|
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 |
$57.04 |
| Max. Negotiated Rate |
$648.80 |
| Rate for Payer: Aetna American Axle |
$347.61
|
| Rate for Payer: Aetna Commercial |
$454.56
|
| Rate for Payer: Aetna Medicare |
$214.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.61
|
| 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 |
$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 |
$206.43
|
| 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 |
$110.65
|
| 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 |
$454.56
|
| 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 |
$454.56
|
| 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 |
$347.61
|
| 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 |
$336.91
|
| 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 |
$197.87
|
| Rate for Payer: VA VA |
$206.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
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 LACTATED RINGERS 1000
|
Facility
|
OP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.51 |
| 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: BCBS Trust/PPO |
$6.51
|
| Rate for Payer: BCN Commercial |
$6.51
|
| Rate for Payer: Cash Price |
$66.99
|
| 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
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
IP
|
$85.72
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.72 |
| Max. Negotiated Rate |
$77.15 |
| Rate for Payer: Aetna American Axle |
$55.72
|
| Rate for Payer: Aetna Commercial |
$72.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.72
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$73.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$77.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.86
|
| Rate for Payer: PHP Commercial |
$72.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.72
|
| Rate for Payer: Priority Health SBD |
$54.00
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.29
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
OP
|
$85.72
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.44 |
| Max. Negotiated Rate |
$77.15 |
| Rate for Payer: Aetna American Axle |
$55.72
|
| Rate for Payer: Aetna Commercial |
$72.86
|
| Rate for Payer: Aetna Medicare |
$42.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.72
|
| Rate for Payer: BCBS Complete |
$34.29
|
| Rate for Payer: BCBS Trust/PPO |
$3.44
|
| Rate for Payer: BCN Commercial |
$3.44
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$73.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$77.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.86
|
| Rate for Payer: PHP Commercial |
$72.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.72
|
| Rate for Payer: Priority Health SBD |
$54.00
|
| Rate for Payer: UMR Bronson Commercial |
$31.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.29
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
IP
|
$167.72
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.80 |
| Max. Negotiated Rate |
$150.95 |
| Rate for Payer: Aetna American Axle |
$109.02
|
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.02
|
| Rate for Payer: Cash Price |
$134.18
|
| Rate for Payer: Cofinity Commercial |
$117.40
|
| Rate for Payer: Cofinity Commercial |
$144.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.18
|
| Rate for Payer: Healthscope Commercial |
$150.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.56
|
| Rate for Payer: PHP Commercial |
$142.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.02
|
| Rate for Payer: Priority Health SBD |
$105.66
|
| Rate for Payer: UMR Bronson Commercial |
$73.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.79
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
OP
|
$167.72
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$150.95 |
| Rate for Payer: Aetna American Axle |
$109.02
|
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: Aetna Medicare |
$47.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.02
|
| 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 |
$80.43
|
| Rate for Payer: BCN Commercial |
$80.43
|
| Rate for Payer: BCN Medicare Advantage |
$45.21
|
| Rate for Payer: Cash Price |
$134.18
|
| Rate for Payer: Cash Price |
$134.18
|
| Rate for Payer: Cofinity Commercial |
$144.24
|
| Rate for Payer: Cofinity Commercial |
$117.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$117.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$150.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.79
|
| 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 |
$142.56
|
| 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 |
$142.56
|
| 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 |
$109.02
|
| 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 |
$105.66
|
| Rate for Payer: Railroad Medicare Medicare |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.21
|
| Rate for Payer: UHC Exchange |
$14.10
|
| Rate for Payer: UHC Medicare Advantage |
$45.21
|
| Rate for Payer: UHCCP Medicaid |
$24.23
|
| Rate for Payer: UMR Bronson Commercial |
$62.06
|
| Rate for Payer: VA VA |
$45.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.79
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
IP
|
$154.83
