|
HC INJ BEBTELOVIMAB
|
Facility
|
IP
|
$475.49
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$427.94 |
| Rate for Payer: Aetna Commercial |
$404.17
|
| Rate for Payer: BCBS Trust/PPO |
$367.46
|
| Rate for Payer: BCN Commercial |
$367.46
|
| Rate for Payer: Cash Price |
$380.39
|
| Rate for Payer: Cofinity Commercial |
$408.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.39
|
| Rate for Payer: Healthscope Commercial |
$427.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.17
|
| Rate for Payer: PHP Commercial |
$404.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.43
|
| Rate for Payer: UHC Core |
$397.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.62
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
IP
|
$1,081.82
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$659.80 |
| Max. Negotiated Rate |
$973.64 |
| Rate for Payer: Aetna Commercial |
$919.55
|
| Rate for Payer: BCBS Trust/PPO |
$836.03
|
| Rate for Payer: BCN Commercial |
$836.03
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$930.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.46
|
| Rate for Payer: Healthscope Commercial |
$973.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$811.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PHP Commercial |
$919.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$941.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$659.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$952.00
|
| Rate for Payer: UHC Core |
$903.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$811.36
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
OP
|
$1,081.82
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.93 |
| Max. Negotiated Rate |
$973.64 |
| Rate for Payer: Aetna Commercial |
$919.55
|
| Rate for Payer: Aetna Medicare |
$281.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$338.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$338.07
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$270.46
|
| Rate for Payer: BCBS Trust/PPO |
$841.12
|
| Rate for Payer: BCN Commercial |
$841.12
|
| Rate for Payer: BCN Medicare Advantage |
$270.46
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$930.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.46
|
| Rate for Payer: Healthscope Commercial |
$973.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$811.36
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$283.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PACE Senior Care Partners |
$256.93
|
| Rate for Payer: PACE SWMI |
$270.46
|
| Rate for Payer: PHP Commercial |
$919.55
|
| Rate for Payer: PHP Medicare Advantage |
$270.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$941.18
|
| Rate for Payer: Priority Health Medicare |
$270.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$659.80
|
| Rate for Payer: Railroad Medicare Medicare |
$270.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$952.00
|
| Rate for Payer: UHC Core |
$903.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$270.46
|
| Rate for Payer: UHC Medicare Advantage |
$278.57
|
| Rate for Payer: VA VA |
$270.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$811.36
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
OP
|
$1,081.82
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.93 |
| Max. Negotiated Rate |
$973.64 |
| Rate for Payer: Aetna Commercial |
$919.55
|
| Rate for Payer: Aetna Medicare |
$281.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$338.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$338.07
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$270.46
|
| Rate for Payer: BCBS Trust/PPO |
$841.12
|
| Rate for Payer: BCN Commercial |
$841.12
|
| Rate for Payer: BCN Medicare Advantage |
$270.46
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$930.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.46
|
| Rate for Payer: Healthscope Commercial |
$973.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$811.36
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$283.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PACE Senior Care Partners |
$256.93
|
| Rate for Payer: PACE SWMI |
$270.46
|
| Rate for Payer: PHP Commercial |
$919.55
|
| Rate for Payer: PHP Medicare Advantage |
$270.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$941.18
|
| Rate for Payer: Priority Health Medicare |
$270.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$659.80
|
| Rate for Payer: Railroad Medicare Medicare |
$270.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$952.00
|
| Rate for Payer: UHC Core |
$903.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$270.46
|
| Rate for Payer: UHC Medicare Advantage |
$278.57
|
| Rate for Payer: VA VA |
$270.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$811.36
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
IP
|
$1,081.82
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$659.80 |
| Max. Negotiated Rate |
$973.64 |
| Rate for Payer: Aetna Commercial |
$919.55
|
| Rate for Payer: BCBS Trust/PPO |
$836.03
|
| Rate for Payer: BCN Commercial |
$836.03
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$930.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.46
|
| Rate for Payer: Healthscope Commercial |
$973.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$811.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PHP Commercial |
$919.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$941.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$659.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$952.00
|
| Rate for Payer: UHC Core |
$903.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$811.36
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
IP
|
$1,081.82
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$659.80 |
| Max. Negotiated Rate |
$973.64 |
| Rate for Payer: Aetna Commercial |
$919.55
|
| Rate for Payer: BCBS Trust/PPO |
$836.03
|
| Rate for Payer: BCN Commercial |
$836.03
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$930.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.46
|
| Rate for Payer: Healthscope Commercial |
