|
HC INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
OP
|
$8.32
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$21.10 |
| Rate for Payer: Aetna American Axle |
$5.41
|
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna Medicare |
$6.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.14
|
| Rate for Payer: BCBS Complete |
$3.58
|
| Rate for Payer: BCBS MAPPO |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$21.10
|
| Rate for Payer: BCN Commercial |
$21.10
|
| Rate for Payer: BCN Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Advantage |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.24
|
| Rate for Payer: Mclaren Medicaid |
$6.51
|
| Rate for Payer: Mclaren Medicare |
$6.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.84
|
| Rate for Payer: Meridian Medicaid |
$6.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Nomi Health Commercial |
$19.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.24
|
| Rate for Payer: PACE Medicare |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.51
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: PHP Medicare Advantage |
$6.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.50
|
| Rate for Payer: Priority Health Medicare |
$6.51
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: Priority Health Tiered Network |
$16.40
|
| Rate for Payer: Railroad Medicare Medicare |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.16
|
| Rate for Payer: UHC Core |
$7.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.51
|
| Rate for Payer: UHC Exchange |
$7.16
|
| Rate for Payer: UHC Medicaid |
$3.40
|
| Rate for Payer: UHCCP Medicaid |
$3.40
|
| Rate for Payer: UMR Bronson Commercial |
$3.08
|
| Rate for Payer: VA VA |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.24
|
|
|
HC INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Aetna American Axle |
$5.41
|
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Advantage |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.24
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: UMR Bronson Commercial |
$3.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.24
|
|
|
HC INJ PEN G BENZATHINE/PROCAINE 100,000 UNITS
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna American Axle |
$39.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Advantage |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: UMR Bronson Commercial |
$26.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC INJ PEN G BENZATHINE/PROCAINE 100,000 UNITS
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
63600271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$63.30 |
| Rate for Payer: Aetna American Axle |
$39.00
|
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$20.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.40
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: BCBS MAPPO |
$19.52
|
| Rate for Payer: BCBS Trust/PPO |
$63.30
|
| Rate for Payer: BCN Commercial |
$63.30
|
| Rate for Payer: BCN Medicare Advantage |
$19.52
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Advantage |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Mclaren Medicaid |
$19.52
|
| Rate for Payer: Mclaren Medicare |
$19.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.50
|
| Rate for Payer: Meridian Medicaid |
$20.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.00
|
| Rate for Payer: Nomi Health Commercial |
$58.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.00
|
| Rate for Payer: PACE Medicare |
$18.54
|
| Rate for Payer: PACE SWMI |
$19.52
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: PHP Medicare Advantage |
$19.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$61.59
|
| Rate for Payer: Priority Health Medicare |
$19.52
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: Priority Health Tiered Network |
$49.27
|
| Rate for Payer: Railroad Medicare Medicare |
$19.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.21
|
| Rate for Payer: UHC Core |
$32.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.52
|
| Rate for Payer: UHC Exchange |
$32.21
|
| Rate for Payer: UHC Medicaid |
$10.21
|
| Rate for Payer: UHCCP Medicaid |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$22.20
|
| Rate for Payer: VA VA |
$19.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS
|
Facility
|
OP
|
$17.52
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$107.73 |
| Rate for Payer: Aetna American Axle |
$11.39
|
| Rate for Payer: Aetna Commercial |
$14.89
|
| Rate for Payer: Aetna Medicare |
$32.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.34
|
| Rate for Payer: BCBS Complete |
$17.28
|
| Rate for Payer: BCBS MAPPO |
$31.47
|
| Rate for Payer: BCBS Trust/PPO |
$107.73
|
| Rate for Payer: BCN Commercial |
$107.73
|
| Rate for Payer: BCN Medicare Advantage |
$31.47
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cofinity Advantage |
$12.26
|
