|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
IP
|
$1,129.61
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$688.95 |
| Max. Negotiated Rate |
$1,016.65 |
| Rate for Payer: Aetna Commercial |
$960.17
|
| Rate for Payer: BCBS Trust/PPO |
$872.96
|
| Rate for Payer: BCN Commercial |
$872.96
|
| Rate for Payer: Cash Price |
$903.69
|
| Rate for Payer: Cofinity Commercial |
$971.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.69
|
| Rate for Payer: Healthscope Commercial |
$1,016.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$847.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$960.17
|
| Rate for Payer: PHP Commercial |
$960.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$982.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$688.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$994.06
|
| Rate for Payer: UHC Core |
$943.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$847.21
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
OP
|
$366.05
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$329.44 |
| Rate for Payer: Aetna Commercial |
$311.14
|
| Rate for Payer: Aetna Medicare |
$95.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.39
|
| Rate for Payer: BCBS Complete |
$146.42
|
| Rate for Payer: BCBS MAPPO |
$91.51
|
| Rate for Payer: BCBS Trust/PPO |
$284.60
|
| Rate for Payer: BCN Commercial |
$284.60
|
| Rate for Payer: BCN Medicare Advantage |
$91.51
|
| Rate for Payer: Cash Price |
$292.84
|
| Rate for Payer: Cofinity Commercial |
$314.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.51
|
| Rate for Payer: Healthscope Commercial |
$329.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.14
|
| Rate for Payer: PACE Senior Care Partners |
$86.94
|
| Rate for Payer: PACE SWMI |
$91.51
|
| Rate for Payer: PHP Commercial |
$311.14
|
| Rate for Payer: PHP Medicare Advantage |
$91.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.46
|
| Rate for Payer: Priority Health Medicare |
$91.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.25
|
| Rate for Payer: Railroad Medicare Medicare |
$91.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.12
|
| Rate for Payer: UHC Core |
$305.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.51
|
| Rate for Payer: UHC Medicare Advantage |
$94.26
|
| Rate for Payer: VA VA |
$91.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.54
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
IP
|
$366.05
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.25 |
| Max. Negotiated Rate |
$329.44 |
| Rate for Payer: Aetna Commercial |
$311.14
|
| Rate for Payer: BCBS Trust/PPO |
$282.88
|
| Rate for Payer: BCN Commercial |
$282.88
|
| Rate for Payer: Cash Price |
$292.84
|
| Rate for Payer: Cofinity Commercial |
$314.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.84
|
| Rate for Payer: Healthscope Commercial |
$329.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.14
|
| Rate for Payer: PHP Commercial |
$311.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.12
|
| Rate for Payer: UHC Core |
$305.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.54
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
IP
|
$2,726.36
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,662.81 |
| Max. Negotiated Rate |
$2,453.72 |
| Rate for Payer: Aetna Commercial |
$2,317.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,106.93
|
| Rate for Payer: BCN Commercial |
$2,106.93
|
| Rate for Payer: Cash Price |
$2,181.09
|
| Rate for Payer: Cofinity Commercial |
$2,344.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,181.09
|
| Rate for Payer: Healthscope Commercial |
$2,453.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,044.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,317.41
|
| Rate for Payer: PHP Commercial |
$2,317.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,371.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,662.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,399.20
|
| Rate for Payer: UHC Core |
$2,276.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,044.77
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
OP
|
$2,726.36
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$647.51 |
| Max. Negotiated Rate |
$2,453.72 |
| Rate for Payer: Aetna Commercial |
$2,317.41
|
| Rate for Payer: Aetna Medicare |
$708.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$851.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$851.99
|
| Rate for Payer: BCBS Complete |
$1,090.54
|
| Rate for Payer: BCBS MAPPO |
$681.59
|
| Rate for Payer: BCBS Trust/PPO |
$2,119.74
|
| Rate for Payer: BCN Commercial |
$2,119.74
|
| Rate for Payer: BCN Medicare Advantage |
$681.59
|
| Rate for Payer: Cash Price |
$2,181.09
|
| Rate for Payer: Cofinity Commercial |
$2,344.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,181.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.59
|
| Rate for Payer: Healthscope Commercial |
$2,453.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,044.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$715.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$783.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,317.41
|
| Rate for Payer: PACE Senior Care Partners |
$647.51
|
| Rate for Payer: PACE SWMI |
$681.59
|
| Rate for Payer: PHP Commercial |
$2,317.41
|
| Rate for Payer: PHP Medicare Advantage |
