|
HC IUPC ASSIST
|
Facility
|
IP
|
$119.72
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.68 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna American Axle |
$77.82
|
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.82
|
| Rate for Payer: Cash Price |
$95.78
|
| Rate for Payer: Cofinity Commercial |
$102.96
|
| Rate for Payer: Cofinity Commercial |
$83.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.78
|
| Rate for Payer: Healthscope Commercial |
$107.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.76
|
| Rate for Payer: PHP Commercial |
$101.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.82
|
| Rate for Payer: Priority Health SBD |
$75.42
|
| Rate for Payer: UMR Bronson Commercial |
$52.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.79
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
OP
|
$85.41
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$76.87 |
| Rate for Payer: Aetna American Axle |
$55.52
|
| Rate for Payer: Aetna Commercial |
$72.60
|
| Rate for Payer: Aetna Medicare |
$42.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.52
|
| Rate for Payer: BCBS Complete |
$34.16
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cofinity Commercial |
$59.79
|
| Rate for Payer: Cofinity Commercial |
$73.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$76.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.60
|
| Rate for Payer: PHP Commercial |
$72.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.52
|
| Rate for Payer: Priority Health SBD |
$53.81
|
| Rate for Payer: UMR Bronson Commercial |
$31.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.06
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
IP
|
$85.41
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.58 |
| Max. Negotiated Rate |
$76.87 |
| Rate for Payer: Aetna American Axle |
$55.52
|
| Rate for Payer: Aetna Commercial |
$72.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.52
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cofinity Commercial |
$59.79
|
| Rate for Payer: Cofinity Commercial |
$73.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$76.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.60
|
| Rate for Payer: PHP Commercial |
$72.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.52
|
| Rate for Payer: Priority Health SBD |
$53.81
|
| Rate for Payer: UMR Bronson Commercial |
$37.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.06
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
IP
|
$203.57
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$89.57 |
| Max. Negotiated Rate |
$183.21 |
| Rate for Payer: Aetna American Axle |
$132.32
|
| Rate for Payer: Aetna Commercial |
$173.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.32
|
| Rate for Payer: Cash Price |
$162.86
|
| Rate for Payer: Cofinity Commercial |
$142.50
|
| Rate for Payer: Cofinity Commercial |
$175.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.86
|
| Rate for Payer: Healthscope Commercial |
$183.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.03
|
| Rate for Payer: PHP Commercial |
$173.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.32
|
| Rate for Payer: Priority Health SBD |
$128.25
|
| Rate for Payer: UMR Bronson Commercial |
$89.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.68
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
OP
|
$203.57
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna American Axle |
$132.32
|
| Rate for Payer: Aetna Commercial |
$173.03
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$162.86
|
| Rate for Payer: Cash Price |
$162.86
|
| Rate for Payer: Cofinity Commercial |
$175.07
|
| Rate for Payer: Cofinity Commercial |
$142.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$183.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.68
|
| Rate for Payer: Mclaren Medicaid |
$24.12
|
| Rate for Payer: Mclaren Medicare |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.03
|
| Rate for Payer: PACE Medicare |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$173.03
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.32
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health SBD |
$128.25
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.67
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$86.00
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: UMR Bronson Commercial |
$75.32
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.68
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
OP
|
$510.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$578.41 |
| Rate for Payer: Aetna American Axle |
$331.66
|
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna Medicare |
$213.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Cofinity Commercial |
$357.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health SBD |
$321.45
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.41
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Exchange |
$392.69
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$110.14
|
| Rate for Payer: UMR Bronson Commercial |
$188.79
|
| Rate for Payer: VA VA |
$205.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
IP
|
$510.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$224.51 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna American Axle |
$331.66
|
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$357.17
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health SBD |
$321.45
|
| Rate for Payer: UMR Bronson Commercial |
$224.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
OP
|
$129.02
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna American Axle |
$83.86
|
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$90.31
|
| Rate for Payer: Cofinity Commercial |
$110.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$116.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.77
|
| Rate for Payer: Mclaren Medicaid |
$24.12
|
| Rate for Payer: Mclaren Medicare |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: PACE Medicare |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$109.67
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health SBD |
$81.28
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.67
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$86.00
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: UMR Bronson Commercial |
$47.74
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.77
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
IP
|
$129.02
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$56.77 |
