|
HC ISOVUE 370 PER ML
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna American Axle |
$1.24
|
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.24
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.17
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.33
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.52
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health SBD |
$1.20
|
| Rate for Payer: UMR Bronson Commercial |
$0.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$321.69
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.57 |
| Max. Negotiated Rate |
$936.74 |
| Rate for Payer: Aetna American Axle |
$209.10
|
| Rate for Payer: Aetna Commercial |
$273.44
|
| Rate for Payer: Aetna Medicare |
$309.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.55
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS MAPPO |
$298.04
|
| Rate for Payer: BCBS Trust/PPO |
$174.60
|
| Rate for Payer: BCN Commercial |
$174.60
|
| Rate for Payer: BCN Medicare Advantage |
$298.04
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cofinity Commercial |
$225.18
|
| Rate for Payer: Cofinity Commercial |
$276.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.04
|
| Rate for Payer: Healthscope Commercial |
$289.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.27
|
| Rate for Payer: Mclaren Medicaid |
$159.75
|
| Rate for Payer: Mclaren Medicare |
$298.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.94
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.44
|
| Rate for Payer: Nomi Health Commercial |
$894.12
|
| Rate for Payer: PACE Medicare |
$283.14
|
| Rate for Payer: PACE SWMI |
$298.04
|
| Rate for Payer: PHP Commercial |
$273.44
|
| Rate for Payer: PHP Medicare Advantage |
$298.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$936.74
|
| Rate for Payer: Priority Health Medicare |
$298.04
|
| Rate for Payer: Priority Health Narrow Network |
$749.39
|
| Rate for Payer: Priority Health SBD |
$202.66
|
| Rate for Payer: Railroad Medicare Medicare |
$298.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.03
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.04
|
| Rate for Payer: UHC Exchange |
$64.57
|
| Rate for Payer: UHC Medicare Advantage |
$298.04
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
| Rate for Payer: UMR Bronson Commercial |
$119.03
|
| Rate for Payer: VA VA |
$298.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.27
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$321.69
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.54 |
| Max. Negotiated Rate |
$289.52 |
| Rate for Payer: Aetna American Axle |
$209.10
|
| Rate for Payer: Aetna Commercial |
$273.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.10
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cofinity Commercial |
$225.18
|
| Rate for Payer: Cofinity Commercial |
$276.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.35
|
| Rate for Payer: Healthscope Commercial |
$289.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.44
|
| Rate for Payer: PHP Commercial |
$273.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.10
|
| Rate for Payer: Priority Health SBD |
$202.66
|
| Rate for Payer: UMR Bronson Commercial |
$141.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.27
|
|
|
HC IUPC ASSIST
|
Facility
|
OP
|
$119.72
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna American Axle |
$77.82
|
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Medicare |
$59.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.82
|
| Rate for Payer: BCBS Complete |
$47.89
|
| 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 |
$44.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.79
|
|
|
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: PHP Commercial |
$101.76
|
| 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: 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
|
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 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 HYDRATION ONLY, EACH ADDL HR
|
Facility
|
OP
|
$203.57
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$24.23
|
| Rate for Payer: UMR Bronson Commercial |
$75.32
|
| Rate for Payer: VA VA |
$45.21
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.53
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$11.39
|
| Rate for Payer: Aetna American Axle |
$132.32
|
| Rate for Payer: Aetna Commercial |
$173.03
|
| Rate for Payer: Aetna Medicare |
$47.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$64.70
|
| Rate for Payer: BCN Commercial |
$64.70
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| 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 |
$45.21
|
| 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 |
$24.23
|
| Rate for Payer: Mclaren Medicare |
$45.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.47
|
| Rate for Payer: Meridian Medicaid |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.03
|
| Rate for Payer: Nomi Health Commercial |
$135.63
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$173.03
|
| Rate for Payer: PHP Medicare Advantage |
$45.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.07
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$113.66
|
| Rate for Payer: Priority Health SBD |
$128.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.68
|
|
|
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,INITIAL HR
|
Facility
|
OP
|
$510.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$29.52 |
| Max. Negotiated Rate |
$648.80 |
| Rate for Payer: Aetna American Axle |
$331.66
|
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna Medicare |
$214.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.04
|
| Rate for Payer: BCBS Complete |
$116.18
|
| Rate for Payer: BCBS MAPPO |
$206.43
|
| Rate for Payer: BCBS Trust/PPO |
$169.59
|
| Rate for Payer: BCN Commercial |
$169.59
|
| Rate for Payer: BCN Medicare Advantage |
$206.43
|
| 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 |
$206.43
|
| 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 |
