|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
OP
|
$2,427.77
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.60 |
| Max. Negotiated Rate |
$2,184.99 |
| Rate for Payer: Aetna Commercial |
$2,063.60
|
| Rate for Payer: Aetna Medicare |
$631.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$758.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$758.68
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$606.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,887.59
|
| Rate for Payer: BCN Commercial |
$1,887.59
|
| Rate for Payer: BCN Medicare Advantage |
$606.94
|
| Rate for Payer: Cash Price |
$1,942.22
|
| Rate for Payer: Cash Price |
$1,942.22
|
| Rate for Payer: Cofinity Commercial |
$2,087.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,942.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$606.94
|
| Rate for Payer: Healthscope Commercial |
$2,184.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,820.83
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$697.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,063.60
|
| Rate for Payer: PACE Senior Care Partners |
$576.60
|
| Rate for Payer: PACE SWMI |
$606.94
|
| Rate for Payer: PHP Commercial |
$2,063.60
|
| Rate for Payer: PHP Medicare Advantage |
$606.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,699.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,112.16
|
| Rate for Payer: Priority Health Medicare |
$606.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,480.70
|
| Rate for Payer: Railroad Medicare Medicare |
$606.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,136.44
|
| Rate for Payer: UHC Core |
$2,027.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$606.94
|
| Rate for Payer: UHC Medicare Advantage |
$625.15
|
| Rate for Payer: VA VA |
$606.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,820.83
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
IP
|
$403.74
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$246.24 |
| Max. Negotiated Rate |
$363.37 |
| Rate for Payer: Aetna Commercial |
$343.18
|
| Rate for Payer: BCBS Trust/PPO |
$312.01
|
| Rate for Payer: BCN Commercial |
$312.01
|
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cofinity Commercial |
$347.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.99
|
| Rate for Payer: Healthscope Commercial |
$363.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.18
|
| Rate for Payer: PHP Commercial |
$343.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.29
|
| Rate for Payer: UHC Core |
$337.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.80
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
OP
|
$403.74
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$95.89 |
| Max. Negotiated Rate |
$363.37 |
| Rate for Payer: Aetna Commercial |
$343.18
|
| Rate for Payer: Aetna Medicare |
$104.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.17
|
| Rate for Payer: BCBS Complete |
$161.50
|
| Rate for Payer: BCBS MAPPO |
$100.94
|
| Rate for Payer: BCBS Trust/PPO |
$313.91
|
| Rate for Payer: BCN Commercial |
$313.91
|
| Rate for Payer: BCN Medicare Advantage |
$100.94
|
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cofinity Commercial |
$347.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.94
|
| Rate for Payer: Healthscope Commercial |
$363.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.18
|
| Rate for Payer: PACE Senior Care Partners |
$95.89
|
| Rate for Payer: PACE SWMI |
$100.94
|
| Rate for Payer: PHP Commercial |
$343.18
|
| Rate for Payer: PHP Medicare Advantage |
$100.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.25
|
| Rate for Payer: Priority Health Medicare |
$100.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.24
|
| Rate for Payer: Railroad Medicare Medicare |
$100.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.29
|
| Rate for Payer: UHC Core |
$337.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.94
|
| Rate for Payer: UHC Medicare Advantage |
$103.96
|
| Rate for Payer: VA VA |
$100.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.80
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
OP
|
$605.60
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$143.83 |
| Max. Negotiated Rate |
$545.04 |
| Rate for Payer: Aetna Commercial |
$514.76
|
| Rate for Payer: Aetna Medicare |
$157.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.25
|
| Rate for Payer: BCBS Complete |
$242.24
|
| Rate for Payer: BCBS MAPPO |
$151.40
|
| Rate for Payer: BCBS Trust/PPO |
$470.85
|
| Rate for Payer: BCN Commercial |
$470.85
|
| Rate for Payer: BCN Medicare Advantage |
$151.40
|
| Rate for Payer: Cash Price |
$484.48
|
| Rate for Payer: Cofinity Commercial |
$520.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$484.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.40
|
| Rate for Payer: Healthscope Commercial |
$545.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$454.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.76
|
| Rate for Payer: PACE Senior Care Partners |
$143.83
|
| Rate for Payer: PACE SWMI |
$151.40
|
| Rate for Payer: PHP Commercial |
$514.76
|
| Rate for Payer: PHP Medicare Advantage |
$151.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$526.87
|
| Rate for Payer: Priority Health Medicare |
