|
HC INJECTION PROC RETROGRAD CYSTOGRAPHY
|
Facility
|
IP
|
$816.16
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
36100252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$497.78 |
| Max. Negotiated Rate |
$734.54 |
| Rate for Payer: Aetna Commercial |
$693.74
|
| Rate for Payer: BCBS Trust/PPO |
$630.73
|
| Rate for Payer: BCN Commercial |
$630.73
|
| Rate for Payer: Cash Price |
$652.93
|
| Rate for Payer: Cofinity Commercial |
$701.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$652.93
|
| Rate for Payer: Healthscope Commercial |
$734.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$693.74
|
| Rate for Payer: PHP Commercial |
$693.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$710.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$497.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$718.22
|
| Rate for Payer: UHC Core |
$681.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.12
|
|
|
HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.78
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS MAPPO |
$3.82
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Medicare Advantage |
$3.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.82
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Senior Care Partners |
$3.63
|
| Rate for Payer: PACE SWMI |
$3.82
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicare Advantage |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.31
|
| Rate for Payer: Priority Health Medicare |
$3.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.33
|
| Rate for Payer: Railroad Medicare Medicare |
$3.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$12.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.82
|
| Rate for Payer: UHC Medicare Advantage |
$3.94
|
| Rate for Payer: VA VA |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.82
|
| Rate for Payer: BCN Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$12.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
HC INJECTION PUDENDAL NERVE
|
Facility
|
IP
|
$1,170.21
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$713.71 |
| Max. Negotiated Rate |
$1,053.19 |
| Rate for Payer: Aetna Commercial |
$994.68
|
| Rate for Payer: BCBS Trust/PPO |
$904.34
|
| Rate for Payer: BCN Commercial |
$904.34
|
| Rate for Payer: Cash Price |
$936.17
|
| Rate for Payer: Cofinity Commercial |
$1,006.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.17
|
| Rate for Payer: Healthscope Commercial |
$1,053.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$877.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$994.68
|
| Rate for Payer: PHP Commercial |
$994.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,018.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$713.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.78
|
| Rate for Payer: UHC Core |
$977.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$877.66
|
|
|
HC INJECTION PUDENDAL NERVE
|
Facility
|
OP
|
$1,170.21
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$277.92 |
| Max. Negotiated Rate |
$1,053.19 |
| Rate for Payer: Aetna Commercial |
$994.68
|
| Rate for Payer: Aetna Medicare |
$304.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$365.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$365.69
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$292.55
|
| Rate for Payer: BCBS Trust/PPO |
$909.84
|
| Rate for Payer: BCN Commercial |
$909.84
|
| Rate for Payer: BCN Medicare Advantage |
$292.55
|
| Rate for Payer: Cash Price |
$936.17
|
| Rate for Payer: Cash Price |
$936.17
|
| Rate for Payer: Cofinity Commercial |
$1,006.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.55
|
| Rate for Payer: Healthscope Commercial |
$1,053.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$877.66
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$307.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$994.68
|
| Rate for Payer: PACE Senior Care Partners |
$277.92
|
| Rate for Payer: PACE SWMI |
$292.55
|
| Rate for Payer: PHP Commercial |
$994.68
|
| Rate for Payer: PHP Medicare Advantage |
$292.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,018.08
|
| Rate for Payer: Priority Health Medicare |
$292.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$713.71
|
| Rate for Payer: Railroad Medicare Medicare |
$292.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.78
|
| Rate for Payer: UHC Core |
$977.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$292.55
|
| Rate for Payer: UHC Medicare Advantage |
$301.33
|
| Rate for Payer: VA VA |
$292.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$877.66
|
|
|
HC INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
OP
|
$322.83
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.67 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Aetna Commercial |
$274.41
|
| Rate for Payer: Aetna Medicare |
$83.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.88
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$80.71
|
| Rate for Payer: BCBS Trust/PPO |
$251.00
|
| Rate for Payer: BCN Commercial |
$251.00
|
| Rate for Payer: BCN Medicare Advantage |
$80.71
|
| Rate for Payer: Cash Price |
$258.26
|
| Rate for Payer: Cash Price |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$277.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.71
|
| Rate for Payer: Healthscope Commercial |
$290.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.12
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.41
|
| Rate for Payer: PACE Senior Care Partners |
