|
HC REDTOP BENT GRASS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200057
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC REDUCER ASY 3/8 X 3/8 STRAIGHT
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
27000717
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna American Axle |
$3.90
|
| Rate for Payer: Aetna Commercial |
$5.10
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.90
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Advantage |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: PHP Commercial |
$5.10
|
| Rate for Payer: Priority Health SBD |
$3.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.90
|
| Rate for Payer: UHC Core |
$3.13
|
| Rate for Payer: UHC Exchange |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$2.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.50
|
|
|
HC REDUCER ASY 3/8 X 3/8 STRAIGHT
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
27000717
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna American Axle |
$3.90
|
| Rate for Payer: Aetna Commercial |
$5.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.90
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Advantage |
$4.20
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.80
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: PHP Commercial |
$5.10
|
| Rate for Payer: Priority Health SBD |
$3.78
|
| Rate for Payer: UMR Bronson Commercial |
$2.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.50
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
OP
|
$9.36
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna American Axle |
$6.08
|
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna Medicare |
$4.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: BCBS Complete |
$3.74
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Advantage |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.02
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: Priority Health SBD |
$5.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.08
|
| Rate for Payer: UHC Core |
$4.88
|
| Rate for Payer: UHC Exchange |
$3.68
|
| Rate for Payer: UMR Bronson Commercial |
$3.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.02
|
|
|
HC REDUCER W/LL ASY 1/4 X 3/8
|
Facility
|
IP
|
$9.36
|
|
| Hospital Charge Code |
27000679
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna American Axle |
$6.08
|
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.08
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Advantage |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.02
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: Priority Health SBD |
$5.90
|
| Rate for Payer: UMR Bronson Commercial |
$4.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.02
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
IP
|
$447.42
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$196.86 |
| Max. Negotiated Rate |
$402.68 |
| Rate for Payer: Aetna American Axle |
$290.82
|
| Rate for Payer: Aetna Commercial |
$380.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.82
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cofinity Advantage |
$313.19
|
| Rate for Payer: Cofinity Commercial |
$384.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.94
|
| Rate for Payer: Healthscope Commercial |
$402.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.56
|
| Rate for Payer: PHP Commercial |
$380.31
|
| Rate for Payer: Priority Health SBD |
$281.87
|
| Rate for Payer: UMR Bronson Commercial |
$196.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.56
|
|
|
HC REFILL AND MAINTENANCE OF IMPLANTED PUMP
|
Facility
|
OP
|
$447.42
|
|
|
Service Code
|
HCPCS 96522
|
| Hospital Charge Code |
33500009
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$685.39 |
| Rate for Payer: Aetna American Axle |
$290.82
|
| Rate for Payer: Aetna Commercial |
$380.31
|
| Rate for Payer: Aetna Medicare |
$220.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$241.76
|
| Rate for Payer: BCN Commercial |
$241.76
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cash Price |
$357.94
|
| Rate for Payer: Cofinity Advantage |
$313.19
|
| Rate for Payer: Cofinity Commercial |
$384.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$402.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.56
|
| Rate for Payer: Mclaren Medicaid |
$211.94
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$222.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.31
|
| Rate for Payer: Nomi Health Commercial |
$635.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.56
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$380.31
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$685.39
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health SBD |
$281.87
|
| Rate for Payer: Priority Health Tiered Network |
$548.31
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.82
|
| Rate for Payer: UHC Core |
$233.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$175.84
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: UMR Bronson Commercial |
$165.55
|
| Rate for Payer: VA VA |
$211.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.56
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
OP
|
$899.63
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$809.67 |
| Rate for Payer: Aetna American Axle |
$584.76
|
| Rate for Payer: Aetna Commercial |
$764.69
|
| Rate for Payer: Aetna Medicare |
$220.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$254.75
