Rate |
$217.67 |
| Rate for Payer: Aetna American Axle |
$157.21
|
| Rate for Payer: Aetna Commercial |
$205.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.21
|
| Rate for Payer: Cash Price |
$193.49
|
| Rate for Payer: Cofinity Advantage |
$169.30
|
| Rate for Payer: Cofinity Commercial |
$208.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.49
|
| Rate for Payer: Healthscope Commercial |
$217.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.40
|
| Rate for Payer: PHP Commercial |
$205.58
|
| Rate for Payer: Priority Health SBD |
$152.37
|
| Rate for Payer: UMR Bronson Commercial |
$106.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.40
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
OP
|
$241.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.49 |
| Max. Negotiated Rate |
$217.67 |
| Rate for Payer: Aetna American Axle |
$157.21
|
| Rate for Payer: Aetna Commercial |
$205.58
|
| Rate for Payer: Aetna Medicare |
$120.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.21
|
| Rate for Payer: BCBS Complete |
$96.74
|
| Rate for Payer: Cash Price |
$193.49
|
| Rate for Payer: Cofinity Advantage |
$169.30
|
| Rate for Payer: Cofinity Commercial |
$208.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.49
|
| Rate for Payer: Healthscope Commercial |
$217.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.40
|
| Rate for Payer: PHP Commercial |
$205.58
|
| Rate for Payer: Priority Health SBD |
$152.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.21
|
| Rate for Payer: UHC Core |
$126.01
|
| Rate for Payer: UHC Exchange |
$95.05
|
| Rate for Payer: UMR Bronson Commercial |
$89.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.40
|
|
|
HC INFUSION CATHETER LVL 3
|
Facility
|
IP
|
$396.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.64 |
| Max. Negotiated Rate |
$357.21 |
| Rate for Payer: Aetna American Axle |
$257.99
|
| Rate for Payer: Aetna Commercial |
$337.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.99
|
| Rate for Payer: Cash Price |
$317.52
|
| Rate for Payer: Cofinity Advantage |
$277.83
|
| Rate for Payer: Cofinity Commercial |
$341.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.52
|
| Rate for Payer: Healthscope Commercial |
$357.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.68
|
| Rate for Payer: PHP Commercial |
$337.37
|
| Rate for Payer: Priority Health SBD |
$250.05
|
| Rate for Payer: UMR Bronson Commercial |
$174.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.68
|
|
|
HC INFUSION CATHETER LVL 3
|
Facility
|
OP
|
$396.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.85 |
| Max. Negotiated Rate |
$357.21 |
| Rate for Payer: Aetna American Axle |
$257.99
|
| Rate for Payer: Aetna Commercial |
$337.37
|
| Rate for Payer: Aetna Medicare |
$198.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.99
|
| Rate for Payer: BCBS Complete |
$158.76
|
| Rate for Payer: Cash Price |
$317.52
|
| Rate for Payer: Cofinity Advantage |
$277.83
|
| Rate for Payer: Cofinity Commercial |
$341.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.52
|
| Rate for Payer: Healthscope Commercial |
$357.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.68
|
| Rate for Payer: PHP Commercial |
$337.37
|
| Rate for Payer: Priority Health SBD |
$250.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.99
|
| Rate for Payer: UHC Core |
$206.78
|
| Rate for Payer: UHC Exchange |
$155.98
|
| Rate for Payer: UMR Bronson Commercial |
$146.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.68
|
|
|
HC INFUSION CATHETER LVL 6
|
Facility
|
OP
|
$676.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.16 |
| Max. Negotiated Rate |
$608.51 |
| Rate for Payer: Aetna American Axle |
$439.48
|
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Medicare |
$338.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.48
|
| Rate for Payer: BCBS Complete |
$270.45
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cofinity Advantage |
$473.28
|
| Rate for Payer: Cofinity Commercial |
$581.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.90
|
| Rate for Payer: Healthscope Commercial |
$608.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$540.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.09
|
| Rate for Payer: PHP Commercial |
$574.70
|
| Rate for Payer: Priority Health SBD |
$425.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.48
|
| Rate for Payer: UHC Core |