| Max. Negotiated Rate |
$116.12 |
| Rate for Payer: Aetna American Axle |
$83.86
|
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.86
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$110.96
|
| Rate for Payer: Cofinity Commercial |
$90.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$116.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: PHP Commercial |
$109.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health SBD |
$81.28
|
| Rate for Payer: UMR Bronson Commercial |
$56.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.77
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
OP
|
$270.93
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$100.24 |
| Max. Negotiated Rate |
$578.41 |
| Rate for Payer: Aetna American Axle |
$176.10
|
| Rate for Payer: Aetna Commercial |
$230.29
|
| Rate for Payer: Aetna Medicare |
$213.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$216.74
|
| Rate for Payer: Cash Price |
$216.74
|
| Rate for Payer: Cofinity Commercial |
$233.00
|
| Rate for Payer: Cofinity Commercial |
$189.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$243.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.20
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.29
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$230.29
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.10
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health SBD |
$170.69
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.41
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Exchange |
$392.69
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$110.14
|
| Rate for Payer: UMR Bronson Commercial |
$100.24
|
| Rate for Payer: VA VA |
$205.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.20
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
IP
|
$270.93
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$119.21 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna American Axle |
$176.10
|
| Rate for Payer: Aetna Commercial |
$230.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.10
|
| Rate for Payer: Cash Price |
$216.74
|
| Rate for Payer: Cofinity Commercial |
$189.65
|
| Rate for Payer: Cofinity Commercial |
$233.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.74
|
| Rate for Payer: Healthscope Commercial |
$243.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.29
|
| Rate for Payer: PHP Commercial |
$230.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.10
|
| Rate for Payer: Priority Health SBD |
$170.69
|
| Rate for Payer: UMR Bronson Commercial |
$119.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.20
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
IP
|
$688.17
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$302.79 |
| Max. Negotiated Rate |
$619.35 |
| Rate for Payer: Aetna American Axle |
$447.31
|
| Rate for Payer: Aetna Commercial |
$584.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.31
|
| Rate for Payer: Cash Price |
$550.54
|
| Rate for Payer: Cofinity Commercial |
$481.72
|
| Rate for Payer: Cofinity Commercial |
$591.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.54
|
| Rate for Payer: Healthscope Commercial |
$619.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.94
|
| Rate for Payer: PHP Commercial |
$584.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.31
|
| Rate for Payer: Priority Health SBD |
$433.55
|
| Rate for Payer: UMR Bronson Commercial |
$302.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.13
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
OP
|
$688.17
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$619.35 |
| Rate for Payer: Aetna American Axle |
$447.31
|
| Rate for Payer: Aetna Commercial |
$584.94
|
| Rate for Payer: Aetna Medicare |
$213.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$550.54
|
| Rate for Payer: Cash Price |
$550.54
|
| Rate for Payer: Cofinity Commercial |
$591.83
|
| Rate for Payer: Cofinity Commercial |
$481.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$481.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$619.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$481.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.13
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.94
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$584.94
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.31
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health SBD |
$433.55
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.41
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Exchange |
$392.69
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$110.14
|
| Rate for Payer: UMR Bronson Commercial |
$254.62
|
| Rate for Payer: VA VA |
$205.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.13
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna American Axle |
$347.60
|
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$267.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: BCBS Complete |
$213.91
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Commercial |
$374.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: UHC Core |
$47.00
|
| Rate for Payer: UMR Bronson Commercial |
$197.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$235.30 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna American Axle |
$347.60
|
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$374.34
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: UMR Bronson Commercial |
$235.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna American Axle |
$347.60
|
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$267.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: BCBS Complete |
$213.91
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Commercial |
$374.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: UHC Core |
$47.00
|
| Rate for Payer: UMR Bronson Commercial |
$197.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$235.30 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna American Axle |
$347.60
|
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$374.34
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: UMR Bronson Commercial |
$235.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
OP
|
$173.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna American Axle |
$112.89
|
| Rate for Payer: Aetna Commercial |
$147.62
|
| Rate for Payer: Aetna Medicare |
$86.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.89
|
| Rate for Payer: BCBS Complete |
$69.47
|
| Rate for Payer: Cash Price |
$138.94
|