$973.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$811.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PHP Commercial |
$919.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$941.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$659.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$952.00
|
| Rate for Payer: UHC Core |
$903.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$811.36
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
OP
|
$1,081.82
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.93 |
| Max. Negotiated Rate |
$973.64 |
| Rate for Payer: Aetna Commercial |
$919.55
|
| Rate for Payer: Aetna Medicare |
$281.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$338.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$338.07
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$270.46
|
| Rate for Payer: BCBS Trust/PPO |
$841.12
|
| Rate for Payer: BCN Commercial |
$841.12
|
| Rate for Payer: BCN Medicare Advantage |
$270.46
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cash Price |
$865.46
|
| Rate for Payer: Cofinity Commercial |
$930.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$865.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.46
|
| Rate for Payer: Healthscope Commercial |
$973.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$811.36
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$283.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$919.55
|
| Rate for Payer: PACE Senior Care Partners |
$256.93
|
| Rate for Payer: PACE SWMI |
$270.46
|
| Rate for Payer: PHP Commercial |
$919.55
|
| Rate for Payer: PHP Medicare Advantage |
$270.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$941.18
|
| Rate for Payer: Priority Health Medicare |
$270.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$659.80
|
| Rate for Payer: Railroad Medicare Medicare |
$270.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$952.00
|
| Rate for Payer: UHC Core |
$903.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$270.46
|
| Rate for Payer: UHC Medicare Advantage |
$278.57
|
| Rate for Payer: VA VA |
$270.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$811.36
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: BCBS Trust/PPO |
$50.23
|
| Rate for Payer: BCN Commercial |
$50.23
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.20
|
| Rate for Payer: UHC Core |
$54.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$16.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.31
|
| Rate for Payer: BCBS Complete |
$51.35
|
| Rate for Payer: BCBS MAPPO |
$16.25
|
| Rate for Payer: BCBS Trust/PPO |
$50.54
|
| Rate for Payer: BCN Commercial |
$50.54
|
| Rate for Payer: BCN Medicare Advantage |
$16.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.25
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Mclaren Medicaid |
$48.91
|
| Rate for Payer: Meridian Medicaid |
$51.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Senior Care Partners |
$15.44
|
| Rate for Payer: PACE SWMI |
$16.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$16.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.55
|
| Rate for Payer: Priority Health Medicare |
$16.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.64
|
| Rate for Payer: Railroad Medicare Medicare |
$16.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.20
|
| Rate for Payer: UHC Core |
$54.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.25
|
| Rate for Payer: UHC Medicare Advantage |
$16.74
|
| Rate for Payer: VA VA |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
IP
|
$353.94
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.87 |
| Max. Negotiated Rate |
$318.55 |
| Rate for Payer: Aetna Commercial |
$300.85
|
| Rate for Payer: BCBS Trust/PPO |
$273.52
|
| Rate for Payer: BCN Commercial |
$273.52
|
| Rate for Payer: Cash Price |
$283.15
|
| Rate for Payer: Cofinity Commercial |
$304.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.15
|
| Rate for Payer: Healthscope Commercial |
$318.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.85
|
| Rate for Payer: PHP Commercial |
$300.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.47
|
| Rate for Payer: UHC Core |
$295.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.46
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
OP
|
$353.94
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.06 |
| Max. Negotiated Rate |
$318.55 |
| Rate for Payer: Aetna Commercial |
$300.85
|
| Rate for Payer: Aetna Medicare |
$92.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.61
|
| Rate for Payer: BCBS Complete |
$170.23
|
| Rate for Payer: BCBS MAPPO |
$88.48
|
| Rate for Payer: BCBS Trust/PPO |
$275.19
|
| Rate for Payer: BCN Commercial |
$275.19
|
| Rate for Payer: BCN Medicare Advantage |
$88.48
|
| Rate for Payer: Cash Price |
$283.15
|
| Rate for Payer: Cash Price |
$283.15
|
| Rate for Payer: Cofinity Commercial |
$304.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.48
|
| Rate for Payer: Healthscope Commercial |
$318.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.46
|
| Rate for Payer: Mclaren Medicaid |
$162.12
|
| Rate for Payer: Meridian Medicaid |
$170.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.85
|
| Rate for Payer: PACE Senior Care Partners |
$84.06
|
| Rate for Payer: PACE SWMI |
$88.48
|
| Rate for Payer: PHP Commercial |
$300.85
|
| Rate for Payer: PHP Medicare Advantage |
$88.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.93
|
| Rate for Payer: Priority Health Medicare |
$88.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.87
|
| Rate for Payer: Railroad Medicare Medicare |
$88.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.47
|
| Rate for Payer: UHC Core |
$295.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.48
|
| Rate for Payer: UHC Medicare Advantage |
$91.14
|
| Rate for Payer: VA VA |
$88.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.46
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$859.16
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$524.00 |
| Max. Negotiated Rate |
$773.24 |
| Rate for Payer: Aetna Commercial |
$730.29
|
| Rate for Payer: BCBS Trust/PPO |
$663.96
|
