|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
IP
|
$2,161.30
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
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 THOR SAME MD
|
Facility
|
OP
|
$2,161.30
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
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 LYMPHANGIOGRAPHY
|
Facility
|
OP
|
$1,279.58
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$303.90 |
| Max. Negotiated Rate |
$1,151.62 |
| Rate for Payer: Aetna Commercial |
$1,087.64
|
| Rate for Payer: Aetna Medicare |
$332.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.87
|
| Rate for Payer: BCBS Complete |
$511.83
|
| Rate for Payer: BCBS MAPPO |
$319.90
|
| Rate for Payer: BCBS Trust/PPO |
$994.87
|
| Rate for Payer: BCN Commercial |
$994.87
|
| Rate for Payer: BCN Medicare Advantage |
$319.90
|
| Rate for Payer: Cash Price |
$1,023.66
|
| Rate for Payer: Cofinity Commercial |
$1,100.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.90
|
| Rate for Payer: Healthscope Commercial |
$1,151.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$959.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,087.64
|
| Rate for Payer: PACE Senior Care Partners |
$303.90
|
| Rate for Payer: PACE SWMI |
$319.90
|
| Rate for Payer: PHP Commercial |
$1,087.64
|
| Rate for Payer: PHP Medicare Advantage |
$319.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,113.23
|
| Rate for Payer: Priority Health Medicare |
$319.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$780.42
|
| Rate for Payer: Railroad Medicare Medicare |
$319.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,126.03
|
| Rate for Payer: UHC Core |
$1,068.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.90
|
| Rate for Payer: UHC Medicare Advantage |
$329.49
|
| Rate for Payer: VA VA |
$319.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$959.68
|
|
|
HC INJ LYMPHANGIOGRAPHY
|
Facility
|
IP
|
$1,279.58
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$780.42 |
| Max. Negotiated Rate |
$1,151.62 |
| Rate for Payer: Aetna Commercial |
$1,087.64
|
| Rate for Payer: BCBS Trust/PPO |
$988.86
|
| Rate for Payer: BCN Commercial |
$988.86
|
| Rate for Payer: Cash Price |
$1,023.66
|
| Rate for Payer: Cofinity Commercial |
$1,100.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.66
|
| Rate for Payer: Healthscope Commercial |
$1,151.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$959.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,087.64
|
| Rate for Payer: PHP Commercial |
$1,087.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,113.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$780.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,126.03
|
| Rate for Payer: UHC Core |
$1,068.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$959.68
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
63600102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
63600102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
63600101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
63600101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC INJ NERV BLOCK GREAT OCCIPTL
|
Facility
|
OP
|
$259.20
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
36100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Aetna Medicare |
$67.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.00
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$64.80
|
| Rate for Payer: BCBS Trust/PPO |
$201.53
|
| Rate for Payer: BCN Commercial |
$201.53
|
| Rate for Payer: BCN Medicare Advantage |
$64.80
|
| Rate for Payer: Cash Price |
$207.36
|
| Rate for Payer: Cash Price |
$207.36
|
| Rate for Payer: Cofinity Commercial |
$222.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$233.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.40
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$220.32
|
| Rate for Payer: PACE Senior Care Partners |
$61.56
|
| Rate for Payer: PACE SWMI |
$64.80
|
| Rate for Payer: PHP Commercial |
$220.32
|
| Rate for Payer: PHP Medicare Advantage |
$64.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.50
|
| Rate for Payer: Priority Health Medicare |
$64.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.09
|
| Rate for Payer: Railroad Medicare Medicare |
$64.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.10
|
| Rate for Payer: UHC Core |
$216.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.80
|
| Rate for Payer: UHC Medicare Advantage |
$66.74
|
| Rate for Payer: VA VA |
$64.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.40
|
|
|
HC INJ NERV BLOCK GREAT OCCIPTL
|
Facility
|
IP
|
$259.20
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
36100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.09 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: BCBS Trust/PPO |
$200.31
|
| Rate for Payer: BCN Commercial |
$200.31
|