| Rate for Payer: Cofinity Commercial |
$15.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$15.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.14
|
| Rate for Payer: Mclaren Medicaid |
$31.47
|
| Rate for Payer: Mclaren Medicare |
$31.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.04
|
| Rate for Payer: Meridian Medicaid |
$33.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.89
|
| Rate for Payer: Nomi Health Commercial |
$94.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.14
|
| Rate for Payer: PACE Medicare |
$29.90
|
| Rate for Payer: PACE SWMI |
$31.47
|
| Rate for Payer: PHP Commercial |
$14.89
|
| Rate for Payer: PHP Medicare Advantage |
$31.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$94.66
|
| Rate for Payer: Priority Health Medicare |
$31.47
|
| Rate for Payer: Priority Health SBD |
$11.04
|
| Rate for Payer: Priority Health Tiered Network |
$75.73
|
| Rate for Payer: Railroad Medicare Medicare |
$31.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.75
|
| Rate for Payer: UHC Core |
$52.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.47
|
| Rate for Payer: UHC Exchange |
$52.75
|
| Rate for Payer: UHC Medicaid |
$16.46
|
| Rate for Payer: UHCCP Medicaid |
$16.46
|
| Rate for Payer: UMR Bronson Commercial |
$6.48
|
| Rate for Payer: VA VA |
$31.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.14
|
|
|
HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS
|
Facility
|
IP
|
$17.52
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: Aetna American Axle |
$11.39
|
| Rate for Payer: Aetna Commercial |
$14.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.39
|
| Rate for Payer: Cash Price |
$14.02
|
| Rate for Payer: Cofinity Advantage |
$12.26
|
| Rate for Payer: Cofinity Commercial |
$15.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.02
|
| Rate for Payer: Healthscope Commercial |
$15.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.14
|
| Rate for Payer: PHP Commercial |
$14.89
|
| Rate for Payer: Priority Health SBD |
$11.04
|
| Rate for Payer: UMR Bronson Commercial |
$7.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.14
|
|
|
HC INJ PROCHLORPERAZINE UP TO 10 MG
|
Facility
|
IP
|
$79.78
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
63600246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$71.80 |
| Rate for Payer: Aetna American Axle |
$51.86
|
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.86
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cofinity Advantage |
$55.85
|
| Rate for Payer: Cofinity Commercial |
$68.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.82
|
| Rate for Payer: Healthscope Commercial |
$71.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.84
|
| Rate for Payer: PHP Commercial |
$67.81
|
| Rate for Payer: Priority Health SBD |
$50.26
|
| Rate for Payer: UMR Bronson Commercial |
$35.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.84
|
|
|
HC INJ PROCHLORPERAZINE UP TO 10 MG
|
Facility
|
OP
|
$79.78
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
63600246
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$71.80 |
| Rate for Payer: Aetna American Axle |
$51.86
|
| Rate for Payer: Aetna Commercial |
$67.81
|
| Rate for Payer: Aetna Medicare |
$39.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.86
|
| Rate for Payer: BCBS Complete |
$31.91
|
| Rate for Payer: BCBS Trust/PPO |
$8.15
|
| Rate for Payer: BCN Commercial |
$8.15
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cash Price |
$63.82
|
| Rate for Payer: Cofinity Advantage |
$55.85
|
| Rate for Payer: Cofinity Commercial |
$68.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.82
|
| Rate for Payer: Healthscope Commercial |
$71.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.84
|
| Rate for Payer: PHP Commercial |
$67.81
|
| Rate for Payer: Priority Health SBD |
$50.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.16
|
| Rate for Payer: UHC Core |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UMR Bronson Commercial |
$29.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.84
|
|
|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
IP
|
$697.21
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$306.77 |
| Max. Negotiated Rate |
$627.49 |
| Rate for Payer: Aetna American Axle |
$453.19
|
| Rate for Payer: Aetna Commercial |
$592.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.19
|
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cofinity Advantage |
$488.05
|
| Rate for Payer: Cofinity Commercial |
$599.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.77
|
| Rate for Payer: Healthscope Commercial |
$627.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$488.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$522.91
|
| Rate for Payer: PHP Commercial |
$592.63
|
| Rate for Payer: Priority Health SBD |
$439.24
|
| Rate for Payer: UMR Bronson Commercial |
