|
HC HSV CULTURE, NEONATE CMPT
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
30600297
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$31.53
|
| Rate for Payer: BCN Commercial |
$31.53
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC HSV CULTURE, NEONATE CMPT
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
30600297
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.75
|
| Rate for Payer: BCBS Complete |
$15.16
|
| Rate for Payer: BCBS MAPPO |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.72
|
| Rate for Payer: BCN Commercial |
$31.72
|
| Rate for Payer: BCN Medicare Advantage |
$10.20
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.20
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Mclaren Medicaid |
$14.44
|
| Rate for Payer: Meridian Medicaid |
$15.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Senior Care Partners |
$9.69
|
| Rate for Payer: PACE SWMI |
$10.20
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$10.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$10.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: Railroad Medicare Medicare |
$10.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.20
|
| Rate for Payer: UHC Medicare Advantage |
$10.51
|
| Rate for Payer: VA VA |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC HTLV I II ANTIBODY SCREEN,S
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200427
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$9.98
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$9.51
|
| Rate for Payer: Meridian Medicaid |
$9.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HTLV I II ANTIBODY SCREEN,S
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200427
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HTLV I II CONFIRMATION
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200276
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: Aetna Medicare |
$41.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.38
|
| Rate for Payer: BCBS Complete |
$14.99
|
| Rate for Payer: BCBS MAPPO |
$39.50
|
| Rate for Payer: BCBS Trust/PPO |
$122.84
|
| Rate for Payer: BCN Commercial |
$122.84
|
| Rate for Payer: BCN Medicare Advantage |
$39.50
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$135.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.50
|
| Rate for Payer: Healthscope Commercial |
$142.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.50
|
| Rate for Payer: Mclaren Medicaid |
$14.28
|
| Rate for Payer: Meridian Medicaid |
$14.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.30
|
| Rate for Payer: PACE Senior Care Partners |
$37.52
|
| Rate for Payer: PACE SWMI |
$39.50
|
| Rate for Payer: PHP Commercial |
$134.30
|
| Rate for Payer: PHP Medicare Advantage |
$39.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.46
|
| Rate for Payer: Priority Health Medicare |
$39.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.36
|
| Rate for Payer: Railroad Medicare Medicare |
$39.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.04
|
| Rate for Payer: UHC Core |
$131.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.50
|
| Rate for Payer: UHC Medicare Advantage |
$40.68
|
| Rate for Payer: VA VA |
$39.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.50
|
|
|
HC HTLV I II CONFIRMATION
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200276
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$96.36 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Aetna Commercial |
$134.30
|
| Rate for Payer: BCBS Trust/PPO |
$122.10
|
| Rate for Payer: BCN Commercial |
$122.10
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$135.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.40
|
| Rate for Payer: Healthscope Commercial |
$142.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.30
|
| Rate for Payer: PHP Commercial |
$134.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.04
|
| Rate for Payer: UHC Core |
$131.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.50
|
|
|
HC HUM/AEROSOL CONTINUOUS
|
Facility
|
IP
|
$371.75
|
|
| Hospital Charge Code |
27000115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$226.73 |
| Max. Negotiated Rate |
$334.58 |
| Rate for Payer: Aetna Commercial |
$315.99
|
| Rate for Payer: BCBS Trust/PPO |
$287.29
|
| Rate for Payer: BCN Commercial |
$287.29
|
| Rate for Payer: Cash Price |
$297.40
|
| Rate for Payer: Cofinity Commercial |
$319.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.40
|
| Rate for Payer: Healthscope Commercial |
$334.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.99
|
| Rate for Payer: PHP Commercial |
$315.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.14
|
| Rate for Payer: UHC Core |
$310.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.81
|
|
|
HC HUM/AEROSOL CONTINUOUS
|
Facility
|
OP
|
$371.75
|
|
| Hospital Charge Code |