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.13 |
| Max. Negotiated Rate |
$139.35 |
| Rate for Payer: Aetna American Axle |
$100.64
|
| Rate for Payer: Aetna Commercial |
$131.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.64
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$108.38
|
| Rate for Payer: Cofinity Commercial |
$133.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$139.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: PHP Commercial |
$131.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health SBD |
$97.54
|
| Rate for Payer: UMR Bronson Commercial |
$68.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.12
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
OP
|
$154.83
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$139.35 |
| Rate for Payer: Aetna American Axle |
$100.64
|
| Rate for Payer: Aetna Commercial |
$131.61
|
| Rate for Payer: Aetna Medicare |
$77.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.64
|
| Rate for Payer: BCBS Complete |
$61.93
|
| Rate for Payer: BCBS Trust/PPO |
$39.98
|
| Rate for Payer: BCN Commercial |
$39.98
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$108.38
|
| Rate for Payer: Cofinity Commercial |
$133.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$139.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: PHP Commercial |
$131.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health SBD |
$97.54
|
| Rate for Payer: UMR Bronson Commercial |
$57.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.12
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
OP
|
$401.79
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$361.61 |
| Rate for Payer: Aetna American Axle |
$261.16
|
| Rate for Payer: Aetna Commercial |
$341.52
|
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$284.98
|
| Rate for Payer: BCN Commercial |
$284.98
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$321.43
|
| Rate for Payer: Cash Price |
$321.43
|
| Rate for Payer: Cofinity Commercial |
$345.54
|
| Rate for Payer: Cofinity Commercial |
$281.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$361.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.34
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.52
|
| Rate for Payer: Nomi Health Commercial |
$209.19
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$341.52
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.18
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$175.34
|
| Rate for Payer: Priority Health SBD |
$253.13
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.41
|
| Rate for Payer: UHC Core |
$284.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$49.46
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$37.38
|
| Rate for Payer: UMR Bronson Commercial |
$148.66
|
| Rate for Payer: VA VA |
$69.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.34
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
IP
|
$401.79
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$176.79 |
| Max. Negotiated Rate |
$361.61 |
| Rate for Payer: Aetna American Axle |
$261.16
|
| Rate for Payer: Aetna Commercial |
$341.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.16
|
| Rate for Payer: Cash Price |
$321.43
|
| Rate for Payer: Cofinity Commercial |
$281.25
|
| Rate for Payer: Cofinity Commercial |
$345.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.43
|
| Rate for Payer: Healthscope Commercial |
$361.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.52
|
| Rate for Payer: PHP Commercial |
$341.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.16
|
| Rate for Payer: Priority Health SBD |
$253.13
|
| Rate for Payer: UMR Bronson Commercial |
$176.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.34
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
IP
|
$696.51
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$306.46 |
| Max. Negotiated Rate |
$626.86 |
| Rate for Payer: Aetna American Axle |
$452.73
|
| Rate for Payer: Aetna Commercial |
$592.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.73
|
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$487.56
|
| Rate for Payer: Cofinity Commercial |
$599.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$487.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.21
|
| Rate for Payer: Healthscope Commercial |
$626.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$487.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.03
|
| Rate for Payer: PHP Commercial |
$592.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.73
|
| Rate for Payer: Priority Health SBD |
$438.80
|
| Rate for Payer: UMR Bronson Commercial |
$306.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.38
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
OP
|
$696.51
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$90.70 |
| Max. Negotiated Rate |
$1,021.42 |
| Rate for Payer: Aetna American Axle |
$452.73
|
| Rate for Payer: Aetna Commercial |
$592.03
|
| Rate for Payer: Aetna Medicare |
$337.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.22
|
| Rate for Payer: BCBS Complete |
$182.90
|
| Rate for Payer: BCBS MAPPO |
$324.98
|
| Rate for Payer: BCBS Trust/PPO |
$524.53
|
| Rate for Payer: BCN Commercial |
$524.53
|