$681.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,371.93
|
| Rate for Payer: Priority Health Medicare |
$681.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,662.81
|
| Rate for Payer: Railroad Medicare Medicare |
$681.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,399.20
|
| Rate for Payer: UHC Core |
$2,276.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.59
|
| Rate for Payer: UHC Medicare Advantage |
$702.04
|
| Rate for Payer: VA VA |
$681.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,044.77
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
IP
|
$354.07
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.95 |
| Max. Negotiated Rate |
$318.66 |
| Rate for Payer: Aetna Commercial |
$300.96
|
| Rate for Payer: BCBS Trust/PPO |
$273.63
|
| Rate for Payer: BCN Commercial |
$273.63
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$304.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.26
|
| Rate for Payer: Healthscope Commercial |
$318.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: PHP Commercial |
$300.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$308.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.58
|
| Rate for Payer: UHC Core |
$295.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.55
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
OP
|
$354.07
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.09 |
| Max. Negotiated Rate |
$318.66 |
| Rate for Payer: Aetna Commercial |
$300.96
|
| Rate for Payer: Aetna Medicare |
$92.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.65
|
| Rate for Payer: BCBS Complete |
$170.23
|
| Rate for Payer: BCBS MAPPO |
$88.52
|
| Rate for Payer: BCBS Trust/PPO |
$275.29
|
| Rate for Payer: BCN Commercial |
$275.29
|
| Rate for Payer: BCN Medicare Advantage |
$88.52
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cash Price |
$283.26
|
| Rate for Payer: Cofinity Commercial |
$304.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.52
|
| Rate for Payer: Healthscope Commercial |
$318.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.55
|
| Rate for Payer: Mclaren Medicaid |
$162.12
|
| Rate for Payer: Meridian Medicaid |
$170.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.96
|
| Rate for Payer: PACE Senior Care Partners |
$84.09
|
| Rate for Payer: PACE SWMI |
$88.52
|
| Rate for Payer: PHP Commercial |
$300.96
|
| Rate for Payer: PHP Medicare Advantage |
$88.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$308.04
|
| Rate for Payer: Priority Health Medicare |
$88.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.95
|
| Rate for Payer: Railroad Medicare Medicare |
$88.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.58
|
| Rate for Payer: UHC Core |
$295.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.52
|
| Rate for Payer: UHC Medicare Advantage |
$91.17
|
| Rate for Payer: VA VA |
$88.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.55
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
IP
|
$366.80
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.71 |
| Max. Negotiated Rate |
$330.12 |
| Rate for Payer: Aetna Commercial |
$311.78
|
| Rate for Payer: BCBS Trust/PPO |
$283.46
|
| Rate for Payer: BCN Commercial |
$283.46
|
| Rate for Payer: Cash Price |
$293.44
|
| Rate for Payer: Cofinity Commercial |
$315.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.44
|
| Rate for Payer: Healthscope Commercial |
$330.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.78
|
| Rate for Payer: PHP Commercial |
$311.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.78
|
| Rate for Payer: UHC Core |
$306.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.10
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
OP
|
$366.80
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$330.12 |
| Rate for Payer: Aetna Commercial |
$311.78
|
| Rate for Payer: Aetna Medicare |
$95.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.62
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$91.70
|
| Rate for Payer: BCBS Trust/PPO |
$285.19
|
| Rate for Payer: BCN Commercial |
$285.19
|
| Rate for Payer: BCN Medicare Advantage |
$91.70
|
| Rate for Payer: Cash Price |
$293.44
|
| Rate for Payer: Cash Price |
$293.44
|
| Rate for Payer: Cofinity Commercial |
$315.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.70
|
| Rate for Payer: Healthscope Commercial |
$330.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.10
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.78
|
| Rate for Payer: PACE Senior Care Partners |
$87.12
|
| Rate for Payer: PACE SWMI |
$91.70
|
| Rate for Payer: PHP Commercial |
$311.78
|
| Rate for Payer: PHP Medicare Advantage |
$91.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.12
|
| Rate for Payer: Priority Health Medicare |
$91.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.71
|
| Rate for Payer: Railroad Medicare Medicare |
$91.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.78
|
| Rate for Payer: UHC Core |
$306.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.70
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: VA VA |
$91.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.10
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
IP
|
$478.11
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.60 |
| Max. Negotiated Rate |
$430.30 |
| Rate for Payer: Aetna Commercial |
$406.39
|
| Rate for Payer: BCBS Trust/PPO |