| Rate for Payer: Cash Price |
$207.36
|
| Rate for Payer: Cofinity Commercial |
$222.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.36
|
| Rate for Payer: Healthscope Commercial |
$233.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$220.32
|
| Rate for Payer: PHP Commercial |
$220.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.10
|
| Rate for Payer: UHC Core |
$216.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.40
|
|
|
HC INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: BCBS Trust/PPO |
$6.18
|
| Rate for Payer: BCN Commercial |
$6.18
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.40
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.80
|
| Rate for Payer: PHP Commercial |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.04
|
| Rate for Payer: UHC Core |
$6.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.00
|
|
|
HC INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.50
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS MAPPO |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$6.22
|
| Rate for Payer: BCN Commercial |
$6.22
|
| Rate for Payer: BCN Medicare Advantage |
$2.00
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.00
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.00
|
| Rate for Payer: Mclaren Medicaid |
$4.67
|
| Rate for Payer: Meridian Medicaid |
$4.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.80
|
| Rate for Payer: PACE Senior Care Partners |
$1.90
|
| Rate for Payer: PACE SWMI |
$2.00
|
| Rate for Payer: PHP Commercial |
$6.80
|
| Rate for Payer: PHP Medicare Advantage |
$2.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.96
|
| Rate for Payer: Priority Health Medicare |
$2.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.88
|
| Rate for Payer: Railroad Medicare Medicare |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.04
|
| Rate for Payer: UHC Core |
$6.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.00
|
| Rate for Payer: UHC Medicare Advantage |
$2.06
|
| Rate for Payer: VA VA |
$2.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.00
|
|
|
HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS
|
Facility
|
OP
|
$16.84
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$16.84 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.26
|
| Rate for Payer: BCBS Complete |
$16.84
|
| Rate for Payer: BCBS MAPPO |
$4.21
|
| Rate for Payer: BCBS Trust/PPO |
$13.09
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: BCN Medicare Advantage |
$4.21
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$14.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.21
|
| Rate for Payer: Healthscope Commercial |
$15.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.63
|
| Rate for Payer: Mclaren Medicaid |
$16.04
|
| Rate for Payer: Meridian Medicaid |
$16.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.31
|
| Rate for Payer: PACE Senior Care Partners |
$4.00
|
| Rate for Payer: PACE SWMI |
$4.21
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: PHP Medicare Advantage |
$4.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.65
|
| Rate for Payer: Priority Health Medicare |
$4.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.27
|
| Rate for Payer: Railroad Medicare Medicare |
$4.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.82
|
| Rate for Payer: UHC Core |
$14.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.21
|
| Rate for Payer: UHC Medicare Advantage |
$4.34
|
| Rate for Payer: VA VA |
$4.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.63
|
|
|
HC INJ, PENICILLIN G BENZATHINE, 100,000 UNITS
|
Facility
|
IP
|
$16.84
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
63600162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$15.16 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: BCBS Trust/PPO |
$13.01
|
| Rate for Payer: BCN Commercial |
$13.01
|
| Rate for Payer: Cash Price |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$14.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$15.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.31
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.82
|
| Rate for Payer: UHC Core |
$14.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.63
|
|
|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
IP
|
$670.14
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$408.72 |
| Max. Negotiated Rate |
$603.13 |
| Rate for Payer: Aetna Commercial |
$569.62
|
| Rate for Payer: BCBS Trust/PPO |
$517.88
|
| Rate for Payer: BCN Commercial |
$517.88
|
| Rate for Payer: Cash Price |
$536.11
|
| Rate for Payer: Cofinity Commercial |
$576.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.11
|
| Rate for Payer: Healthscope Commercial |
$603.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$569.62
|
| Rate for Payer: PHP Commercial |