$110.65
|
| Rate for Payer: Mclaren Medicare |
$206.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.75
|
| Rate for Payer: Meridian Medicaid |
$116.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: Nomi Health Commercial |
$619.29
|
| Rate for Payer: PACE Medicare |
$196.11
|
| Rate for Payer: PACE SWMI |
$206.43
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: PHP Medicare Advantage |
$206.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$648.80
|
| Rate for Payer: Priority Health Medicare |
$206.43
|
| Rate for Payer: Priority Health Narrow Network |
$519.04
|
| Rate for Payer: Priority Health SBD |
$321.45
|
| Rate for Payer: Railroad Medicare Medicare |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.47
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.43
|
| Rate for Payer: UHC Exchange |
$29.52
|
| Rate for Payer: UHC Medicare Advantage |
$206.43
|
| Rate for Payer: UHCCP Medicaid |
$110.65
|
| Rate for Payer: UMR Bronson Commercial |
$188.79
|
| Rate for Payer: VA VA |
$206.43
|
| 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 |
$11.39 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$11.39
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$24.23
|
| Rate for Payer: UMR Bronson Commercial |
$47.74
|
| Rate for Payer: VA VA |
$45.21
|
| Rate for Payer: Aetna American Axle |
$83.86
|
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Medicare |
$47.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$64.70
|
| Rate for Payer: BCN Commercial |
$64.70
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| 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 |
$45.21
|
| 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 |
$96.76
|
| Rate for Payer: Mclaren Medicaid |
$24.23
|
| Rate for Payer: Mclaren Medicare |
$45.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.47
|
| Rate for Payer: Meridian Medicaid |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: Nomi Health Commercial |
$135.63
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$109.67
|
| Rate for Payer: PHP Medicare Advantage |
$45.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.07
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$113.66
|
| Rate for Payer: Priority Health SBD |
$81.28
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.53
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.76
|
|
|
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 |
$96.76
|
| 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 |
$96.76
|
|
|
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 |
$29.52 |
| Max. Negotiated Rate |
$648.80 |
| Rate for Payer: Aetna American Axle |
$176.10
|
| Rate for Payer: Aetna Commercial |
$230.29
|
| Rate for Payer: Aetna Medicare |
$214.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.04
|
| Rate for Payer: BCBS Complete |
$116.18
|
| Rate for Payer: BCBS MAPPO |
$206.43
|
| Rate for Payer: BCBS Trust/PPO |
$169.59
|
| Rate for Payer: BCN Commercial |
$169.59
|
| Rate for Payer: BCN Medicare Advantage |
$206.43
|
| 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 |
$206.43
|
| 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 |
$110.65
|
| Rate for Payer: Mclaren Medicare |
$206.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.75
|
| Rate for Payer: Meridian Medicaid |
$116.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.29
|
| Rate for Payer: Nomi Health Commercial |
$619.29
|
| Rate for Payer: PACE Medicare |
$196.11
|
| Rate for Payer: PACE SWMI |
$206.43
|
| Rate for Payer: PHP Commercial |
$230.29
|
| Rate for Payer: PHP Medicare Advantage |
$206.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$648.80
|
| Rate for Payer: Priority Health Medicare |
$206.43
|
| Rate for Payer: Priority Health Narrow Network |
$519.04
|
| Rate for Payer: Priority Health SBD |
$170.69
|
| Rate for Payer: Railroad Medicare Medicare |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.47
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.43
|
| Rate for Payer: UHC Exchange |
$29.52
|
| Rate for Payer: UHC Medicare Advantage |
$206.43
|
| Rate for Payer: UHCCP Medicaid |
$110.65
|
| Rate for Payer: UMR Bronson Commercial |
$100.24
|
| Rate for Payer: VA VA |
$206.43
|
| 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 |
$57.04 |
| Max. Negotiated Rate |
$648.80 |
| Rate for Payer: Aetna American Axle |
$447.31
|
| Rate for Payer: Aetna Commercial |
$584.94
|
| Rate for Payer: Aetna Medicare |
$214.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.04
|
| Rate for Payer: BCBS Complete |
$116.18
|
| Rate for Payer: BCBS MAPPO |
$206.43
|
| Rate for Payer: BCBS Trust/PPO |
$328.71
|
| Rate for Payer: BCN Commercial |
$328.71
|
| Rate for Payer: BCN Medicare Advantage |
$206.43
|
| 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 |
$206.43
|
| 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 |
$110.65
|
| Rate for Payer: Mclaren Medicare |
$206.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.75
|
| Rate for Payer: Meridian Medicaid |
$116.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.94
|
| Rate for Payer: Nomi Health Commercial |
$619.29
|
| Rate for Payer: PACE Medicare |
$196.11
|
| Rate for Payer: PACE SWMI |
$206.43
|
| Rate for Payer: PHP Commercial |
$584.94
|
| Rate for Payer: PHP Medicare Advantage |
$206.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$648.80
|
| Rate for Payer: Priority Health Medicare |
$206.43
|
| Rate for Payer: Priority Health Narrow Network |
$519.04
|
| Rate for Payer: Priority Health SBD |
$433.55
|
| Rate for Payer: Railroad Medicare Medicare |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.74
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.43
|
| Rate for Payer: UHC Exchange |
$57.04
|
| Rate for Payer: UHC Medicare Advantage |
$206.43
|
| Rate for Payer: UHCCP Medicaid |
$110.65
|
| Rate for Payer: UMR Bronson Commercial |
$254.62
|
| Rate for Payer: VA VA |
$206.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.13
|
|
|