27000115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.29 |
| Max. Negotiated Rate |
$334.58 |
| Rate for Payer: Aetna Commercial |
$315.99
|
| Rate for Payer: Aetna Medicare |
$96.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.17
|
| Rate for Payer: BCBS Complete |
$148.70
|
| Rate for Payer: BCBS MAPPO |
$92.94
|
| Rate for Payer: BCBS Trust/PPO |
$289.04
|
| Rate for Payer: BCN Commercial |
$289.04
|
| Rate for Payer: BCN Medicare Advantage |
$92.94
|
| Rate for Payer: Cash Price |
$297.40
|
| Rate for Payer: Cofinity Commercial |
$319.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.94
|
| Rate for Payer: Healthscope Commercial |
$334.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$278.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$97.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$315.99
|
| Rate for Payer: PACE Senior Care Partners |
$88.29
|
| Rate for Payer: PACE SWMI |
$92.94
|
| Rate for Payer: PHP Commercial |
$315.99
|
| Rate for Payer: PHP Medicare Advantage |
$92.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.42
|
| Rate for Payer: Priority Health Medicare |
$92.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.73
|
| Rate for Payer: Railroad Medicare Medicare |
$92.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.14
|
| Rate for Payer: UHC Core |
$310.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.94
|
| Rate for Payer: UHC Medicare Advantage |
$95.73
|
| Rate for Payer: VA VA |
$92.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$278.81
|
|
|
HC HUMAN HERPESVIRUS 6 (HHV-6)
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
30600272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HUMAN HERPESVIRUS 6 (HHV-6)
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
30600272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HUMAN PAPILLOMAVIRUS HIGH RISK
|
Facility
|
IP
|
$97.13
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
30600221
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.24 |
| Max. Negotiated Rate |
$87.42 |
| Rate for Payer: Aetna Commercial |
$82.56
|
| Rate for Payer: BCBS Trust/PPO |
$75.06
|
| Rate for Payer: BCN Commercial |
$75.06
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$83.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.70
|
| Rate for Payer: Healthscope Commercial |
$87.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.56
|
| Rate for Payer: PHP Commercial |
$82.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.47
|
| Rate for Payer: UHC Core |
$81.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.85
|
|
|
HC HUMAN PAPILLOMAVIRUS HIGH RISK
|
Facility
|
OP
|
$97.13
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
30600221
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$87.42 |
| Rate for Payer: Aetna Commercial |
$82.56
|
| Rate for Payer: Aetna Medicare |
$25.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.35
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$24.28
|
| Rate for Payer: BCBS Trust/PPO |
$75.52
|
| Rate for Payer: BCCCP Commercial |
$35.09
|
| Rate for Payer: BCN Commercial |
$75.52
|
| Rate for Payer: BCN Medicare Advantage |
$24.28
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$83.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.28
|
| Rate for Payer: Healthscope Commercial |
$87.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.85
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.56
|
| Rate for Payer: PACE Senior Care Partners |
$23.07
|
| Rate for Payer: PACE SWMI |
$24.28
|
| Rate for Payer: PHP Commercial |
$82.56
|
| Rate for Payer: PHP Medicare Advantage |
$24.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.50
|
| Rate for Payer: Priority Health Medicare |
$24.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.24
|
| Rate for Payer: Railroad Medicare Medicare |
$24.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.47
|
| Rate for Payer: UHC Core |
$81.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.28
|
| Rate for Payer: UHC Medicare Advantage |
$25.01
|
| Rate for Payer: VA VA |
$24.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.85
|
|
|
HC HUMAN PARECHOVIRUS
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600273
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HUMAN PARECHOVIRUS
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600273
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HYALUORAN OR DERIVATIVE, SYN OR SYN1, INTRA-ARTICULAR INJ, 1MG
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
63600107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HYALUORAN OR DERIVATIVE, SYN OR SYN1, INTRA-ARTICULAR INJ, 1MG
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
63600107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HYALURONAN FOR IA INJ PER DOSE
|
Facility
|
IP
|
$302.94
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$184.76 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: BCBS Trust/PPO |