|
| Rate for Payer: BCN Commercial |
$254.75
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Cash Price |
$719.70
|
| Rate for Payer: Cash Price |
$719.70
|
| Rate for Payer: Cash Price |
$719.70
|
| Rate for Payer: Cofinity Advantage |
$629.74
|
| Rate for Payer: Cofinity Commercial |
$773.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Healthscope Commercial |
$809.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$629.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$674.72
|
| Rate for Payer: Mclaren Medicaid |
$211.94
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$222.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.69
|
| Rate for Payer: Nomi Health Commercial |
$635.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.72
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Commercial |
$764.69
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$685.39
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health SBD |
$566.77
|
| Rate for Payer: Priority Health Tiered Network |
$548.31
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$584.76
|
| Rate for Payer: UHC Core |
$468.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Exchange |
$353.55
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: UMR Bronson Commercial |
$332.86
|
| Rate for Payer: VA VA |
$211.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.72
|
|
|
HC REFILL AND MAINTENANCE OF PORT PUMP
|
Facility
|
IP
|
$899.63
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
33500008
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$395.84 |
| Max. Negotiated Rate |
$809.67 |
| Rate for Payer: Aetna American Axle |
$584.76
|
| Rate for Payer: Aetna Commercial |
$764.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.76
|
| Rate for Payer: Cash Price |
$719.70
|
| Rate for Payer: Cofinity Advantage |
$629.74
|
| Rate for Payer: Cofinity Commercial |
$773.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.70
|
| Rate for Payer: Healthscope Commercial |
$809.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$629.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$674.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.72
|
| Rate for Payer: PHP Commercial |
$764.69
|
| Rate for Payer: Priority Health SBD |
$566.77
|
| Rate for Payer: UMR Bronson Commercial |
$395.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.72
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.10 |
| Max. Negotiated Rate |
$989.69 |
| Rate for Payer: Aetna American Axle |
$279.50
|
| Rate for Payer: Aetna Commercial |
$365.50
|
| Rate for Payer: Aetna Medicare |
$318.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.54
|
| Rate for Payer: BCBS Complete |
$168.07
|
| Rate for Payer: BCBS MAPPO |
$306.03
|
| Rate for Payer: BCBS Trust/PPO |
$374.86
|
| Rate for Payer: BCN Commercial |
$374.86
|
| Rate for Payer: BCN Medicare Advantage |
$306.03
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Advantage |
$301.00
|
| Rate for Payer: Cofinity Commercial |
$369.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.03
|
| Rate for Payer: Healthscope Commercial |
$387.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.50
|
| Rate for Payer: Mclaren Medicaid |
$306.03
|
| Rate for Payer: Mclaren Medicare |
$306.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.33
|
| Rate for Payer: Meridian Medicaid |
$321.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.50
|
| Rate for Payer: Nomi Health Commercial |
$918.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.50
|
| Rate for Payer: PACE Medicare |
$290.73
|
| Rate for Payer: PACE SWMI |
$306.03
|
| Rate for Payer: PHP Commercial |
$365.50
|
| Rate for Payer: PHP Medicare Advantage |
$306.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.69
|
| Rate for Payer: Priority Health Medicare |
$306.03
|
| Rate for Payer: Priority Health SBD |
$270.90
|
| Rate for Payer: Priority Health Tiered Network |
$791.75
|
| Rate for Payer: Railroad Medicare Medicare |
$306.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$306.03
|
| Rate for Payer: UHC Medicaid |
$160.05
|
| Rate for Payer: UHCCP Medicaid |
$160.05
|
| Rate for Payer: UMR Bronson Commercial |
$159.10
|
| Rate for Payer: VA VA |
$306.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.50
|
|
|
HC REFILL AND REPROGRAM INTRATHECAL INF PUMP
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 62370
|
| Hospital Charge Code |
36100587
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$189.20 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna American Axle |
$279.50
|
| Rate for Payer: Aetna Commercial |
$365.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.50
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Advantage |
$301.00
|
| Rate for Payer: Cofinity Commercial |
$369.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.00
|
| Rate for Payer: Healthscope Commercial |
$387.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.50
|
| Rate for Payer: PHP Commercial |
$365.50
|
| Rate for Payer: Priority Health SBD |
$270.90
|
| Rate for Payer: UMR Bronson Commercial |
$189.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.50
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
OP
|
$158.12
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$142.31 |
| Rate for Payer: Aetna American Axle |
$102.78
|
| Rate for Payer: Aetna Commercial |
$134.40
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$14.87