$151.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$369.36
|
| Rate for Payer: Railroad Medicare Medicare |
$151.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.93
|
| Rate for Payer: UHC Core |
$505.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.40
|
| Rate for Payer: UHC Medicare Advantage |
$155.94
|
| Rate for Payer: VA VA |
$151.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$454.20
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
IP
|
$605.60
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$369.36 |
| Max. Negotiated Rate |
$545.04 |
| Rate for Payer: Aetna Commercial |
$514.76
|
| Rate for Payer: BCBS Trust/PPO |
$468.01
|
| Rate for Payer: BCN Commercial |
$468.01
|
| Rate for Payer: Cash Price |
$484.48
|
| Rate for Payer: Cofinity Commercial |
$520.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$484.48
|
| Rate for Payer: Healthscope Commercial |
$545.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$454.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.76
|
| Rate for Payer: PHP Commercial |
$514.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$526.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$369.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.93
|
| Rate for Payer: UHC Core |
$505.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$454.20
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
OP
|
$403.74
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$95.89 |
| Max. Negotiated Rate |
$363.37 |
| Rate for Payer: Aetna Commercial |
$343.18
|
| Rate for Payer: Aetna Medicare |
$104.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.17
|
| Rate for Payer: BCBS Complete |
$161.50
|
| Rate for Payer: BCBS MAPPO |
$100.94
|
| Rate for Payer: BCBS Trust/PPO |
$313.91
|
| Rate for Payer: BCN Commercial |
$313.91
|
| Rate for Payer: BCN Medicare Advantage |
$100.94
|
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cofinity Commercial |
$347.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.94
|
| Rate for Payer: Healthscope Commercial |
$363.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.18
|
| Rate for Payer: PACE Senior Care Partners |
$95.89
|
| Rate for Payer: PACE SWMI |
$100.94
|
| Rate for Payer: PHP Commercial |
$343.18
|
| Rate for Payer: PHP Medicare Advantage |
$100.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.25
|
| Rate for Payer: Priority Health Medicare |
$100.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.24
|
| Rate for Payer: Railroad Medicare Medicare |
$100.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.29
|
| Rate for Payer: UHC Core |
$337.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.94
|
| Rate for Payer: UHC Medicare Advantage |
$103.96
|
| Rate for Payer: VA VA |
$100.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.80
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
IP
|
$403.74
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$246.24 |
| Max. Negotiated Rate |
$363.37 |
| Rate for Payer: Aetna Commercial |
$343.18
|
| Rate for Payer: BCBS Trust/PPO |
$312.01
|
| Rate for Payer: BCN Commercial |
$312.01
|
| Rate for Payer: Cash Price |
$322.99
|
| Rate for Payer: Cofinity Commercial |
$347.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.99
|
| Rate for Payer: Healthscope Commercial |
$363.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.18
|
| Rate for Payer: PHP Commercial |
$343.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.29
|
| Rate for Payer: UHC Core |
$337.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.80
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
OP
|
$605.60
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$143.83 |
| Max. Negotiated Rate |
$545.04 |
| Rate for Payer: Aetna Commercial |
$514.76
|
| Rate for Payer: Aetna Medicare |
$157.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.25
|
| Rate for Payer: BCBS Complete |
$242.24
|
| Rate for Payer: BCBS MAPPO |
$151.40
|
| Rate for Payer: BCBS Trust/PPO |
$470.85
|
| Rate for Payer: BCN Commercial |
$470.85
|
| Rate for Payer: BCN Medicare Advantage |
$151.40
|
| Rate for Payer: Cash Price |
$484.48
|
| Rate for Payer: Cofinity Commercial |
$520.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$484.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.40
|
| Rate for Payer: Healthscope Commercial |
$545.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$454.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.76
|
| Rate for Payer: PACE Senior Care Partners |
$143.83
|
| Rate for Payer: PACE SWMI |
$151.40
|
| Rate for Payer: PHP Commercial |
$514.76
|
| Rate for Payer: PHP Medicare Advantage |
$151.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$526.87
|
| Rate for Payer: Priority Health Medicare |
$151.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$369.36
|
| Rate for Payer: Railroad Medicare Medicare |
$151.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.93
|
| Rate for Payer: UHC Core |
$505.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.40
|
| Rate for Payer: UHC Medicare Advantage |
$155.94
|
| Rate for Payer: VA VA |
$151.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$454.20
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