| Rate for Payer: Cash Price |
$138.94
|
| Rate for Payer: Cofinity Commercial |
$149.36
|
| Rate for Payer: Cofinity Commercial |
$121.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.94
|
| Rate for Payer: Healthscope Commercial |
$156.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.62
|
| Rate for Payer: PHP Commercial |
$147.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.89
|
| Rate for Payer: Priority Health SBD |
$109.41
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UMR Bronson Commercial |
$64.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.25
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
IP
|
$173.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$76.41 |
| Max. Negotiated Rate |
$156.30 |
| Rate for Payer: Aetna American Axle |
$112.89
|
| Rate for Payer: Aetna Commercial |
$147.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.89
|
| Rate for Payer: Cash Price |
$138.94
|
| Rate for Payer: Cofinity Commercial |
$121.57
|
| Rate for Payer: Cofinity Commercial |
$149.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.94
|
| Rate for Payer: Healthscope Commercial |
$156.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.62
|
| Rate for Payer: PHP Commercial |
$147.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.89
|
| Rate for Payer: Priority Health SBD |
$109.41
|
| Rate for Payer: UMR Bronson Commercial |
$76.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.25
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
OP
|
$194.54
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna American Axle |
$126.45
|
| Rate for Payer: Aetna Commercial |
$165.36
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$25.33
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$155.63
|
| Rate for Payer: Cash Price |
$155.63
|
| Rate for Payer: Cofinity Commercial |
$167.30
|
| Rate for Payer: Cofinity Commercial |
$136.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.91
|
| Rate for Payer: Mclaren Medicaid |
$24.12
|
| Rate for Payer: Mclaren Medicare |
$45.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: Meridian Medicaid |
$25.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.36
|
| Rate for Payer: PACE Medicare |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$165.36
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.45
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health SBD |
$122.56
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.67
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$86.00
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: UMR Bronson Commercial |
$71.98
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.91
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
IP
|
$194.54
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$175.09 |
| Rate for Payer: Aetna American Axle |
$126.45
|
| Rate for Payer: Aetna Commercial |
$165.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.45
|
| Rate for Payer: Cash Price |
$155.63
|
| Rate for Payer: Cofinity Commercial |
$136.18
|
| Rate for Payer: Cofinity Commercial |
$167.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.63
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.36
|
| Rate for Payer: PHP Commercial |
$165.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.45
|
| Rate for Payer: Priority Health SBD |
$122.56
|
| Rate for Payer: UMR Bronson Commercial |
$85.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.91
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
IP
|
$534.78
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$235.30 |
| Max. Negotiated Rate |
$481.30 |
| Rate for Payer: Aetna American Axle |
$347.61
|
| Rate for Payer: Aetna Commercial |
$454.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.61
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$374.35
|
| Rate for Payer: Cofinity Commercial |
$459.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.56
|
| Rate for Payer: PHP Commercial |
$454.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.61
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: UMR Bronson Commercial |
$235.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
OP
|
$534.78
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.14 |
| Max. Negotiated Rate |
$578.41 |
| Rate for Payer: Aetna American Axle |
$347.61
|
| Rate for Payer: Aetna Commercial |
$454.56
|
| Rate for Payer: Aetna Medicare |
$213.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: BCBS Complete |
$115.64
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.91
|
| Rate for Payer: Cofinity Commercial |
$374.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$481.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Mclaren Medicaid |
$110.14
|
| Rate for Payer: Mclaren Medicare |
$205.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$115.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.56
|
| Rate for Payer: PACE Medicare |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$454.56
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.61
|
| Rate for Payer: Priority Health Medicare |
$205.48
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.41
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.48
|
| Rate for Payer: UHC Exchange |
$392.69
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$110.14
|
| Rate for Payer: UMR Bronson Commercial |
$197.87
|
| Rate for Payer: VA VA |
$205.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
OP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna American Axle |
$54.43
|
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: Aetna Medicare |
$41.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.43
|
| Rate for Payer: BCBS Complete |
$33.50
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$58.62
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.18
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.43
|
| Rate for Payer: Priority Health SBD |
$52.76
|
| Rate for Payer: UMR Bronson Commercial |
$30.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.80
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
IP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna American Axle |
$54.43
|
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.43
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$58.62
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.18
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.43
|
| Rate for Payer: Priority Health SBD |
$52.76
|
| Rate for Payer: UMR Bronson Commercial |
$36.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.80
|
|