$369.48
|
| Rate for Payer: BCN Commercial |
$369.48
|
| Rate for Payer: Cash Price |
$382.49
|
| Rate for Payer: Cofinity Commercial |
$411.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.49
|
| Rate for Payer: Healthscope Commercial |
$430.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$358.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$406.39
|
| Rate for Payer: PHP Commercial |
$406.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$415.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.74
|
| Rate for Payer: UHC Core |
$399.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$358.58
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
OP
|
$478.11
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.55 |
| Max. Negotiated Rate |
$430.30 |
| Rate for Payer: Aetna Commercial |
$406.39
|
| Rate for Payer: Aetna Medicare |
$124.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$149.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$149.41
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$119.53
|
| Rate for Payer: BCBS Trust/PPO |
$371.73
|
| Rate for Payer: BCN Commercial |
$371.73
|
| Rate for Payer: BCN Medicare Advantage |
$119.53
|
| Rate for Payer: Cash Price |
$382.49
|
| Rate for Payer: Cash Price |
$382.49
|
| Rate for Payer: Cofinity Commercial |
$411.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$382.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.53
|
| Rate for Payer: Healthscope Commercial |
$430.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$358.58
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$125.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$406.39
|
| Rate for Payer: PACE Senior Care Partners |
$113.55
|
| Rate for Payer: PACE SWMI |
$119.53
|
| Rate for Payer: PHP Commercial |
$406.39
|
| Rate for Payer: PHP Medicare Advantage |
$119.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$415.96
|
| Rate for Payer: Priority Health Medicare |
$119.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.60
|
| Rate for Payer: Railroad Medicare Medicare |
$119.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.74
|
| Rate for Payer: UHC Core |
$399.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.53
|
| Rate for Payer: UHC Medicare Advantage |
$123.11
|
| Rate for Payer: VA VA |
$119.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$358.58
|
|
|
HC INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
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 INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
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 INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
IP
|
$332.99
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.09 |
| Max. Negotiated Rate |
$299.69 |
| Rate for Payer: Aetna Commercial |
$283.04
|
| Rate for Payer: BCBS Trust/PPO |
$257.33
|
| Rate for Payer: BCN Commercial |
$257.33
|
| Rate for Payer: Cash Price |
$266.39
|
| Rate for Payer: Cofinity Commercial |
$286.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.39
|
| Rate for Payer: Healthscope Commercial |
$299.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.04
|
| Rate for Payer: PHP Commercial |
$283.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.03
|
| Rate for Payer: UHC Core |
$278.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.74
|
|
|
HC INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
OP
|
$332.99
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.09 |
| Max. Negotiated Rate |
$299.69 |
| Rate for Payer: Aetna Commercial |
$283.04
|
| Rate for Payer: Aetna Medicare |
$86.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.06
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$83.25
|
| Rate for Payer: BCBS Trust/PPO |
$258.90
|
| Rate for Payer: BCN Commercial |
$258.90
|
| Rate for Payer: BCN Medicare Advantage |
$83.25
|
| Rate for Payer: Cash Price |
$266.39
|
| Rate for Payer: Cash Price |
$266.39
|
| Rate for Payer: Cofinity Commercial |
$286.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.25
|
| Rate for Payer: Healthscope Commercial |
$299.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.74
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.04
|
| Rate for Payer: PACE Senior Care Partners |
$79.09
|
| Rate for Payer: PACE SWMI |
$83.25
|
| Rate for Payer: PHP Commercial |
$283.04
|
| Rate for Payer: PHP Medicare Advantage |
$83.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$289.70
|
| Rate for Payer: Priority Health Medicare |
$83.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.09
|
| Rate for Payer: Railroad Medicare Medicare |
$83.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.03
|
| Rate for Payer: UHC Core |
$278.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.25
|
| Rate for Payer: UHC Medicare Advantage |
$85.74
|
| Rate for Payer: VA VA |
$83.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.74
|
|
|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.87
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC Core |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.32
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.79
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: BCN Medicare Advantage |
$0.26
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.87
|
| Rate for Payer: PACE Senior Care Partners |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.26