$306.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.91
|
|
|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
OP
|
$697.21
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$25.37 |
| Max. Negotiated Rate |
$627.49 |
| Rate for Payer: Aetna American Axle |
$453.19
|
| Rate for Payer: Aetna Commercial |
$592.63
|
| Rate for Payer: Aetna Medicare |
$348.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.19
|
| Rate for Payer: BCBS Complete |
$278.88
|
| Rate for Payer: BCBS Trust/PPO |
$25.37
|
| Rate for Payer: BCN Commercial |
$25.37
|
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cash Price |
$557.77
|
| Rate for Payer: Cofinity Advantage |
$488.05
|
| Rate for Payer: Cofinity Commercial |
$599.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.77
|
| Rate for Payer: Healthscope Commercial |
$627.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$488.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$557.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$522.91
|
| Rate for Payer: PHP Commercial |
$592.63
|
| Rate for Payer: Priority Health SBD |
$439.24
|
| Rate for Payer: UMR Bronson Commercial |
$257.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.91
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
IP
|
$212.24
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$93.39 |
| Max. Negotiated Rate |
$191.02 |
| Rate for Payer: Aetna American Axle |
$137.96
|
| Rate for Payer: Aetna Commercial |
$180.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.96
|
| Rate for Payer: Cash Price |
$169.79
|
| Rate for Payer: Cofinity Advantage |
$148.57
|
| Rate for Payer: Cofinity Commercial |
$182.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.79
|
| Rate for Payer: Healthscope Commercial |
$191.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.18
|
| Rate for Payer: PHP Commercial |
$180.40
|
| Rate for Payer: Priority Health SBD |
$133.71
|
| Rate for Payer: UMR Bronson Commercial |
$93.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.18
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
OP
|
$212.24
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$78.53 |
| Max. Negotiated Rate |
$191.02 |
| Rate for Payer: Aetna American Axle |
$137.96
|
| Rate for Payer: Aetna Commercial |
$180.40
|
| Rate for Payer: Aetna Medicare |
$106.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.96
|
| Rate for Payer: BCBS Complete |
$84.90
|
| Rate for Payer: Cash Price |
$169.79
|
| Rate for Payer: Cofinity Advantage |
$148.57
|
| Rate for Payer: Cofinity Commercial |
$182.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.79
|
| Rate for Payer: Healthscope Commercial |
$191.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.18
|
| Rate for Payer: PHP Commercial |
$180.40
|
| Rate for Payer: Priority Health SBD |
$133.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.96
|
| Rate for Payer: UHC Core |
$110.58
|
| Rate for Payer: UHC Exchange |
$83.41
|
| Rate for Payer: UMR Bronson Commercial |
$78.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.18
|
|
|
HC INJ, TRIAMCINOLONE ACETONIDE, NOT SPECIFIED, 10 MG
|
Facility
|
OP
|
$10.61
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna American Axle |
$6.90
|
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: BCBS Complete |
$4.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$9.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: Priority Health SBD |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.22
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Exchange |
$1.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
HC INJ, TRIAMCINOLONE ACETONIDE, NOT SPECIFIED, 10 MG
|
Facility
|
IP
|
$10.61
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna American Axle |
$6.90
|
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.90
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Advantage |
$7.43
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$9.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: Priority Health SBD |
$6.68
|
| Rate for Payer: UMR Bronson Commercial |
$4.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
HC INJ, VIT B12 CYANCOBALAMIN, UP TO 1000MCG
|
Facility
|
OP
|
$5.30
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Aetna American Axle |
$3.44
|
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Medicare |
$2.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.44
|
| Rate for Payer: BCBS Complete |
$2.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cofinity Advantage |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$4.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.24
|
| Rate for Payer: Healthscope Commercial |
$4.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.98
|
| Rate for Payer: PHP Commercial |
$4.50
|
| Rate for Payer: Priority Health SBD |
$3.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.06
|
| Rate for Payer: UHC Core |
$1.06