| Rate for Payer: BCN Medicare Advantage |
$324.98
|
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$599.00
|
| Rate for Payer: Cofinity Commercial |
$487.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$487.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.98
|
| Rate for Payer: Healthscope Commercial |
$626.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$487.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.38
|
| Rate for Payer: Mclaren Medicaid |
$174.19
|
| Rate for Payer: Mclaren Medicare |
$324.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.23
|
| Rate for Payer: Meridian Medicaid |
$182.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.03
|
| Rate for Payer: Nomi Health Commercial |
$974.94
|
| Rate for Payer: PACE Medicare |
$308.73
|
| Rate for Payer: PACE SWMI |
$324.98
|
| Rate for Payer: PHP Commercial |
$592.03
|
| Rate for Payer: PHP Medicare Advantage |
$324.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,021.42
|
| Rate for Payer: Priority Health Medicare |
$324.98
|
| Rate for Payer: Priority Health Narrow Network |
$817.14
|
| Rate for Payer: Priority Health SBD |
$438.80
|
| Rate for Payer: Railroad Medicare Medicare |
$324.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.77
|
| Rate for Payer: UHC Core |
$284.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.98
|
| Rate for Payer: UHC Exchange |
$90.70
|
| Rate for Payer: UHC Medicare Advantage |
$324.98
|
| Rate for Payer: UHCCP Medicaid |
$174.19
|
| Rate for Payer: UMR Bronson Commercial |
$257.71
|
| Rate for Payer: VA VA |
$324.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.38
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
OP
|
$282.63
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.51 |
| Max. Negotiated Rate |
$648.80 |
| Rate for Payer: Aetna American Axle |
$183.71
|
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare |
$214.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.71
|
| 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 |
$192.34
|
| Rate for Payer: BCN Commercial |
$192.34
|
| Rate for Payer: BCN Medicare Advantage |
$206.43
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$243.06
|
| Rate for Payer: Cofinity Commercial |
$197.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.43
|
| Rate for Payer: Healthscope Commercial |
$254.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.97
|
| 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 |
$240.24
|
| 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 |
$240.24
|
| 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 |
$183.71
|
| 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 |
$178.06
|
| Rate for Payer: Railroad Medicare Medicare |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.43
|
| Rate for Payer: UHC Exchange |
$33.51
|
| Rate for Payer: UHC Medicare Advantage |
$206.43
|
| Rate for Payer: UHCCP Medicaid |
$110.65
|
| Rate for Payer: UMR Bronson Commercial |
$104.57
|
| Rate for Payer: VA VA |
$206.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.97
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
IP
|
$282.63
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.36 |
| Max. Negotiated Rate |
$254.37 |
| Rate for Payer: Aetna American Axle |
$183.71
|
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.71
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$197.84
|
| Rate for Payer: Cofinity Commercial |
$243.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.10
|
| Rate for Payer: Healthscope Commercial |
$254.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.24
|
| Rate for Payer: PHP Commercial |
$240.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.71
|
| Rate for Payer: Priority Health SBD |
$178.06
|
| Rate for Payer: UMR Bronson Commercial |
$124.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.97
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
IP
|
$222.24
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.79 |
| Max. Negotiated Rate |
$200.02 |
| Rate for Payer: Aetna American Axle |
$144.46
|
| Rate for Payer: Aetna Commercial |
$188.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.46
|
| Rate for Payer: Cash Price |
$177.79
|
| Rate for Payer: Cofinity Commercial |
$155.57
|
| Rate for Payer: Cofinity Commercial |
$191.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.79
|
| Rate for Payer: Healthscope Commercial |
$200.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.90
|
| Rate for Payer: PHP Commercial |
$188.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.46
|
| Rate for Payer: Priority Health SBD |
$140.01
|
| Rate for Payer: UMR Bronson Commercial |
$97.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.68
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
OP
|
$222.24
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: UHC Dual Complete DSNP |
$69.73
|
| Rate for Payer: UHC Exchange |
$25.99
|
| Rate for Payer: UHC Medicare Advantage |
$69.73
|
| Rate for Payer: UHCCP Medicaid |
$37.38
|
| Rate for Payer: UMR Bronson Commercial |
$82.23
|
| Rate for Payer: VA VA |
$69.73
|
| Rate for Payer: Aetna American Axle |
$144.46
|
| Rate for Payer: Aetna Commercial |
$188.90
|
| Rate for Payer: Aetna Medicare |