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: PHP Medicare Advantage |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.89
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.62
|
| Rate for Payer: Railroad Medicare Medicare |
$0.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC Core |
$0.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.26
|
| Rate for Payer: VA VA |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
IP
|
$542.10
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$330.63 |
| Max. Negotiated Rate |
$487.89 |
| Rate for Payer: Aetna Commercial |
$460.78
|
| Rate for Payer: BCBS Trust/PPO |
$418.93
|
| Rate for Payer: BCN Commercial |
$418.93
|
| Rate for Payer: Cash Price |
$433.68
|
| Rate for Payer: Cofinity Commercial |
$466.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.68
|
| Rate for Payer: Healthscope Commercial |
$487.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.78
|
| Rate for Payer: PHP Commercial |
$460.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$477.05
|
| Rate for Payer: UHC Core |
$452.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.58
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
OP
|
$542.10
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.75 |
| Max. Negotiated Rate |
$487.89 |
| Rate for Payer: Aetna Commercial |
$460.78
|
| Rate for Payer: Aetna Medicare |
$140.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.41
|
| Rate for Payer: BCBS Complete |
$216.84
|
| Rate for Payer: BCBS MAPPO |
$135.52
|
| Rate for Payer: BCBS Trust/PPO |
$421.48
|
| Rate for Payer: BCN Commercial |
$421.48
|
| Rate for Payer: BCN Medicare Advantage |
$135.52
|
| Rate for Payer: Cash Price |
$433.68
|
| Rate for Payer: Cofinity Commercial |
$466.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.52
|
| Rate for Payer: Healthscope Commercial |
$487.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$142.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.78
|
| Rate for Payer: PACE Senior Care Partners |
$128.75
|
| Rate for Payer: PACE SWMI |
$135.52
|
| Rate for Payer: PHP Commercial |
$460.78
|
| Rate for Payer: PHP Medicare Advantage |
$135.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.63
|
| Rate for Payer: Priority Health Medicare |
$135.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.63
|
| Rate for Payer: Railroad Medicare Medicare |
$135.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$477.05
|
| Rate for Payer: UHC Core |
$452.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.52
|
| Rate for Payer: UHC Medicare Advantage |
$139.59
|
| Rate for Payer: VA VA |
$135.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.58
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
OP
|
$2,055.83
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$488.26 |
| Max. Negotiated Rate |
$1,850.25 |
| Rate for Payer: Aetna Commercial |
$1,747.46
|
| Rate for Payer: Aetna Medicare |
$534.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$642.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$642.45
|
| Rate for Payer: BCBS Complete |
$551.50
|
| Rate for Payer: BCBS MAPPO |
$513.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,598.41
|
| Rate for Payer: BCN Commercial |
$1,598.41
|
| Rate for Payer: BCN Medicare Advantage |
$513.96
|
| Rate for Payer: Cash Price |
$1,644.66
|
| Rate for Payer: Cash Price |
$1,644.66
|
| Rate for Payer: Cofinity Commercial |
$1,768.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,644.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$513.96
|
| Rate for Payer: Healthscope Commercial |
$1,850.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,541.87
|
| Rate for Payer: Mclaren Medicaid |
$525.24
|
| Rate for Payer: Meridian Medicaid |
$551.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$539.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$591.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,747.46
|
| Rate for Payer: PACE Senior Care Partners |
$488.26
|
| Rate for Payer: PACE SWMI |
$513.96
|
| Rate for Payer: PHP Commercial |
$1,747.46
|
| Rate for Payer: PHP Medicare Advantage |
$513.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,788.57
|
| Rate for Payer: Priority Health Medicare |
$513.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,253.85
|
| Rate for Payer: Railroad Medicare Medicare |
$513.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,809.13
|
| Rate for Payer: UHC Core |
$1,716.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$513.96
|
| Rate for Payer: UHC Medicare Advantage |
$529.38
|
| Rate for Payer: VA VA |
$513.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,541.87
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
IP
|
$2,055.83
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,253.85 |
| Max. Negotiated Rate |
$1,850.25 |
| Rate for Payer: Aetna Commercial |
$1,747.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,588.75
|
| Rate for Payer: BCN Commercial |
$1,588.75
|
| Rate for Payer: Cash Price |
$1,644.66
|
| Rate for Payer: Cofinity Commercial |
$1,768.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,644.66
|
| Rate for Payer: Healthscope Commercial |
$1,850.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,541.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,747.46
|
| Rate for Payer: PHP Commercial |