|
| Rate for Payer: BCN Commercial |
$14.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cofinity Advantage |
$110.68
|
| Rate for Payer: Cofinity Commercial |
$135.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$142.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.59
|
| Rate for Payer: Mclaren Medicaid |
$12.87
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.40
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.59
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$134.40
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.87
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$99.62
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.31
|
| Rate for Payer: UHC Core |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: UMR Bronson Commercial |
$58.50
|
| Rate for Payer: VA VA |
$12.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.59
|
|
|
HC REFLEX BETHESDA UNITS
|
Facility
|
IP
|
$158.12
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500042
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$69.57 |
| Max. Negotiated Rate |
$142.31 |
| Rate for Payer: Aetna American Axle |
$102.78
|
| Rate for Payer: Aetna Commercial |
$134.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.78
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cofinity Advantage |
$110.68
|
| Rate for Payer: Cofinity Commercial |
$135.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.50
|
| Rate for Payer: Healthscope Commercial |
$142.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.59
|
| Rate for Payer: PHP Commercial |
$134.40
|
| Rate for Payer: Priority Health SBD |
$99.62
|
| Rate for Payer: UMR Bronson Commercial |
$69.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.59
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
IP
|
$326.85
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$143.81 |
| Max. Negotiated Rate |
$294.17 |
| Rate for Payer: Aetna American Axle |
$212.45
|
| Rate for Payer: Aetna Commercial |
$277.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.45
|
| Rate for Payer: Cash Price |
$261.48
|
| Rate for Payer: Cofinity Advantage |
$228.79
|
| Rate for Payer: Cofinity Commercial |
$281.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.48
|
| Rate for Payer: Healthscope Commercial |
$294.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.14
|
| Rate for Payer: PHP Commercial |
$277.82
|
| Rate for Payer: Priority Health SBD |
$205.92
|
| Rate for Payer: UMR Bronson Commercial |
$143.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.14
|
|
|
HC REFLEX COAG FACTOR VIII INHIBITOR
|
Facility
|
OP
|
$326.85
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30500043
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$294.17 |
| Rate for Payer: Aetna American Axle |
$212.45
|
| Rate for Payer: Aetna Commercial |
$277.82
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$14.87
|
| Rate for Payer: BCN Commercial |
$14.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$261.48
|
| Rate for Payer: Cash Price |
$261.48
|
| Rate for Payer: Cofinity Advantage |
$228.79
|
| Rate for Payer: Cofinity Commercial |
$281.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$294.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.14
|
| Rate for Payer: Mclaren Medicaid |
$12.87
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.82
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.14
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$277.82
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.87
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$205.92
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.31
|
| Rate for Payer: UHC Core |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: UMR Bronson Commercial |
$120.93
|
| Rate for Payer: VA VA |
$12.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.14
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
OP
|
$120.14
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$44.45 |
| Max. Negotiated Rate |
$108.13 |
| Rate for Payer: Aetna American Axle |
$78.09
|
| Rate for Payer: Aetna Commercial |
$102.12
|
| Rate for Payer: Aetna Medicare |
$60.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.09
|
| Rate for Payer: BCBS Complete |
$48.06
|
| Rate for Payer: Cash Price |
$96.11
|
| Rate for Payer: Cofinity Advantage |
$84.10
|
| Rate for Payer: Cofinity Commercial |
$103.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.11
|
| Rate for Payer: Healthscope Commercial |
$108.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.11
|
| Rate for Payer: PHP Commercial |
$102.12
|
| Rate for Payer: Priority Health SBD |
$75.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.09
|
| Rate for Payer: UHC Core |
$62.59
|
| Rate for Payer: UHC Exchange |
$47.22
|
| Rate for Payer: UMR Bronson Commercial |
$44.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.11
|
|
|
HC REG/SEDAT ADDL 15 MIN
|
Facility
|
IP
|
$120.14
|
|
| Hospital Charge Code |
37000011
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$52.86 |
| Max. Negotiated Rate |
$108.13 |
| Rate for Payer: Aetna American Axle |
$78.09
|
| Rate for Payer: Aetna Commercial |
$102.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.09
|
| Rate for Payer: Cash Price |
$96.11
|
| Rate for Payer: Cofinity Advantage |
$84.10
|
| Rate for Payer: Cofinity Commercial |
$103.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.11
|