$76.67
|
| Rate for Payer: PACE SWMI |
$80.71
|
| Rate for Payer: PHP Commercial |
$274.41
|
| Rate for Payer: PHP Medicare Advantage |
$80.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.86
|
| Rate for Payer: Priority Health Medicare |
$80.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.89
|
| Rate for Payer: Railroad Medicare Medicare |
$80.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.09
|
| Rate for Payer: UHC Core |
$269.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.71
|
| Rate for Payer: UHC Medicare Advantage |
$83.13
|
| Rate for Payer: VA VA |
$80.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.12
|
|
|
HC INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
IP
|
$322.83
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.89 |
| Max. Negotiated Rate |
$290.55 |
| Rate for Payer: Aetna Commercial |
$274.41
|
| Rate for Payer: BCBS Trust/PPO |
$249.48
|
| Rate for Payer: BCN Commercial |
$249.48
|
| Rate for Payer: Cash Price |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$277.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.26
|
| Rate for Payer: Healthscope Commercial |
$290.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.41
|
| Rate for Payer: PHP Commercial |
$274.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$196.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.09
|
| Rate for Payer: UHC Core |
$269.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.12
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
OP
|
$245.28
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.25 |
| Max. Negotiated Rate |
$274.65 |
| Rate for Payer: Aetna Commercial |
$208.49
|
| Rate for Payer: Aetna Medicare |
$63.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.65
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$61.32
|
| Rate for Payer: BCBS Trust/PPO |
$190.71
|
| Rate for Payer: BCN Commercial |
$190.71
|
| Rate for Payer: BCN Medicare Advantage |
$61.32
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.32
|
| Rate for Payer: Healthscope Commercial |
$220.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.96
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.49
|
| Rate for Payer: PACE Senior Care Partners |
$58.25
|
| Rate for Payer: PACE SWMI |
$61.32
|
| Rate for Payer: PHP Commercial |
$208.49
|
| Rate for Payer: PHP Medicare Advantage |
$61.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.39
|
| Rate for Payer: Priority Health Medicare |
$61.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.60
|
| Rate for Payer: Railroad Medicare Medicare |
$61.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.85
|
| Rate for Payer: UHC Core |
$204.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.32
|
| Rate for Payer: UHC Medicare Advantage |
$63.16
|
| Rate for Payer: VA VA |
$61.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.96
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
IP
|
$245.28
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.60 |
| Max. Negotiated Rate |
$220.75 |
| Rate for Payer: Aetna Commercial |
$208.49
|
| Rate for Payer: BCBS Trust/PPO |
$189.55
|
| Rate for Payer: BCN Commercial |
$189.55
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$210.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.22
|
| Rate for Payer: Healthscope Commercial |
$220.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.49
|
| Rate for Payer: PHP Commercial |
$208.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.85
|
| Rate for Payer: UHC Core |
$204.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.96
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
OP
|
$846.52
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$201.05 |
| Max. Negotiated Rate |
$761.87 |
| Rate for Payer: Aetna Commercial |
$719.54
|
| Rate for Payer: Aetna Medicare |
$220.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.54
|
| Rate for Payer: BCBS Complete |
$338.61
|
| Rate for Payer: BCBS MAPPO |
$211.63
|
| Rate for Payer: BCBS Trust/PPO |
$658.17
|
| Rate for Payer: BCN Commercial |
$658.17
|
| Rate for Payer: BCN Medicare Advantage |
$211.63
|
| Rate for Payer: Cash Price |
$677.22
|
| Rate for Payer: Cofinity Commercial |
$728.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$677.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.63
|
| Rate for Payer: Healthscope Commercial |
$761.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$222.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$719.54
|
| Rate for Payer: PACE Senior Care Partners |
$201.05
|
| Rate for Payer: PACE SWMI |
$211.63
|
| Rate for Payer: PHP Commercial |
$719.54
|
| Rate for Payer: PHP Medicare Advantage |
$211.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$736.47
|
| Rate for Payer: Priority Health Medicare |
$211.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$516.29
|
| Rate for Payer: Railroad Medicare Medicare |
$211.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.94
|
| Rate for Payer: UHC Core |
$706.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.63
|
| Rate for Payer: UHC Medicare Advantage |
$217.98
|
| Rate for Payer: VA VA |
$211.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.89
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
IP
|
$846.52
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$516.29 |
| Max. Negotiated Rate |
$761.87 |
| Rate for Payer: Aetna Commercial |
$719.54
|
| Rate for Payer: BCBS Trust/PPO |
$654.19
|
| Rate for Payer: BCN Commercial |
$654.19
|