$72.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.16
|
| Rate for Payer: BCBS Complete |
$39.24
|
| Rate for Payer: BCBS MAPPO |
$69.73
|
| Rate for Payer: BCBS Trust/PPO |
$148.61
|
| Rate for Payer: BCN Commercial |
$148.61
|
| Rate for Payer: BCN Medicare Advantage |
$69.73
|
| Rate for Payer: Cash Price |
$177.79
|
| Rate for Payer: Cash Price |
$177.79
|
| Rate for Payer: Cofinity Commercial |
$191.13
|
| Rate for Payer: Cofinity Commercial |
$155.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$200.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.68
|
| Rate for Payer: Mclaren Medicaid |
$37.38
|
| Rate for Payer: Mclaren Medicare |
$69.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.22
|
| Rate for Payer: Meridian Medicaid |
$39.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.90
|
| Rate for Payer: Nomi Health Commercial |
$209.19
|
| Rate for Payer: PACE Medicare |
$66.24
|
| Rate for Payer: PACE SWMI |
$69.73
|
| Rate for Payer: PHP Commercial |
$188.90
|
| Rate for Payer: PHP Medicare Advantage |
$69.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.18
|
| Rate for Payer: Priority Health Medicare |
$69.73
|
| Rate for Payer: Priority Health Narrow Network |
$175.34
|
| Rate for Payer: Priority Health SBD |
$140.01
|
| Rate for Payer: Railroad Medicare Medicare |
$69.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.59
|
| Rate for Payer: UHC Core |
$250.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.68
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
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 IVUS CATHETER
|
Facility
|
OP
|
$2,739.36
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,013.56 |
| Max. Negotiated Rate |
$2,465.42 |
| Rate for Payer: Aetna American Axle |
$1,780.58
|
| Rate for Payer: Aetna Commercial |
$2,328.46
|
| Rate for Payer: Aetna Medicare |
$1,369.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,780.58
|
| Rate for Payer: BCBS Complete |
$1,095.74
|
| Rate for Payer: Cash Price |
$2,191.49
|
| Rate for Payer: Cofinity Commercial |
$1,917.55
|
| Rate for Payer: Cofinity Commercial |
$2,355.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,917.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,191.49
|
| Rate for Payer: Healthscope Commercial |
$2,465.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,917.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,054.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,328.46
|
| Rate for Payer: PHP Commercial |
$2,328.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.58
|
| Rate for Payer: Priority Health SBD |
$1,725.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,013.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,054.52
|
|
|
HC IVUS CATHETER
|
Facility
|
IP
|
$2,739.36
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,205.32 |
| Max. Negotiated Rate |
$2,465.42 |
| Rate for Payer: Aetna American Axle |
$1,780.58
|
| Rate for Payer: Aetna Commercial |
$2,328.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,780.58
|
| Rate for Payer: Cash Price |
$2,191.49
|
| Rate for Payer: Cofinity Commercial |
$1,917.55
|
| Rate for Payer: Cofinity Commercial |
$2,355.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,917.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,191.49
|
| Rate for Payer: Healthscope Commercial |
$2,465.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,917.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,054.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,328.46
|
| Rate for Payer: PHP Commercial |
$2,328.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.58
|
| Rate for Payer: Priority Health SBD |
$1,725.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,205.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,054.52
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
OP
|
$1,324.84
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.96 |
| Max. Negotiated Rate |
$1,192.36 |
| Rate for Payer: Aetna American Axle |
$861.15
|
| Rate for Payer: Aetna Commercial |
$1,126.11
|
| Rate for Payer: Aetna Medicare |
$662.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$861.15
|
| Rate for Payer: BCBS Complete |
$529.94
|
| Rate for Payer: BCBS Trust/PPO |
$850.88
|
| Rate for Payer: BCN Commercial |
$850.88
|
| Rate for Payer: Cash Price |
$1,059.87
|
| Rate for Payer: Cash Price |
$1,059.87
|
| Rate for Payer: Cash Price |
$1,059.87
|
| Rate for Payer: Cofinity Commercial |
$927.39
|
| Rate for Payer: Cofinity Commercial |
$1,139.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$927.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,059.87
|
| Rate for Payer: Healthscope Commercial |
$1,192.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$927.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$993.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,126.11
|
| Rate for Payer: PHP Commercial |
$1,126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.15
|
| Rate for Payer: Priority Health SBD |
$834.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.76
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$67.96
|
| Rate for Payer: UMR Bronson Commercial |
$490.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$993.63
|
|