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UMR Bronson Commercial |
$1.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.98
|
|
|
HC INJ, VIT B12 CYANCOBALAMIN, UP TO 1000MCG
|
Facility
|
IP
|
$5.30
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: Aetna American Axle |
$3.44
|
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.44
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cofinity Advantage |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$4.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.24
|
| Rate for Payer: Healthscope Commercial |
$4.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.98
|
| Rate for Payer: PHP Commercial |
$4.50
|
| Rate for Payer: Priority Health SBD |
$3.34
|
| Rate for Payer: UMR Bronson Commercial |
$2.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.98
|
|
|
HC INSECT VENOM ALLERGY PANEL
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC INSECT VENOM ALLERGY PANEL
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC INSERT CATH COMPLICATED
|
Facility
|
OP
|
$510.33
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$459.30 |
| Rate for Payer: Aetna American Axle |
$331.71
|
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: Aetna Medicare |
$133.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.26
|
| Rate for Payer: BCBS Complete |
$70.41
|
| Rate for Payer: BCBS MAPPO |
$128.21
|
| Rate for Payer: BCBS Trust/PPO |
$109.84
|
| Rate for Payer: BCN Commercial |
$109.84
|
| Rate for Payer: BCN Medicare Advantage |
$128.21
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Advantage |
$357.23
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.75
|
| Rate for Payer: Mclaren Medicaid |
$128.21
|
| Rate for Payer: Mclaren Medicare |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.62
|
| Rate for Payer: Meridian Medicaid |
$134.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Nomi Health Commercial |
$384.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PACE Medicare |
$121.80
|
| Rate for Payer: PACE SWMI |
$128.21
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: PHP Medicare Advantage |
$128.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$414.63
|
| Rate for Payer: Priority Health Medicare |
$128.21
|
| Rate for Payer: Priority Health SBD |
$321.51
|
| Rate for Payer: Priority Health Tiered Network |
$331.70
|
| Rate for Payer: Railroad Medicare Medicare |
$128.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.71
|
| Rate for Payer: UHC Core |
$265.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.21
|
| Rate for Payer: UHC Exchange |
$200.56
|
| Rate for Payer: UHC Medicaid |
$67.05
|
| Rate for Payer: UHCCP Medicaid |
$67.05
|
| Rate for Payer: UMR Bronson Commercial |
$188.82
|
| Rate for Payer: VA VA |
$128.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.75
|
|
|
HC INSERT CATH COMPLICATED
|
Facility
|
IP
|
$510.33
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.55 |
| Max. Negotiated Rate |
$459.30 |
| Rate for Payer: Aetna American Axle |
$331.71
|
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.71
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Advantage |
$357.23
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: Priority Health SBD |
$321.51
|
| Rate for Payer: UMR Bronson Commercial |
$224.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.75
|
|
|
HC INSERT CERVICAL DILATOR
|
Facility
|
OP
|
$431.70
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
36100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$981.93 |
| Rate for Payer: Aetna American Axle |
$280.61
|
| Rate for Payer: Aetna Commercial |
$366.94
|
| Rate for Payer: Aetna Medicare |
$315.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$395.61
|
| Rate for Payer: BCN Commercial |
$395.61
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Cash Price |
$345.36
|
| Rate for Payer: Cash Price |
$345.36
|
| Rate for Payer: Cash Price |
$345.36
|
| Rate for Payer: Cofinity Advantage |
$302.19
|
| Rate for Payer: Cofinity Commercial |
$371.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Healthscope Commercial |
$388.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.77
|
| Rate for Payer: Mclaren Medicaid |
$303.63
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$318.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.94
|
| Rate for Payer: Nomi Health Commercial |
$910.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.77
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Commercial |
$366.94
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$981.93
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health SBD |
$271.97
|
| Rate for Payer: Priority Health Tiered Network |
$785.54
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.61
|
| Rate for Payer: UHC Core |
$224.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Exchange |
$169.66