IP
|
$605.60
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$369.36 |
| Max. Negotiated Rate |
$545.04 |
| Rate for Payer: Aetna Commercial |
$514.76
|
| Rate for Payer: BCBS Trust/PPO |
$468.01
|
| Rate for Payer: BCN Commercial |
$468.01
|
| Rate for Payer: Cash Price |
$484.48
|
| Rate for Payer: Cofinity Commercial |
$520.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$484.48
|
| Rate for Payer: Healthscope Commercial |
$545.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$454.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$514.76
|
| Rate for Payer: PHP Commercial |
$514.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$526.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$369.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.93
|
| Rate for Payer: UHC Core |
$505.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$454.20
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
IP
|
$810.15
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$494.11 |
| Max. Negotiated Rate |
$729.14 |
| Rate for Payer: Aetna Commercial |
$688.63
|
| Rate for Payer: BCBS Trust/PPO |
$626.08
|
| Rate for Payer: BCN Commercial |
$626.08
|
| Rate for Payer: Cash Price |
$648.12
|
| Rate for Payer: Cofinity Commercial |
$696.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.12
|
| Rate for Payer: Healthscope Commercial |
$729.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$688.63
|
| Rate for Payer: PHP Commercial |
$688.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$494.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$712.93
|
| Rate for Payer: UHC Core |
$676.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.61
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
OP
|
$810.15
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$729.14 |
| Rate for Payer: Aetna Commercial |
$688.63
|
| Rate for Payer: Aetna Medicare |
$210.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$253.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$253.17
|
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: BCBS MAPPO |
$202.54
|
| Rate for Payer: BCBS Trust/PPO |
$629.89
|
| Rate for Payer: BCN Commercial |
$629.89
|
| Rate for Payer: BCN Medicare Advantage |
$202.54
|
| Rate for Payer: Cash Price |
$648.12
|
| Rate for Payer: Cash Price |
$648.12
|
| Rate for Payer: Cofinity Commercial |
$696.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.54
|
| Rate for Payer: Healthscope Commercial |
$729.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.61
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$212.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$688.63
|
| Rate for Payer: PACE Senior Care Partners |
$192.41
|
| Rate for Payer: PACE SWMI |
$202.54
|
| Rate for Payer: PHP Commercial |
$688.63
|
| Rate for Payer: PHP Medicare Advantage |
$202.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$704.83
|
| Rate for Payer: Priority Health Medicare |
$202.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$494.11
|
| Rate for Payer: Railroad Medicare Medicare |
$202.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$712.93
|
| Rate for Payer: UHC Core |
$676.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.54
|
| Rate for Payer: UHC Medicare Advantage |
$208.61
|
| Rate for Payer: VA VA |
$202.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.61
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$643.62
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.86 |
| Max. Negotiated Rate |
$579.26 |
| Rate for Payer: Aetna Commercial |
$547.08
|
| Rate for Payer: Aetna Medicare |
$167.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$201.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$201.13
|
| Rate for Payer: BCBS Complete |
$257.45
|
| Rate for Payer: BCBS MAPPO |
$160.90
|
| Rate for Payer: BCBS Trust/PPO |
$500.41
|
| Rate for Payer: BCN Commercial |
$500.41
|
| Rate for Payer: BCN Medicare Advantage |
$160.90
|
| Rate for Payer: Cash Price |
$514.90
|
| Rate for Payer: Cofinity Commercial |
$553.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.90
|
| Rate for Payer: Healthscope Commercial |
$579.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$168.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$547.08
|
| Rate for Payer: PACE Senior Care Partners |
$152.86
|
| Rate for Payer: PACE SWMI |
$160.90
|
| Rate for Payer: PHP Commercial |
$547.08
|
| Rate for Payer: PHP Medicare Advantage |
$160.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$559.95
|
| Rate for Payer: Priority Health Medicare |
$160.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.54
|
| Rate for Payer: Railroad Medicare Medicare |
$160.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.39
|
| Rate for Payer: UHC Core |
$537.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.90
|
| Rate for Payer: UHC Medicare Advantage |
$165.73
|
| Rate for Payer: VA VA |
$160.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.72
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$643.62
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$392.54 |
| Max. Negotiated Rate |
$579.26 |
| Rate for Payer: Aetna Commercial |
$547.08
|
| Rate for Payer: BCBS Trust/PPO |
$497.39
|
| Rate for Payer: BCN Commercial |