$234.11
|
| Rate for Payer: BCN Commercial |
$234.11
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$260.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.35
|
| Rate for Payer: Healthscope Commercial |
$272.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.50
|
| Rate for Payer: PHP Commercial |
$257.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.59
|
| Rate for Payer: UHC Core |
$252.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.20
|
|
|
HC HYALURONAN FOR IA INJ PER DOSE
|
Facility
|
OP
|
$302.94
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.95 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$257.50
|
| Rate for Payer: Aetna Medicare |
$78.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.67
|
| Rate for Payer: BCBS Complete |
$121.18
|
| Rate for Payer: BCBS MAPPO |
$75.74
|
| Rate for Payer: BCBS Trust/PPO |
$235.54
|
| Rate for Payer: BCN Commercial |
$235.54
|
| Rate for Payer: BCN Medicare Advantage |
$75.74
|
| Rate for Payer: Cash Price |
$242.35
|
| Rate for Payer: Cofinity Commercial |
$260.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.74
|
| Rate for Payer: Healthscope Commercial |
$272.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.50
|
| Rate for Payer: PACE Senior Care Partners |
$71.95
|
| Rate for Payer: PACE SWMI |
$75.74
|
| Rate for Payer: PHP Commercial |
$257.50
|
| Rate for Payer: PHP Medicare Advantage |
$75.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.56
|
| Rate for Payer: Priority Health Medicare |
$75.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.76
|
| Rate for Payer: Railroad Medicare Medicare |
$75.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.59
|
| Rate for Payer: UHC Core |
$252.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.74
|
| Rate for Payer: UHC Medicare Advantage |
$78.01
|
| Rate for Payer: VA VA |
$75.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.20
|
|
|
HC HYALURONAN OR DERIVATIVE, DURALONE, INTRAARTICULAR INJ, 1MG
|
Facility
|
IP
|
$21.08
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$18.97 |
| Rate for Payer: Aetna Commercial |
$17.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.29
|
| Rate for Payer: BCN Commercial |
$16.29
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.86
|
| Rate for Payer: Healthscope Commercial |
$18.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.92
|
| Rate for Payer: PHP Commercial |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.55
|
| Rate for Payer: UHC Core |
$17.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.81
|
|
|
HC HYALURONAN OR DERIVATIVE, DURALONE, INTRAARTICULAR INJ, 1MG
|
Facility
|
OP
|
$21.08
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$18.97 |
| Rate for Payer: Aetna Commercial |
$17.92
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.59
|
| Rate for Payer: BCBS Complete |
$4.76
|
| Rate for Payer: BCBS MAPPO |
$5.27
|
| Rate for Payer: BCBS Trust/PPO |
$16.39
|
| Rate for Payer: BCN Commercial |
$16.39
|
| Rate for Payer: BCN Medicare Advantage |
$5.27
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.27
|
| Rate for Payer: Healthscope Commercial |
$18.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.81
|
| Rate for Payer: Mclaren Medicaid |
$4.53
|
| Rate for Payer: Meridian Medicaid |
$4.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.92
|
| Rate for Payer: PACE Senior Care Partners |
$5.01
|
| Rate for Payer: PACE SWMI |
$5.27
|
| Rate for Payer: PHP Commercial |
$17.92
|
| Rate for Payer: PHP Medicare Advantage |
$5.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.34
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.86
|
| Rate for Payer: Railroad Medicare Medicare |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.55
|
| Rate for Payer: UHC Core |
$17.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.27
|
| Rate for Payer: UHC Medicare Advantage |
$5.43
|
| Rate for Payer: VA VA |
$5.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.81
|
|
|
HC HYALURONAN OR DERIVATIVE, GEL 1, INTRA-ARTICULAR INJ PER DOSE
|
Facility
|
OP
|
$1,366.80
|
|
|
Service Code
|
CPT J7326
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$324.62 |
| Max. Negotiated Rate |
$1,230.12 |
| Rate for Payer: Aetna Commercial |
$1,161.78
|
| Rate for Payer: Aetna Medicare |
$355.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.12
|
| Rate for Payer: BCBS Complete |
$385.35
|
| Rate for Payer: BCBS MAPPO |
$341.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.69
|
| Rate for Payer: BCN Commercial |
$1,062.69
|
| Rate for Payer: BCN Medicare Advantage |
$341.70
|
| Rate for Payer: Cash Price |
$1,093.44
|
| Rate for Payer: Cash Price |
$1,093.44
|
| Rate for Payer: Cofinity Commercial |
$1,175.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.70
|
| Rate for Payer: Healthscope Commercial |