| Rate for Payer: BCN Commercial |
$663.96
|
| Rate for Payer: Cash Price |
$687.33
|
| Rate for Payer: Cofinity Commercial |
$738.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.33
|
| Rate for Payer: Healthscope Commercial |
$773.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.29
|
| Rate for Payer: PHP Commercial |
$730.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$747.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$524.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$756.06
|
| Rate for Payer: UHC Core |
$717.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.37
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$859.16
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.05 |
| Max. Negotiated Rate |
$773.24 |
| Rate for Payer: Aetna Commercial |
$730.29
|
| Rate for Payer: Aetna Medicare |
$223.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.49
|
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: BCBS MAPPO |
$214.79
|
| Rate for Payer: BCBS Trust/PPO |
$668.00
|
| Rate for Payer: BCN Commercial |
$668.00
|
| Rate for Payer: BCN Medicare Advantage |
$214.79
|
| Rate for Payer: Cash Price |
$687.33
|
| Rate for Payer: Cash Price |
$687.33
|
| Rate for Payer: Cofinity Commercial |
$738.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.79
|
| Rate for Payer: Healthscope Commercial |
$773.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.37
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$225.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.29
|
| Rate for Payer: PACE Senior Care Partners |
$204.05
|
| Rate for Payer: PACE SWMI |
$214.79
|
| Rate for Payer: PHP Commercial |
$730.29
|
| Rate for Payer: PHP Medicare Advantage |
$214.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$747.47
|
| Rate for Payer: Priority Health Medicare |
$214.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$524.00
|
| Rate for Payer: Railroad Medicare Medicare |
$214.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$756.06
|
| Rate for Payer: UHC Core |
$717.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.79
|
| Rate for Payer: UHC Medicare Advantage |
$221.23
|
| Rate for Payer: VA VA |
$214.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.37
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$902.12
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.25 |
| Max. Negotiated Rate |
$811.91 |
| Rate for Payer: Aetna Commercial |
$766.80
|
| Rate for Payer: Aetna Medicare |
$234.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$281.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$281.91
|
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: BCBS MAPPO |
$225.53
|
| Rate for Payer: BCBS Trust/PPO |
$701.40
|
| Rate for Payer: BCN Commercial |
$701.40
|
| Rate for Payer: BCN Medicare Advantage |
$225.53
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: Cofinity Commercial |
$775.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.53
|
| Rate for Payer: Healthscope Commercial |
$811.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$676.59
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$236.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$766.80
|
| Rate for Payer: PACE Senior Care Partners |
$214.25
|
| Rate for Payer: PACE SWMI |
$225.53
|
| Rate for Payer: PHP Commercial |
$766.80
|
| Rate for Payer: PHP Medicare Advantage |
$225.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$784.84
|
| Rate for Payer: Priority Health Medicare |
$225.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$550.20
|
| Rate for Payer: Railroad Medicare Medicare |
$225.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$793.87
|
| Rate for Payer: UHC Core |
$753.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.53
|
| Rate for Payer: UHC Medicare Advantage |
$232.30
|
| Rate for Payer: VA VA |
$225.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$676.59
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$902.12
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$550.20 |
| Max. Negotiated Rate |
$811.91 |
| Rate for Payer: Aetna Commercial |
$766.80
|
| Rate for Payer: BCBS Trust/PPO |
$697.16
|
| Rate for Payer: BCN Commercial |
$697.16
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: Cofinity Commercial |
$775.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.70
|
| Rate for Payer: Healthscope Commercial |
$811.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$676.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$766.80
|
| Rate for Payer: PHP Commercial |
$766.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$784.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$550.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$793.87
|
| Rate for Payer: UHC Core |
$753.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$676.59
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$378.64
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.93 |
| Max. Negotiated Rate |
$340.78 |
| Rate for Payer: Aetna Commercial |
$321.84
|
| Rate for Payer: BCBS Trust/PPO |
$292.61
|
| Rate for Payer: BCN Commercial |
$292.61
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$325.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.91
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PHP Commercial |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.20
|
| Rate for Payer: UHC Core |
$316.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.98
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$378.64
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.93 |
| Max. Negotiated Rate |
$340.78 |
| Rate for Payer: Aetna Commercial |
$321.84
|
| Rate for Payer: Aetna Medicare |
$98.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.32
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$94.66
|
| Rate for Payer: BCBS Trust/PPO |
$294.39
|
| Rate for Payer: BCN Commercial |
$294.39
|
| Rate for Payer: BCN Medicare Advantage |
$94.66
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$325.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.66
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.98