$497.39
|
| Rate for Payer: Cash Price |
$514.90
|
| Rate for Payer: Cofinity Commercial |
$553.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.90
|
| Rate for Payer: Healthscope Commercial |
$579.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$547.08
|
| Rate for Payer: PHP Commercial |
$547.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$559.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.39
|
| Rate for Payer: UHC Core |
$537.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.72
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
OP
|
$1,283.57
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$304.85 |
| Max. Negotiated Rate |
$1,155.21 |
| Rate for Payer: Aetna Commercial |
$1,091.03
|
| Rate for Payer: Aetna Medicare |
$333.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$401.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$401.12
|
| Rate for Payer: BCBS Complete |
$513.43
|
| Rate for Payer: BCBS MAPPO |
$320.89
|
| Rate for Payer: BCBS Trust/PPO |
$997.98
|
| Rate for Payer: BCN Commercial |
$997.98
|
| Rate for Payer: BCN Medicare Advantage |
$320.89
|
| Rate for Payer: Cash Price |
$1,026.86
|
| Rate for Payer: Cofinity Commercial |
$1,103.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,026.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.89
|
| Rate for Payer: Healthscope Commercial |
$1,155.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$962.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$336.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$369.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,091.03
|
| Rate for Payer: PACE Senior Care Partners |
$304.85
|
| Rate for Payer: PACE SWMI |
$320.89
|
| Rate for Payer: PHP Commercial |
$1,091.03
|
| Rate for Payer: PHP Medicare Advantage |
$320.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$898.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,116.71
|
| Rate for Payer: Priority Health Medicare |
$320.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$782.85
|
| Rate for Payer: Railroad Medicare Medicare |
$320.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,129.54
|
| Rate for Payer: UHC Core |
$1,071.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.89
|
| Rate for Payer: UHC Medicare Advantage |
$330.52
|
| Rate for Payer: VA VA |
$320.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$962.68
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
IP
|
$1,283.57
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$782.85 |
| Max. Negotiated Rate |
$1,155.21 |
| Rate for Payer: Aetna Commercial |
$1,091.03
|
| Rate for Payer: BCBS Trust/PPO |
$991.94
|
| Rate for Payer: BCN Commercial |
$991.94
|
| Rate for Payer: Cash Price |
$1,026.86
|
| Rate for Payer: Cofinity Commercial |
$1,103.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,026.86
|
| Rate for Payer: Healthscope Commercial |
$1,155.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$962.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,091.03
|
| Rate for Payer: PHP Commercial |
$1,091.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$898.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,116.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$782.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,129.54
|
| Rate for Payer: UHC Core |
$1,071.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$962.68
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
IP
|
$1,190.22
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$725.92 |
| Max. Negotiated Rate |
$1,071.20 |
| Rate for Payer: Aetna Commercial |
$1,011.69
|
| Rate for Payer: BCBS Trust/PPO |
$919.80
|
| Rate for Payer: BCN Commercial |
$919.80
|
| Rate for Payer: Cash Price |
$952.18
|
| Rate for Payer: Cofinity Commercial |
$1,023.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$952.18
|
| Rate for Payer: Healthscope Commercial |
$1,071.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$892.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,011.69
|
| Rate for Payer: PHP Commercial |
$1,011.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,035.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$725.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,047.39
|
| Rate for Payer: UHC Core |
$993.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$892.66
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
OP
|
$1,190.22
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.68 |
| Max. Negotiated Rate |
$1,071.20 |
| Rate for Payer: Aetna Commercial |
$1,011.69
|
| Rate for Payer: Aetna Medicare |
$309.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$371.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$371.94
|
| Rate for Payer: BCBS Complete |
$476.09
|
| Rate for Payer: BCBS MAPPO |
$297.56
|
| Rate for Payer: BCBS Trust/PPO |
$925.40
|
| Rate for Payer: BCN Commercial |
$925.40
|
| Rate for Payer: BCN Medicare Advantage |
$297.56
|
| Rate for Payer: Cash Price |
$952.18
|
| Rate for Payer: Cofinity Commercial |
$1,023.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$952.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.56
|
| Rate for Payer: Healthscope Commercial |