$1,230.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,025.10
|
| Rate for Payer: Mclaren Medicaid |
$367.00
|
| Rate for Payer: Meridian Medicaid |
$385.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$392.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,161.78
|
| Rate for Payer: PACE Senior Care Partners |
$324.62
|
| Rate for Payer: PACE SWMI |
$341.70
|
| Rate for Payer: PHP Commercial |
$1,161.78
|
| Rate for Payer: PHP Medicare Advantage |
$341.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.12
|
| Rate for Payer: Priority Health Medicare |
$341.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$833.61
|
| Rate for Payer: Railroad Medicare Medicare |
$341.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,202.78
|
| Rate for Payer: UHC Core |
$1,141.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$341.70
|
| Rate for Payer: UHC Medicare Advantage |
$351.95
|
| Rate for Payer: VA VA |
$341.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,025.10
|
|
|
HC HYALURONAN OR DERIVATIVE, GEL 1, INTRA-ARTICULAR INJ PER DOSE
|
Facility
|
IP
|
$1,366.80
|
|
|
Service Code
|
CPT J7326
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$833.61 |
| Max. Negotiated Rate |
$1,230.12 |
| Rate for Payer: Aetna Commercial |
$1,161.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,056.26
|
| Rate for Payer: BCN Commercial |
$1,056.26
|
| Rate for Payer: Cash Price |
$1,093.44
|
| Rate for Payer: Cofinity Commercial |
$1,175.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,093.44
|
| Rate for Payer: Healthscope Commercial |
$1,230.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,025.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,161.78
|
| Rate for Payer: PHP Commercial |
$1,161.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$833.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,202.78
|
| Rate for Payer: UHC Core |
$1,141.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,025.10
|
|
|
HC HYDROCODONE AND MTB, FREE
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Medicare |
$25.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.62
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS MAPPO |
$24.50
|
| Rate for Payer: BCBS Trust/PPO |
$76.20
|
| Rate for Payer: BCN Commercial |
$76.20
|
| Rate for Payer: BCN Medicare Advantage |
$24.50
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.50
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PACE Senior Care Partners |
$23.28
|
| Rate for Payer: PACE SWMI |
$24.50
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: PHP Medicare Advantage |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.26
|
| Rate for Payer: Priority Health Medicare |
$24.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.77
|
| Rate for Payer: Railroad Medicare Medicare |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.24
|
| Rate for Payer: UHC Core |
$81.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.50
|
| Rate for Payer: UHC Medicare Advantage |
$25.24
|
| Rate for Payer: VA VA |
$24.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.50
|
|
|
HC HYDROCODONE AND MTB, FREE
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.77 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: BCBS Trust/PPO |
$75.73
|
| Rate for Payer: BCN Commercial |
$75.73
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.24
|
| Rate for Payer: UHC Core |
$81.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.50
|
|
|
HC HYDROCORTIZONE CREAM
|
Facility
|
OP
|
$9.73
|
|
| Hospital Charge Code |
27000116
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Aetna Commercial |
$8.27
|
| Rate for Payer: Aetna Medicare |
$2.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.04
|
| Rate for Payer: BCBS Complete |
$3.89
|
| Rate for Payer: BCBS MAPPO |
$2.43
|
| Rate for Payer: BCBS Trust/PPO |
$7.57
|
| Rate for Payer: BCN Commercial |
$7.57
|
| Rate for Payer: BCN Medicare Advantage |
$2.43
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$8.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.43
|
| Rate for Payer: Healthscope Commercial |
$8.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.27
|
| Rate for Payer: PACE Senior Care Partners |
$2.31
|
| Rate for Payer: PACE SWMI |
$2.43
|
| Rate for Payer: PHP Commercial |
$8.27
|
| Rate for Payer: PHP Medicare Advantage |
$2.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.47
|
| Rate for Payer: Priority Health Medicare |
$2.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.93
|
| Rate for Payer: Railroad Medicare Medicare |
$2.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.56
|
| Rate for Payer: UHC Core |
$8.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.43
|
| Rate for Payer: UHC Medicare Advantage |
$2.51
|
| Rate for Payer: VA VA |
$2.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.30
|
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