| Rate for Payer: Healthscope Commercial |
$108.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.11
|
| Rate for Payer: PHP Commercial |
$102.12
|
| Rate for Payer: Priority Health SBD |
$75.69
|
| Rate for Payer: UMR Bronson Commercial |
$52.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.11
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
IP
|
$607.70
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$267.39 |
| Max. Negotiated Rate |
$546.93 |
| Rate for Payer: Aetna American Axle |
$395.00
|
| Rate for Payer: Aetna Commercial |
$516.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.00
|
| Rate for Payer: Cash Price |
$486.16
|
| Rate for Payer: Cofinity Advantage |
$425.39
|
| Rate for Payer: Cofinity Commercial |
$522.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.16
|
| Rate for Payer: Healthscope Commercial |
$546.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$425.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$455.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$455.77
|
| Rate for Payer: PHP Commercial |
$516.54
|
| Rate for Payer: Priority Health SBD |
$382.85
|
| Rate for Payer: UMR Bronson Commercial |
$267.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$455.77
|
|
|
HC REG/SEDAT INIT 30 MIN
|
Facility
|
OP
|
$607.70
|
|
| Hospital Charge Code |
37000012
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$224.85 |
| Max. Negotiated Rate |
$546.93 |
| Rate for Payer: Aetna American Axle |
$395.00
|
| Rate for Payer: Aetna Commercial |
$516.54
|
| Rate for Payer: Aetna Medicare |
$303.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.00
|
| Rate for Payer: BCBS Complete |
$243.08
|
| Rate for Payer: Cash Price |
$486.16
|
| Rate for Payer: Cofinity Advantage |
$425.39
|
| Rate for Payer: Cofinity Commercial |
$522.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$486.16
|
| Rate for Payer: Healthscope Commercial |
$546.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$425.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$455.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$486.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$455.77
|
| Rate for Payer: PHP Commercial |
$516.54
|
| Rate for Payer: Priority Health SBD |
$382.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.00
|
| Rate for Payer: UHC Core |
$316.61
|
| Rate for Payer: UHC Exchange |
$238.83
|
| Rate for Payer: UMR Bronson Commercial |
$224.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$455.77
|
|
|
HC REM MNTR PHYSIOL PARAM 16-30 DAYS
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.07 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna American Axle |
$71.01
|
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Advantage |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health SBD |
$68.82
|
| Rate for Payer: UMR Bronson Commercial |
$48.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC REM MNTR PHYSIOL PARAM 16-30 DAYS
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 99454
|
| Hospital Charge Code |
51000110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$185.96 |
| Rate for Payer: Aetna American Axle |
$71.01
|
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna Medicare |
$38.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.49
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS MAPPO |
$37.19
|
| Rate for Payer: BCBS Trust/PPO |
$185.96
|
| Rate for Payer: BCN Commercial |
$185.96
|
| Rate for Payer: BCN Medicare Advantage |
$37.19
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Advantage |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.19
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Mclaren Medicaid |
$37.19
|
| Rate for Payer: Mclaren Medicare |
$37.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.05
|
| Rate for Payer: Meridian Medicaid |
$39.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$111.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: PACE Medicare |
$35.33
|
| Rate for Payer: PACE SWMI |
$37.19
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: PHP Medicare Advantage |
$37.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.26
|
| Rate for Payer: Priority Health Medicare |
$37.19
|
| Rate for Payer: Priority Health SBD |
$68.82
|
| Rate for Payer: Priority Health Tiered Network |
$96.21
|
| Rate for Payer: Railroad Medicare Medicare |
$37.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.01
|
| Rate for Payer: UHC Core |
$56.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.19
|
| Rate for Payer: UHC Exchange |
$42.93
|
| Rate for Payer: UHC Medicaid |
$19.45
|
| Rate for Payer: UHCCP Medicaid |
$19.45
|
| Rate for Payer: UMR Bronson Commercial |
$40.42
|
| Rate for Payer: VA VA |
$37.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Facility
|
OP
|
$353.74
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
51000111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.38 |
| Max. Negotiated Rate |
$428.99 |
| Rate for Payer: Aetna American Axle |
$229.93
|
| Rate for Payer: Aetna Commercial |
$300.68
|
| Rate for Payer: Aetna Medicare |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.82
|
| Rate for Payer: BCBS Complete |
$72.86
|
| Rate for Payer: BCBS MAPPO |
$132.66
|
| Rate for Payer: BCBS Trust/PPO |
$83.12
|
| Rate for Payer: BCN Commercial |
$83.12
|
| Rate for Payer: BCN Medicare Advantage |
$132.66
|
| Rate for Payer: Cash Price |
$282.99
|
| Rate for Payer: Cash Price |