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: UMR Bronson Commercial |
$159.73
|
| Rate for Payer: VA VA |
$303.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.77
|
|
|
HC INSERT CERVICAL DILATOR
|
Facility
|
IP
|
$431.70
|
|
|
Service Code
|
CPT 59200
|
| Hospital Charge Code |
36100397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.95 |
| Max. Negotiated Rate |
$388.53 |
| Rate for Payer: Aetna American Axle |
$280.61
|
| Rate for Payer: Aetna Commercial |
$366.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.61
|
| Rate for Payer: Cash Price |
$345.36
|
| Rate for Payer: Cofinity Advantage |
$302.19
|
| Rate for Payer: Cofinity Commercial |
$371.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.36
|
| Rate for Payer: Healthscope Commercial |
$388.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.77
|
| Rate for Payer: PHP Commercial |
$366.94
|
| Rate for Payer: Priority Health SBD |
$271.97
|
| Rate for Payer: UMR Bronson Commercial |
$189.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.77
|
|
|
HC INSERT EMERGENCY AIRWAY
|
Facility
|
OP
|
$587.84
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
45000012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.43 |
| Max. Negotiated Rate |
$763.21 |
| Rate for Payer: Aetna American Axle |
$382.10
|
| Rate for Payer: Aetna Commercial |
$499.66
|
| Rate for Payer: Aetna Medicare |
$245.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.00
|
| Rate for Payer: BCBS Complete |
$129.61
|
| Rate for Payer: BCBS MAPPO |
$236.00
|
| Rate for Payer: BCBS Trust/PPO |
$281.61
|
| Rate for Payer: BCN Commercial |
$281.61
|
| Rate for Payer: BCN Medicare Advantage |
$236.00
|
| Rate for Payer: Cash Price |
$470.27
|
| Rate for Payer: Cash Price |
$470.27
|
| Rate for Payer: Cash Price |
$470.27
|
| Rate for Payer: Cofinity Advantage |
$411.49
|
| Rate for Payer: Cofinity Commercial |
$505.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$529.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$411.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.88
|
| Rate for Payer: Mclaren Medicaid |
$236.00
|
| Rate for Payer: Mclaren Medicare |
$236.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.80
|
| Rate for Payer: Meridian Medicaid |
$247.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.66
|
| Rate for Payer: Nomi Health Commercial |
$708.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.88
|
| Rate for Payer: PACE Medicare |
$224.20
|
| Rate for Payer: PACE SWMI |
$236.00
|
| Rate for Payer: PHP Commercial |
$499.66
|
| Rate for Payer: PHP Medicare Advantage |
$236.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$763.21
|
| Rate for Payer: Priority Health Medicare |
$236.00
|
| Rate for Payer: Priority Health SBD |
$370.34
|
| Rate for Payer: Priority Health Tiered Network |
$610.57
|
| Rate for Payer: Railroad Medicare Medicare |
$236.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$236.00
|
| Rate for Payer: UHC Medicaid |
$123.43
|
| Rate for Payer: UHCCP Medicaid |
$123.43
|
| Rate for Payer: UMR Bronson Commercial |
$217.50
|
| Rate for Payer: VA VA |
$236.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.88
|
|
|
HC INSERT EMERGENCY AIRWAY
|
Facility
|
IP
|
$587.84
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
45000012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.65 |
| Max. Negotiated Rate |
$529.06 |
| Rate for Payer: Aetna American Axle |
$382.10
|
| Rate for Payer: Aetna Commercial |
$499.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.10
|
| Rate for Payer: Cash Price |
$470.27
|
| Rate for Payer: Cofinity Advantage |
$411.49
|
| Rate for Payer: Cofinity Commercial |
$505.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.27
|
| Rate for Payer: Healthscope Commercial |
$529.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$411.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.88
|
| Rate for Payer: PHP Commercial |
$499.66
|
| Rate for Payer: Priority Health SBD |
$370.34
|
| Rate for Payer: UMR Bronson Commercial |
$258.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.88
|
|
|
HC INSERT INDWELLING CATH
|
Facility
|
IP
|
$203.24
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
45000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$182.92 |
| Rate for Payer: Aetna American Axle |
$132.11
|
| Rate for Payer: Aetna Commercial |
$172.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.11
|
| Rate for Payer: Cash Price |
$162.59
|
| Rate for Payer: Cofinity Advantage |
$142.27
|
| Rate for Payer: Cofinity Commercial |
$174.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.59
|
| Rate for Payer: Healthscope Commercial |
$182.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.43
|
| Rate for Payer: PHP Commercial |
$172.75
|
| Rate for Payer: Priority Health SBD |
$128.04
|
| Rate for Payer: UMR Bronson Commercial |
$89.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.43
|
|