$1,071.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$892.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$312.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,011.69
|
| Rate for Payer: PACE Senior Care Partners |
$282.68
|
| Rate for Payer: PACE SWMI |
$297.56
|
| Rate for Payer: PHP Commercial |
$1,011.69
|
| Rate for Payer: PHP Medicare Advantage |
$297.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$833.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,035.49
|
| Rate for Payer: Priority Health Medicare |
$297.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$725.92
|
| Rate for Payer: Railroad Medicare Medicare |
$297.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,047.39
|
| Rate for Payer: UHC Core |
$993.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.56
|
| Rate for Payer: UHC Medicare Advantage |
$306.48
|
| Rate for Payer: VA VA |
$297.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$892.66
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
OP
|
$144.23
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.25 |
| Max. Negotiated Rate |
$137.89 |
| Rate for Payer: Aetna Commercial |
$122.60
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.07
|
| Rate for Payer: BCBS Complete |
$137.89
|
| Rate for Payer: BCBS MAPPO |
$36.06
|
| Rate for Payer: BCBS Trust/PPO |
$112.14
|
| Rate for Payer: BCN Commercial |
$112.14
|
| Rate for Payer: BCN Medicare Advantage |
$36.06
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$124.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.06
|
| Rate for Payer: Healthscope Commercial |
$129.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.17
|
| Rate for Payer: Mclaren Medicaid |
$131.33
|
| Rate for Payer: Meridian Medicaid |
$137.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PACE Senior Care Partners |
$34.25
|
| Rate for Payer: PACE SWMI |
$36.06
|
| Rate for Payer: PHP Commercial |
$122.60
|
| Rate for Payer: PHP Medicare Advantage |
$36.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.48
|
| Rate for Payer: Priority Health Medicare |
$36.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.97
|
| Rate for Payer: Railroad Medicare Medicare |
$36.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.92
|
| Rate for Payer: UHC Core |
$120.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.06
|
| Rate for Payer: UHC Medicare Advantage |
$37.14
|
| Rate for Payer: VA VA |
$36.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.17
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
IP
|
$144.23
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$129.81 |
| Rate for Payer: Aetna Commercial |
$122.60
|
| Rate for Payer: BCBS Trust/PPO |
$111.46
|
| Rate for Payer: BCN Commercial |
$111.46
|
| Rate for Payer: Cash Price |
$115.38
|
| Rate for Payer: Cofinity Commercial |
$124.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.38
|
| Rate for Payer: Healthscope Commercial |
$129.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.60
|
| Rate for Payer: PHP Commercial |
$122.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.92
|
| Rate for Payer: UHC Core |
$120.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.17
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.79 |
| 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 |
$13.42
|
| 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: 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: Mclaren Medicaid |
$12.79
|
| Rate for Payer: Meridian Medicaid |
$13.42
|
| 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 Choice Medicaid |
$12.79
|
| 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, IRON DEXTRAN, 50 MG
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
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
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
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 INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
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 INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
IP
|
$44.88
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: BCBS Trust/PPO |
$34.68
|
| Rate for Payer: BCN Commercial |
$34.68
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.49
|
| Rate for Payer: UHC Core |
$37.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.66
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
OP
|
$44.88
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna Medicare |
$11.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.02
|
| Rate for Payer: BCBS Complete |
$17.95
|
| Rate for Payer: BCBS MAPPO |
$11.22
|
| Rate for Payer: BCBS Trust/PPO |
$34.89
|
| Rate for Payer: BCN Commercial |
$34.89
|
| Rate for Payer: BCN Medicare Advantage |
$11.22
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.22
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PACE Senior Care Partners |
$10.66
|
| Rate for Payer: PACE SWMI |
$11.22
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.05
|
| Rate for Payer: Priority Health Medicare |
$11.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.49
|
| Rate for Payer: UHC Core |
$37.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.22
|
| Rate for Payer: UHC Medicare Advantage |
$11.56
|
| Rate for Payer: VA VA |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.66
|
|