$282.99
|
| Rate for Payer: Cofinity Advantage |
$247.62
|
| Rate for Payer: Cofinity Commercial |
$304.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.66
|
| Rate for Payer: Healthscope Commercial |
$318.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.31
|
| Rate for Payer: Mclaren Medicaid |
$132.66
|
| Rate for Payer: Mclaren Medicare |
$132.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.29
|
| Rate for Payer: Meridian Medicaid |
$139.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.68
|
| Rate for Payer: Nomi Health Commercial |
$397.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.31
|
| Rate for Payer: PACE Medicare |
$126.03
|
| Rate for Payer: PACE SWMI |
$132.66
|
| Rate for Payer: PHP Commercial |
$300.68
|
| Rate for Payer: PHP Medicare Advantage |
$132.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.99
|
| Rate for Payer: Priority Health Medicare |
$132.66
|
| Rate for Payer: Priority Health SBD |
$222.86
|
| Rate for Payer: Priority Health Tiered Network |
$343.19
|
| Rate for Payer: Railroad Medicare Medicare |
$132.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.93
|
| Rate for Payer: UHC Core |
$184.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.66
|
| Rate for Payer: UHC Exchange |
$139.02
|
| Rate for Payer: UHC Medicaid |
$69.38
|
| Rate for Payer: UHCCP Medicaid |
$69.38
|
| Rate for Payer: UMR Bronson Commercial |
$130.88
|
| Rate for Payer: VA VA |
$132.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.31
|
|
|
HC REM MNTR PHYSIOL PARAM 1ST SET UP PT EDUCAJ EQP
|
Facility
|
IP
|
$353.74
|
|
|
Service Code
|
CPT 99453
|
| Hospital Charge Code |
51000111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$155.65 |
| Max. Negotiated Rate |
$318.37 |
| Rate for Payer: Aetna American Axle |
$229.93
|
| Rate for Payer: Aetna Commercial |
$300.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.93
|
| Rate for Payer: Cash Price |
$282.99
|
| Rate for Payer: Cofinity Advantage |
$247.62
|
| Rate for Payer: Cofinity Commercial |
$304.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.99
|
| Rate for Payer: Healthscope Commercial |
$318.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.31
|
| Rate for Payer: PHP Commercial |
$300.68
|
| Rate for Payer: Priority Health SBD |
$222.86
|
| Rate for Payer: UMR Bronson Commercial |
$155.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.31
|
|
|
HC REMOTE THER MON DEVICE SUPPLY MS 16-30 DAYS
|
Facility
|
OP
|
$117.05
|
|
|
Service Code
|
CPT 98977
|
| Hospital Charge Code |
42000063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$146.66 |
| Rate for Payer: Aetna American Axle |
$76.08
|
| Rate for Payer: Aetna Commercial |
$99.49
|
| Rate for Payer: Aetna Medicare |
$38.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.49
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS MAPPO |
$37.19
|
| Rate for Payer: BCBS Trust/PPO |
$146.66
|
| Rate for Payer: BCN Commercial |
$146.66
|
| Rate for Payer: BCN Medicare Advantage |
$37.19
|
| Rate for Payer: Cash Price |
$93.64
|
| Rate for Payer: Cash Price |
$93.64
|
| Rate for Payer: Cash Price |
$93.64
|
| Rate for Payer: Cofinity Advantage |
$81.94
|
| Rate for Payer: Cofinity Commercial |
$100.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.19
|
| Rate for Payer: Healthscope Commercial |
$105.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.79
|
| Rate for Payer: Mclaren Medicaid |
$37.19
|
| Rate for Payer: Mclaren Medicare |
$37.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.05
|
| Rate for Payer: Meridian Medicaid |
$39.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.49
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.79
|
| Rate for Payer: PACE Medicare |
$35.33
|
| Rate for Payer: PACE SWMI |
$37.19
|
| Rate for Payer: PHP Commercial |
$99.49
|
| Rate for Payer: PHP Medicare Advantage |
$37.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.26
|
| Rate for Payer: Priority Health Medicare |
$37.19
|
| Rate for Payer: Priority Health SBD |
$73.74
|
| Rate for Payer: Priority Health Tiered Network |
$96.21
|
| Rate for Payer: Railroad Medicare Medicare |
$37.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.08
|
| Rate for Payer: UHC Core |
$60.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.19
|
| Rate for Payer: UHC Exchange |
$46.00
|
| Rate for Payer: UHC Medicaid |
$19.45
|
| Rate for Payer: UHCCP Medicaid |
$19.45
|
| Rate for Payer: UMR Bronson Commercial |
$43.31
|
| Rate for Payer: VA VA |
$37.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.79
|
|
|
HC REMOTE THER MON DEVICE SUPPLY MS 16-30 DAYS
|
Facility
|
IP
|
$117.05
|
|
|
Service Code
|
CPT 98977
|
| Hospital Charge Code |
42000063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$51.50 |
| Max. Negotiated Rate |
$105.34 |
| Rate for Payer: Aetna American Axle |
$76.08
|
| Rate for Payer: Aetna Commercial |
$99.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.08
|
| Rate for Payer: Cash Price |
$93.64
|
| Rate for Payer: Cofinity Advantage |
$81.94
|
| Rate for Payer: Cofinity Commercial |
$100.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.64
|
| Rate for Payer: Healthscope Commercial |
$105.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.79
|
| Rate for Payer: PHP Commercial |
$99.49
|
| Rate for Payer: Priority Health SBD |
$73.74
|
| Rate for Payer: UMR Bronson Commercial |
$51.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.79
|
|