| Rate for Payer: Cash Price |
$677.22
|
| Rate for Payer: Cofinity Commercial |
$728.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$677.22
|
| Rate for Payer: Healthscope Commercial |
$761.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$719.54
|
| Rate for Payer: PHP Commercial |
$719.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$592.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$736.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$516.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.94
|
| Rate for Payer: UHC Core |
$706.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.89
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
OP
|
$381.09
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$90.51 |
| Max. Negotiated Rate |
$342.98 |
| Rate for Payer: Aetna Commercial |
$323.93
|
| Rate for Payer: Aetna Medicare |
$99.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.09
|
| Rate for Payer: BCBS Complete |
$152.44
|
| Rate for Payer: BCBS MAPPO |
$95.27
|
| Rate for Payer: BCBS Trust/PPO |
$296.30
|
| Rate for Payer: BCN Commercial |
$296.30
|
| Rate for Payer: BCN Medicare Advantage |
$95.27
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$327.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.27
|
| Rate for Payer: Healthscope Commercial |
$342.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: PACE Senior Care Partners |
$90.51
|
| Rate for Payer: PACE SWMI |
$95.27
|
| Rate for Payer: PHP Commercial |
$323.93
|
| Rate for Payer: PHP Medicare Advantage |
$95.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.55
|
| Rate for Payer: Priority Health Medicare |
$95.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.43
|
| Rate for Payer: Railroad Medicare Medicare |
$95.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.36
|
| Rate for Payer: UHC Core |
$318.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.27
|
| Rate for Payer: UHC Medicare Advantage |
$98.13
|
| Rate for Payer: VA VA |
$95.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.82
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
IP
|
$381.09
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.43 |
| Max. Negotiated Rate |
$342.98 |
| Rate for Payer: Aetna Commercial |
$323.93
|
| Rate for Payer: BCBS Trust/PPO |
$294.51
|
| Rate for Payer: BCN Commercial |
$294.51
|
| Rate for Payer: Cash Price |
$304.87
|
| Rate for Payer: Cofinity Commercial |
$327.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.87
|
| Rate for Payer: Healthscope Commercial |
$342.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.93
|
| Rate for Payer: PHP Commercial |
$323.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.36
|
| Rate for Payer: UHC Core |
$318.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.82
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
OP
|
$286.12
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$257.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.41
|
| Rate for Payer: BCBS Complete |
$114.45
|
| Rate for Payer: BCBS MAPPO |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$222.46
|
| Rate for Payer: BCN Commercial |
$222.46
|
| Rate for Payer: BCN Medicare Advantage |
$71.53
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.53
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PACE Senior Care Partners |
$67.95
|
| Rate for Payer: PACE SWMI |
$71.53
|
| Rate for Payer: PHP Commercial |
$243.20
|
| Rate for Payer: PHP Medicare Advantage |
$71.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.92
|
| Rate for Payer: Priority Health Medicare |
$71.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.50
|
| Rate for Payer: Railroad Medicare Medicare |
$71.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.79
|
| Rate for Payer: UHC Core |
$238.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.53
|
| Rate for Payer: UHC Medicare Advantage |
$73.68
|
| Rate for Payer: VA VA |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.59
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
IP
|
$286.12
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$257.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: BCBS Trust/PPO |
$221.11
|
| Rate for Payer: BCN Commercial |
$221.11
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PHP Commercial |
$243.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.79
|
| Rate for Payer: UHC Core |
$238.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.59
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
IP
|
$991.42
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$604.67 |
| Max. Negotiated Rate |
$892.28 |
| Rate for Payer: Aetna Commercial |
$842.71
|
| Rate for Payer: BCBS Trust/PPO |
$766.17
|
| Rate for Payer: BCN Commercial |
$766.17
|
| Rate for Payer: Cash Price |
$793.14
|
| Rate for Payer: Cofinity Commercial |
$852.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.14
|
| Rate for Payer: Healthscope Commercial |
$892.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$842.71
|
| Rate for Payer: PHP Commercial |
$842.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$604.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.45
|
| Rate for Payer: UHC Core |
$827.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.56
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
OP
|
$991.42
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$235.46 |
| Max. Negotiated Rate |
$892.28 |
| Rate for Payer: Aetna Commercial |
$842.71
|
| Rate for Payer: Aetna Medicare |