$1,747.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,788.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,253.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,809.13
|
| Rate for Payer: UHC Core |
$1,716.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,541.87
|
|
|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
OP
|
$2,161.30
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$513.31 |
| Max. Negotiated Rate |
$1,945.17 |
| Rate for Payer: Aetna Commercial |
$1,837.10
|
| Rate for Payer: Aetna Medicare |
$561.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$675.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$675.41
|
| Rate for Payer: BCBS Complete |
$551.50
|
| Rate for Payer: BCBS MAPPO |
$540.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,680.41
|
| Rate for Payer: BCN Commercial |
$1,680.41
|
| Rate for Payer: BCN Medicare Advantage |
$540.32
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$1,858.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.32
|
| Rate for Payer: Healthscope Commercial |
$1,945.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$525.24
|
| Rate for Payer: Meridian Medicaid |
$551.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$567.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$621.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PACE Senior Care Partners |
$513.31
|
| Rate for Payer: PACE SWMI |
$540.32
|
| Rate for Payer: PHP Commercial |
$1,837.10
|
| Rate for Payer: PHP Medicare Advantage |
$540.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.33
|
| Rate for Payer: Priority Health Medicare |
$540.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,318.18
|
| Rate for Payer: Railroad Medicare Medicare |
$540.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.94
|
| Rate for Payer: UHC Core |
$1,804.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.32
|
| Rate for Payer: UHC Medicare Advantage |
$556.53
|
| Rate for Payer: VA VA |
$540.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,620.98
|
|
|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
IP
|
$2,161.30
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,318.18 |
| Max. Negotiated Rate |
$1,945.17 |
| Rate for Payer: Aetna Commercial |
$1,837.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,670.25
|
| Rate for Payer: BCN Commercial |
$1,670.25
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$1,858.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Healthscope Commercial |
$1,945.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,620.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PHP Commercial |
$1,837.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,318.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.94
|
| Rate for Payer: UHC Core |
$1,804.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,620.98
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
IP
|
$2,161.30
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,318.18 |
| Max. Negotiated Rate |
$1,945.17 |
| Rate for Payer: Aetna Commercial |
$1,837.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,670.25
|
| Rate for Payer: BCN Commercial |
$1,670.25
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$1,858.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Healthscope Commercial |
$1,945.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,620.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PHP Commercial |
$1,837.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,318.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.94
|
| Rate for Payer: UHC Core |
$1,804.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,620.98
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
OP
|
$2,161.30
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$513.31 |
| Max. Negotiated Rate |
$1,945.17 |
| Rate for Payer: Aetna Commercial |
$1,837.10
|
| Rate for Payer: Aetna Medicare |
$561.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$675.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$675.41
|
| Rate for Payer: BCBS Complete |
$551.50
|
| Rate for Payer: BCBS MAPPO |
$540.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,680.41
|
| Rate for Payer: BCN Commercial |
$1,680.41
|
| Rate for Payer: BCN Medicare Advantage |
$540.32
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$1,858.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.32
|
| Rate for Payer: Healthscope Commercial |
$1,945.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$525.24
|
| Rate for Payer: Meridian Medicaid |
$551.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$567.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$621.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PACE Senior Care Partners |
$513.31
|
| Rate for Payer: PACE SWMI |
$540.32
|
| Rate for Payer: PHP Commercial |
$1,837.10
|
| Rate for Payer: PHP Medicare Advantage |
$540.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.33
|
| Rate for Payer: Priority Health Medicare |
$540.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,318.18
|
| Rate for Payer: Railroad Medicare Medicare |
$540.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.94
|
| Rate for Payer: UHC Core |
$1,804.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.32
|
| Rate for Payer: UHC Medicare Advantage |
$556.53
|
| Rate for Payer: VA VA |
$540.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,620.98
|
|