$352.26
|
| Rate for Payer: UHC Exchange |
$265.72
|
| Rate for Payer: UMR Bronson Commercial |
$250.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.09
|
|
|
HC INFUSION CATHETER LVL 6
|
Facility
|
IP
|
$676.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.49 |
| Max. Negotiated Rate |
$608.51 |
| Rate for Payer: Aetna American Axle |
$439.48
|
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.48
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cofinity Advantage |
$473.28
|
| Rate for Payer: Cofinity Commercial |
$581.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.90
|
| Rate for Payer: Healthscope Commercial |
$608.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.09
|
| Rate for Payer: PHP Commercial |
$574.70
|
| Rate for Payer: Priority Health SBD |
$425.96
|
| Rate for Payer: UMR Bronson Commercial |
$297.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.09
|
|
|
HC INFUSION CATHETER LVL 7
|
Facility
|
IP
|
$755.19
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.28 |
| Max. Negotiated Rate |
$679.67 |
| Rate for Payer: Aetna American Axle |
$490.87
|
| Rate for Payer: Aetna Commercial |
$641.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$490.87
|
| Rate for Payer: Cash Price |
$604.15
|
| Rate for Payer: Cofinity Advantage |
$528.63
|
| Rate for Payer: Cofinity Commercial |
$649.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.15
|
| Rate for Payer: Healthscope Commercial |
$679.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$528.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$566.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$641.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$566.39
|
| Rate for Payer: PHP Commercial |
$641.91
|
| Rate for Payer: Priority Health SBD |
$475.77
|
| Rate for Payer: UMR Bronson Commercial |
$332.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$566.39
|
|
|
HC INFUSION CATHETER LVL 7
|
Facility
|
OP
|
$755.19
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.42 |
| Max. Negotiated Rate |
$679.67 |
| Rate for Payer: Aetna American Axle |
$490.87
|
| Rate for Payer: Aetna Commercial |
$641.91
|
| Rate for Payer: Aetna Medicare |
$377.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$490.87
|
| Rate for Payer: BCBS Complete |
$302.08
|
| Rate for Payer: Cash Price |
$604.15
|
| Rate for Payer: Cofinity Advantage |
$528.63
|
| Rate for Payer: Cofinity Commercial |
$649.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.15
|
| Rate for Payer: Healthscope Commercial |
$679.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$528.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$566.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$604.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$641.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$566.39
|
| Rate for Payer: PHP Commercial |
$641.91
|
| Rate for Payer: Priority Health SBD |
$475.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.87
|
| Rate for Payer: UHC Core |
$393.45
|
| Rate for Payer: UHC Exchange |
$296.79
|
| Rate for Payer: UMR Bronson Commercial |
$279.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$566.39
|
|
|
HC INFUSION CATHETER LVL 9
|
Facility
|
OP
|
$922.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.24 |
| Max. Negotiated Rate |
$830.03 |
| Rate for Payer: Aetna American Axle |
$599.47
|
| Rate for Payer: Aetna Commercial |
$783.92
|
| Rate for Payer: Aetna Medicare |
$461.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.47
|
| Rate for Payer: BCBS Complete |
$368.90
|
| Rate for Payer: Cash Price |
$737.81
|
| Rate for Payer: Cofinity Advantage |
$645.58
|
| Rate for Payer: Cofinity Commercial |
$793.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.81
|
| Rate for Payer: Healthscope Commercial |
$830.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$645.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$691.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$737.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$691.70
|
| Rate for Payer: PHP Commercial |
$783.92
|
| Rate for Payer: Priority Health SBD |
$581.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$599.47
|
| Rate for Payer: UHC Core |
$480.50
|
| Rate for Payer: UHC Exchange |
$362.45
|
| Rate for Payer: UMR Bronson Commercial |
$341.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$691.70
|
|
|
HC INFUSION CATHETER LVL 9
|