$257.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$309.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$309.82
|
| Rate for Payer: BCBS Complete |
$396.57
|
| Rate for Payer: BCBS MAPPO |
$247.86
|
| Rate for Payer: BCBS Trust/PPO |
$770.83
|
| Rate for Payer: BCN Commercial |
$770.83
|
| Rate for Payer: BCN Medicare Advantage |
$247.86
|
| Rate for Payer: Cash Price |
$793.14
|
| Rate for Payer: Cofinity Commercial |
$852.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.86
|
| Rate for Payer: Healthscope Commercial |
$892.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$260.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$842.71
|
| Rate for Payer: PACE Senior Care Partners |
$235.46
|
| Rate for Payer: PACE SWMI |
$247.86
|
| Rate for Payer: PHP Commercial |
$842.71
|
| Rate for Payer: PHP Medicare Advantage |
$247.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.54
|
| Rate for Payer: Priority Health Medicare |
$247.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$604.67
|
| Rate for Payer: Railroad Medicare Medicare |
$247.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.45
|
| Rate for Payer: UHC Core |
$827.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$247.86
|
| Rate for Payer: UHC Medicare Advantage |
$255.29
|
| Rate for Payer: VA VA |
$247.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.56
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,027.30
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$243.98 |
| Max. Negotiated Rate |
$924.57 |
| Rate for Payer: Aetna Commercial |
$873.20
|
| Rate for Payer: Aetna Medicare |
$267.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.03
|
| Rate for Payer: BCBS Complete |
$410.92
|
| Rate for Payer: BCBS MAPPO |
$256.82
|
| Rate for Payer: BCBS Trust/PPO |
$798.73
|
| Rate for Payer: BCN Commercial |
$798.73
|
| Rate for Payer: BCN Medicare Advantage |
$256.82
|
| Rate for Payer: Cash Price |
$821.84
|
| Rate for Payer: Cofinity Commercial |
$883.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$821.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.82
|
| Rate for Payer: Healthscope Commercial |
$924.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$770.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$269.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$295.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$873.20
|
| Rate for Payer: PACE Senior Care Partners |
$243.98
|
| Rate for Payer: PACE SWMI |
$256.82
|
| Rate for Payer: PHP Commercial |
$873.20
|
| Rate for Payer: PHP Medicare Advantage |
$256.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$893.75
|
| Rate for Payer: Priority Health Medicare |
$256.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$626.55
|
| Rate for Payer: Railroad Medicare Medicare |
$256.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$904.02
|
| Rate for Payer: UHC Core |
$857.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.82
|
| Rate for Payer: UHC Medicare Advantage |
$264.53
|
| Rate for Payer: VA VA |
$256.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$770.48
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,027.30
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$626.55 |
| Max. Negotiated Rate |
$924.57 |
| Rate for Payer: Aetna Commercial |
$873.20
|
| Rate for Payer: BCBS Trust/PPO |
$793.90
|
| Rate for Payer: BCN Commercial |
$793.90
|
| Rate for Payer: Cash Price |
$821.84
|
| Rate for Payer: Cofinity Commercial |
$883.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$821.84
|
| Rate for Payer: Healthscope Commercial |
$924.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$770.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$873.20
|
| Rate for Payer: PHP Commercial |
$873.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$893.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$626.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$904.02
|
| Rate for Payer: UHC Core |
$857.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$770.48
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$273.88
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.04 |
| Max. Negotiated Rate |
$246.49 |
| Rate for Payer: Aetna Commercial |
$232.80
|
| Rate for Payer: BCBS Trust/PPO |
$211.65
|
| Rate for Payer: BCN Commercial |
$211.65
|
| Rate for Payer: Cash Price |
$219.10
|
| Rate for Payer: Cofinity Commercial |
$235.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.10
|
| Rate for Payer: Healthscope Commercial |
$246.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.80
|
| Rate for Payer: PHP Commercial |
$232.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.01
|
| Rate for Payer: UHC Core |
$228.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.41
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$273.88
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$246.49 |
| Rate for Payer: Aetna Commercial |
$232.80
|
| Rate for Payer: Aetna Medicare |
$71.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.59
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$68.47
|
| Rate for Payer: BCBS Trust/PPO |
$212.94
|
| Rate for Payer: BCN Commercial |
$212.94
|
| Rate for Payer: BCN Medicare Advantage |
$68.47
|
| Rate for Payer: Cash Price |
$219.10
|
| Rate for Payer: Cash Price |
$219.10
|
| Rate for Payer: Cofinity Commercial |
$235.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.47
|
| Rate for Payer: Healthscope Commercial |
$246.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.41