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PACE Senior Care Partners |
$89.93
|
| Rate for Payer: PACE SWMI |
$94.66
|
| Rate for Payer: PHP Commercial |
$321.84
|
| Rate for Payer: PHP Medicare Advantage |
$94.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.42
|
| Rate for Payer: Priority Health Medicare |
$94.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.93
|
| Rate for Payer: Railroad Medicare Medicare |
$94.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.20
|
| Rate for Payer: UHC Core |
$316.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.66
|
| Rate for Payer: UHC Medicare Advantage |
$97.50
|
| Rate for Payer: VA VA |
$94.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.98
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.50 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$646.00
|
| Rate for Payer: Aetna Medicare |
$197.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.50
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$190.00
|
| Rate for Payer: BCBS Trust/PPO |
$590.90
|
| Rate for Payer: BCN Commercial |
$590.90
|
| Rate for Payer: BCN Medicare Advantage |
$190.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cofinity Commercial |
$653.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.00
|
| Rate for Payer: Healthscope Commercial |
$684.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.00
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.00
|
| Rate for Payer: PACE Senior Care Partners |
$180.50
|
| Rate for Payer: PACE SWMI |
$190.00
|
| Rate for Payer: PHP Commercial |
$646.00
|
| Rate for Payer: PHP Medicare Advantage |
$190.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$661.20
|
| Rate for Payer: Priority Health Medicare |
$190.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.52
|
| Rate for Payer: Railroad Medicare Medicare |
$190.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$668.80
|
| Rate for Payer: UHC Core |
$634.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.00
|
| Rate for Payer: UHC Medicare Advantage |
$195.70
|
| Rate for Payer: VA VA |
$190.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.00
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$463.52 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$646.00
|
| Rate for Payer: BCBS Trust/PPO |
$587.33
|
| Rate for Payer: BCN Commercial |
$587.33
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cofinity Commercial |
$653.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.00
|
| Rate for Payer: Healthscope Commercial |
$684.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.00
|
| Rate for Payer: PHP Commercial |
$646.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$661.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$668.80
|
| Rate for Payer: UHC Core |
$634.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.00
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,866.29 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna Commercial |
$2,601.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,364.77
|
| Rate for Payer: BCN Commercial |
$2,364.77
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cofinity Commercial |
$2,631.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,448.00
|
| Rate for Payer: Healthscope Commercial |
$2,754.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,295.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,601.00
|
| Rate for Payer: PHP Commercial |
$2,601.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,142.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,662.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,866.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,692.80
|
| Rate for Payer: UHC Core |
$2,555.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,295.00
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna Commercial |
$2,601.00
|
| Rate for Payer: Aetna Medicare |
$795.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$956.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$956.25
|
| Rate for Payer: BCBS Complete |
$33.45
|
| Rate for Payer: BCBS MAPPO |
$765.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,379.15
|
| Rate for Payer: BCN Commercial |
$2,379.15
|
| Rate for Payer: BCN Medicare Advantage |
$765.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cofinity Commercial |
$2,631.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,448.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$765.00
|
| Rate for Payer: Healthscope Commercial |
$2,754.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,295.00
|
| Rate for Payer: Mclaren Medicaid |
$31.85
|
| Rate for Payer: Meridian Medicaid |
$33.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$803.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$879.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,601.00
|
| Rate for Payer: PACE Senior Care Partners |
$726.75
|
| Rate for Payer: PACE SWMI |
$765.00
|
| Rate for Payer: PHP Commercial |
$2,601.00
|
| Rate for Payer: PHP Medicare Advantage |
$765.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,142.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,662.20
|
| Rate for Payer: Priority Health Medicare |
$765.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,866.29
|
| Rate for Payer: Railroad Medicare Medicare |
$765.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,692.80
|
| Rate for Payer: UHC Core |
$2,555.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$765.00
|
| Rate for Payer: UHC Medicare Advantage |
$787.95
|
| Rate for Payer: VA VA |
$765.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,295.00
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$47.58
|
| Rate for Payer: BCN Commercial |
$47.58
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Senior Care Partners |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.24
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.33
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.76
|
| Rate for Payer: VA VA |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$47.30
|
| Rate for Payer: BCN Commercial |
$47.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