Facility
|
IP
|
$922.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$405.79 |
| Max. Negotiated Rate |
$830.03 |
| Rate for Payer: Aetna American Axle |
$599.47
|
| Rate for Payer: Aetna Commercial |
$783.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.47
|
| Rate for Payer: Cash Price |
$737.81
|
| Rate for Payer: Cofinity Advantage |
$645.58
|
| Rate for Payer: Cofinity Commercial |
$793.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.81
|
| Rate for Payer: Healthscope Commercial |
$830.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$645.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$691.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$691.70
|
| Rate for Payer: PHP Commercial |
$783.92
|
| Rate for Payer: Priority Health SBD |
$581.02
|
| Rate for Payer: UMR Bronson Commercial |
$405.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$691.70
|
|
|
HC INFUSION CATH LVL 10
|
Facility
|
IP
|
$1,026.84
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.81 |
| Max. Negotiated Rate |
$924.16 |
| Rate for Payer: Aetna American Axle |
$667.45
|
| Rate for Payer: Aetna Commercial |
$872.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$667.45
|
| Rate for Payer: Cash Price |
$821.47
|
| Rate for Payer: Cofinity Advantage |
$718.79
|
| Rate for Payer: Cofinity Commercial |
$883.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$821.47
|
| Rate for Payer: Healthscope Commercial |
$924.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$718.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$770.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$770.13
|
| Rate for Payer: PHP Commercial |
$872.81
|
| Rate for Payer: Priority Health SBD |
$646.91
|
| Rate for Payer: UMR Bronson Commercial |
$451.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$770.13
|
|
|
HC INFUSION CATH LVL 10
|
Facility
|
OP
|
$1,026.84
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$379.93 |
| Max. Negotiated Rate |
$924.16 |
| Rate for Payer: Aetna American Axle |
$667.45
|
| Rate for Payer: Aetna Commercial |
$872.81
|
| Rate for Payer: Aetna Medicare |
$513.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$667.45
|
| Rate for Payer: BCBS Complete |
$410.74
|
| Rate for Payer: Cash Price |
$821.47
|
| Rate for Payer: Cofinity Advantage |
$718.79
|
| Rate for Payer: Cofinity Commercial |
$883.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$821.47
|
| Rate for Payer: Healthscope Commercial |
$924.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$718.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$770.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$821.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$770.13
|
| Rate for Payer: PHP Commercial |
$872.81
|
| Rate for Payer: Priority Health SBD |
$646.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.45
|
| Rate for Payer: UHC Core |
$534.98
|
| Rate for Payer: UHC Exchange |
$403.55
|
| Rate for Payer: UMR Bronson Commercial |
$379.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$770.13
|
|
|
HC INFUSION CATH LVL 11
|
Facility
|
OP
|
$1,143.29
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.02 |
| Max. Negotiated Rate |
$1,028.96 |
| Rate for Payer: Aetna American Axle |
$743.14
|
| Rate for Payer: Aetna Commercial |
$971.80
|
| Rate for Payer: Aetna Medicare |
$571.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.14
|
| Rate for Payer: BCBS Complete |
$457.32
|
| Rate for Payer: Cash Price |
$914.63
|
| Rate for Payer: Cofinity Advantage |
$800.30
|
| Rate for Payer: Cofinity Commercial |
$983.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.63
|
| Rate for Payer: Healthscope Commercial |
$1,028.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$800.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$857.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$914.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$971.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.47
|
| Rate for Payer: PHP Commercial |
$971.80
|
| Rate for Payer: Priority Health SBD |
$720.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$743.14
|
| Rate for Payer: UHC Core |
$595.65
|
| Rate for Payer: UHC Exchange |
$449.31
|
| Rate for Payer: UMR Bronson Commercial |
$423.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$857.47
|
|
|
HC INFUSION CATH LVL 11
|
Facility
|
IP
|
$1,143.29
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$503.05 |