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 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 |
$1,324.17 |
| Rate for Payer: Aetna American Axle |
$347.60
|
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$459.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$551.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$551.74
|
| Rate for Payer: BCBS Complete |
$248.41
|
| Rate for Payer: BCBS MAPPO |
$441.39
|
| Rate for Payer: BCN Medicare Advantage |
$441.39
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| 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: Health Alliance Plan Medicare Advantage |
$441.39
|
| 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: Mclaren Medicaid |
$236.59
|
| Rate for Payer: Mclaren Medicare |
$441.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.46
|
| Rate for Payer: Meridian Medicaid |
$248.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$507.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$1,324.17
|
| Rate for Payer: PACE Medicare |
$419.32
|
| Rate for Payer: PACE SWMI |
$441.39
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: PHP Medicare Advantage |
$441.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.50
|
| Rate for Payer: Priority Health Medicare |
$441.39
|
| Rate for Payer: Priority Health Narrow Network |
$360.40
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: Railroad Medicare Medicare |
$441.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,242.47
|
| Rate for Payer: UHC Core |
$47.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.39
|
| Rate for Payer: UHC Exchange |
$843.54
|
| Rate for Payer: UHC Medicare Advantage |
$441.39
|
| Rate for Payer: UHCCP Medicaid |
$236.59
|
| Rate for Payer: UMR Bronson Commercial |
$197.86
|
| Rate for Payer: VA VA |
$441.39
|
| 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 |
$1,324.17 |
| Rate for Payer: Aetna American Axle |
$347.60
|
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$459.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$551.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$551.74
|
| Rate for Payer: BCBS Complete |
$248.41
|
| Rate for Payer: BCBS MAPPO |
$441.39
|
| Rate for Payer: BCN Medicare Advantage |
$441.39
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| 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: Health Alliance Plan Medicare Advantage |
$441.39
|
| 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: Mclaren Medicaid |
$236.59
|
| Rate for Payer: Mclaren Medicare |
$441.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.46
|
| Rate for Payer: Meridian Medicaid |
$248.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$507.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$1,324.17
|
| Rate for Payer: PACE Medicare |
$419.32
|
| Rate for Payer: PACE SWMI |
$441.39
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: PHP Medicare Advantage |
$441.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.50
|
| Rate for Payer: Priority Health Medicare |
$441.39
|
| Rate for Payer: Priority Health Narrow Network |
$360.40
|
| Rate for Payer: Priority Health SBD |
$336.91
|
| Rate for Payer: Railroad Medicare Medicare |
$441.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,242.47
|
| Rate for Payer: UHC Core |
$47.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.39
|
| Rate for Payer: UHC Exchange |
$843.54
|
| Rate for Payer: UHC Medicare Advantage |
$441.39
|
| Rate for Payer: UHCCP Medicaid |
$236.59
|
| Rate for Payer: UMR Bronson Commercial |
$197.86
|
| Rate for Payer: VA VA |
$441.39
|
| 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
|
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 CONCURRENT
|
Facility
|
OP
|
$173.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$18.18 |
| 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 |
$86.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.89
|
| Rate for Payer: BCBS Complete |
$69.47
|
| Rate for Payer: BCBS Trust/PPO |
$103.15
|
| Rate for Payer: BCN Commercial |
$103.15
|
| Rate for Payer: Cash Price |
$138.94
|
| 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: UHC All Payor (Choice/PPO) |
$20.00
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Exchange |
$18.18
|
| Rate for Payer: UMR Bronson Commercial |
$64.26
|
| 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 |
$18.81 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Mclaren Medicaid |
$24.23
|
| Rate for Payer: Mclaren Medicare |
$45.21
|
| Rate for Payer: Aetna American Axle |
$126.45
|
| Rate for Payer: Aetna Commercial |
$165.36
|
| Rate for Payer: Aetna Medicare |
$47.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.51
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$45.21
|
| Rate for Payer: BCBS Trust/PPO |
$106.66
|
| Rate for Payer: BCN Commercial |
$106.66
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| 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 |
$45.21
|
| 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 |
$145.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.47
|
| Rate for Payer: Meridian Medicaid |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.36
|
| Rate for Payer: Nomi Health Commercial |
$135.63
|
| Rate for Payer: PACE Medicare |
$42.95
|
| Rate for Payer: PACE SWMI |
$45.21
|
| Rate for Payer: PHP Commercial |
$165.36
|
| Rate for Payer: PHP Medicare Advantage |
$45.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.07
|
| Rate for Payer: Priority Health Medicare |
$45.21
|
| Rate for Payer: Priority Health Narrow Network |
$113.66
|
| Rate for Payer: Priority Health SBD |
$122.56
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.69
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$18.81
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$24.23
|
| Rate for Payer: UMR Bronson Commercial |
$71.98
|
| Rate for Payer: VA VA |
$45.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.90
|
|
|
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 |
$145.90
|
| 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 |
$145.90
|
|