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.80
|
| Rate for Payer: PACE Senior Care Partners |
$65.05
|
| Rate for Payer: PACE SWMI |
$68.47
|
| Rate for Payer: PHP Commercial |
$232.80
|
| Rate for Payer: PHP Medicare Advantage |
$68.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.28
|
| Rate for Payer: Priority Health Medicare |
$68.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.04
|
| Rate for Payer: Railroad Medicare Medicare |
$68.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.01
|
| Rate for Payer: UHC Core |
$228.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.47
|
| Rate for Payer: UHC Medicare Advantage |
$70.52
|
| Rate for Payer: VA VA |
$68.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.41
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
OP
|
$429.05
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.90 |
| Max. Negotiated Rate |
$386.14 |
| Rate for Payer: Aetna Commercial |
$364.69
|
| Rate for Payer: Aetna Medicare |
$111.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.08
|
| Rate for Payer: BCBS Complete |
$171.62
|
| Rate for Payer: BCBS MAPPO |
$107.26
|
| Rate for Payer: BCBS Trust/PPO |
$333.59
|
| Rate for Payer: BCN Commercial |
$333.59
|
| Rate for Payer: BCN Medicare Advantage |
$107.26
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$368.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.26
|
| Rate for Payer: Healthscope Commercial |
$386.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: PACE Senior Care Partners |
$101.90
|
| Rate for Payer: PACE SWMI |
$107.26
|
| Rate for Payer: PHP Commercial |
$364.69
|
| Rate for Payer: PHP Medicare Advantage |
$107.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.27
|
| Rate for Payer: Priority Health Medicare |
$107.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.68
|
| Rate for Payer: Railroad Medicare Medicare |
$107.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.56
|
| Rate for Payer: UHC Core |
$358.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.26
|
| Rate for Payer: UHC Medicare Advantage |
$110.48
|
| Rate for Payer: VA VA |
$107.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.79
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
IP
|
$429.05
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$261.68 |
| Max. Negotiated Rate |
$386.14 |
| Rate for Payer: Aetna Commercial |
$364.69
|
| Rate for Payer: BCBS Trust/PPO |
$331.57
|
| Rate for Payer: BCN Commercial |
$331.57
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$368.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.24
|
| Rate for Payer: Healthscope Commercial |
$386.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: PHP Commercial |
$364.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.56
|
| Rate for Payer: UHC Core |
$358.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.79
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.70 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: Aetna Commercial |
$904.40
|
| Rate for Payer: Aetna Medicare |
$276.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$332.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$332.50
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$266.00
|
| Rate for Payer: BCBS Trust/PPO |
$827.26
|
| Rate for Payer: BCN Commercial |
$827.26
|
| Rate for Payer: BCN Medicare Advantage |
$266.00
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cofinity Commercial |
$915.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$266.00
|
| Rate for Payer: Healthscope Commercial |
$957.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$798.00
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$279.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$305.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$904.40
|
| Rate for Payer: PACE Senior Care Partners |
$252.70
|
| Rate for Payer: PACE SWMI |
$266.00
|
| Rate for Payer: PHP Commercial |
$904.40
|
| Rate for Payer: PHP Medicare Advantage |
$266.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$925.68
|
| Rate for Payer: Priority Health Medicare |
$266.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$648.93
|
| Rate for Payer: Railroad Medicare Medicare |
$266.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$936.32
|
| Rate for Payer: UHC Core |
$888.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$266.00
|
| Rate for Payer: UHC Medicare Advantage |
$273.98
|
| Rate for Payer: VA VA |
$266.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$798.00
|
|
|
HC INJECTIONS SCLEROSANT FOR SPIDER VEINS /TRNK
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT 36468
|
| Hospital Charge Code |
76100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$648.93 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: Aetna Commercial |
$904.40
|
| Rate for Payer: BCBS Trust/PPO |
$822.26
|
| Rate for Payer: BCN Commercial |
$822.26
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cofinity Commercial |
$915.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.20
|
| Rate for Payer: Healthscope Commercial |
$957.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$798.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$904.40
|
| Rate for Payer: PHP Commercial |
$904.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$925.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$648.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$936.32
|
| Rate for Payer: UHC Core |
$888.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$798.00
|
|