| Max. Negotiated Rate |
$1,028.96 |
| Rate for Payer: Aetna American Axle |
$743.14
|
| Rate for Payer: Aetna Commercial |
$971.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.14
|
| Rate for Payer: Cash Price |
$914.63
|
| Rate for Payer: Cofinity Advantage |
$800.30
|
| Rate for Payer: Cofinity Commercial |
$983.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.63
|
| Rate for Payer: Healthscope Commercial |
$1,028.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$800.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$857.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$971.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.47
|
| Rate for Payer: PHP Commercial |
$971.80
|
| Rate for Payer: Priority Health SBD |
$720.27
|
| Rate for Payer: UMR Bronson Commercial |
$503.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$857.47
|
|
|
HC INFUSION CATH LVL 12
|
Facility
|
IP
|
$1,272.93
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$560.09 |
| Max. Negotiated Rate |
$1,145.64 |
| Rate for Payer: Aetna American Axle |
$827.40
|
| Rate for Payer: Aetna Commercial |
$1,081.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$827.40
|
| Rate for Payer: Cash Price |
$1,018.34
|
| Rate for Payer: Cofinity Advantage |
$891.05
|
| Rate for Payer: Cofinity Commercial |
$1,094.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.34
|
| Rate for Payer: Healthscope Commercial |
$1,145.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$891.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$954.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,081.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.70
|
| Rate for Payer: PHP Commercial |
$1,081.99
|
| Rate for Payer: Priority Health SBD |
$801.95
|
| Rate for Payer: UMR Bronson Commercial |
$560.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$954.70
|
|
|
HC INFUSION CATH LVL 12
|
Facility
|
OP
|
$1,272.93
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.98 |
| Max. Negotiated Rate |
$1,145.64 |
| Rate for Payer: Aetna American Axle |
$827.40
|
| Rate for Payer: Aetna Commercial |
$1,081.99
|
| Rate for Payer: Aetna Medicare |
$636.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$827.40
|
| Rate for Payer: BCBS Complete |
$509.17
|
| Rate for Payer: Cash Price |
$1,018.34
|
| Rate for Payer: Cofinity Advantage |
$891.05
|
| Rate for Payer: Cofinity Commercial |
$1,094.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.34
|
| Rate for Payer: Healthscope Commercial |
$1,145.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$891.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$954.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,018.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,081.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.70
|
| Rate for Payer: PHP Commercial |
$1,081.99
|
| Rate for Payer: Priority Health SBD |
$801.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.40
|
| Rate for Payer: UHC Core |
$663.20
|
| Rate for Payer: UHC Exchange |
$500.26
|
| Rate for Payer: UMR Bronson Commercial |
$470.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$954.70
|
|
|
HC INFUSION CATH LVL 13
|
Facility
|
OP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200313
|
|
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 Advantage |
$966.04
|
| Rate for Payer: Cofinity Commercial |
$1,186.85
|
| 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 |
$1,035.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,104.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.05
|
| Rate for Payer: PHP Commercial |
$1,173.05
|
| Rate for Payer: Priority Health SBD |
$869.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$897.04
|
| Rate for Payer: UHC Core |
$719.01
|
| Rate for Payer: UHC Exchange |
$542.36
|
| Rate for Payer: UMR Bronson Commercial |
$510.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,035.05
|
|
|
HC INFUSION CATH LVL 13
|
Facility
|
IP
|
$1,380.06
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200313
|
|
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 Advantage |
$966.04
|
| Rate for Payer: Cofinity Commercial |
$1,186.85
|
| 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 |
$1,035.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,035.05
|
| Rate for Payer: PHP Commercial |
$1,173.05
|
| 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 |
$1,035.05
|
|