$569.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$583.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$408.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$589.72
|
| Rate for Payer: UHC Core |
$559.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.60
|
|
|
HC INJ SELECT R VENT/ATRIAL ANGIO HRT CATH
|
Facility
|
OP
|
$670.14
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
36000110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$603.13 |
| Rate for Payer: Aetna Commercial |
$569.62
|
| Rate for Payer: Aetna Medicare |
$174.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.42
|
| Rate for Payer: BCBS Complete |
$268.06
|
| Rate for Payer: BCBS MAPPO |
$167.54
|
| Rate for Payer: BCBS Trust/PPO |
$521.03
|
| Rate for Payer: BCN Commercial |
$521.03
|
| Rate for Payer: BCN Medicare Advantage |
$167.54
|
| Rate for Payer: Cash Price |
$536.11
|
| Rate for Payer: Cofinity Commercial |
$576.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.54
|
| Rate for Payer: Healthscope Commercial |
$603.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$175.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$569.62
|
| Rate for Payer: PACE Senior Care Partners |
$159.16
|
| Rate for Payer: PACE SWMI |
$167.54
|
| Rate for Payer: PHP Commercial |
$569.62
|
| Rate for Payer: PHP Medicare Advantage |
$167.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$583.02
|
| Rate for Payer: Priority Health Medicare |
$167.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$408.72
|
| Rate for Payer: Railroad Medicare Medicare |
$167.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$589.72
|
| Rate for Payer: UHC Core |
$559.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.54
|
| Rate for Payer: UHC Medicare Advantage |
$172.56
|
| Rate for Payer: VA VA |
$167.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.60
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna Medicare |
$53.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.75
|
| Rate for Payer: BCBS Complete |
$108.80
|
| Rate for Payer: BCBS MAPPO |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$158.61
|
| Rate for Payer: BCN Commercial |
$158.61
|
| Rate for Payer: BCN Medicare Advantage |
$51.00
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.00
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.00
|
| Rate for Payer: Mclaren Medicaid |
$103.62
|
| Rate for Payer: Meridian Medicaid |
$108.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PACE Senior Care Partners |
$48.45
|
| Rate for Payer: PACE SWMI |
$51.00
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: PHP Medicare Advantage |
$51.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.48
|
| Rate for Payer: Priority Health Medicare |
$51.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.42
|
| Rate for Payer: Railroad Medicare Medicare |
$51.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.52
|
| Rate for Payer: UHC Core |
$170.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.00
|
| Rate for Payer: UHC Medicare Advantage |
$52.53
|
| Rate for Payer: VA VA |
$51.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.00
|
|
|
HC INJ TIXAGEVIMAB AND CILGAVIMAB
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
77100033
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$124.42 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: BCBS Trust/PPO |
$157.65
|
| Rate for Payer: BCN Commercial |
$157.65
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.52
|
| Rate for Payer: UHC Core |
$170.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.00
|
|
|
HC INJ, TRIAMCINOLONE ACETONIDE, NOT SPECIFIED, 10 MG
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna Medicare |
$2.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.19
|
| Rate for Payer: BCBS Complete |
$4.08
|
| Rate for Payer: BCBS MAPPO |
$2.55
|
| Rate for Payer: BCBS Trust/PPO |
$7.93
|
| Rate for Payer: BCN Commercial |
$7.93
|
| Rate for Payer: BCN Medicare Advantage |
$2.55
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: PACE Senior Care Partners |
$2.42
|
| Rate for Payer: PACE SWMI |
$2.55
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: PHP Medicare Advantage |
$2.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.87
|
| Rate for Payer: Priority Health Medicare |
$2.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.22
|
| Rate for Payer: Railroad Medicare Medicare |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.98
|
| Rate for Payer: UHC Core |
$8.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.55
|
| Rate for Payer: UHC Medicare Advantage |
$2.63
|
| Rate for Payer: VA VA |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.65
|
|
|
HC INJ, TRIAMCINOLONE ACETONIDE, NOT SPECIFIED, 10 MG
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
CPT J3301
|
| Hospital Charge Code |
63600103
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: BCBS Trust/PPO |
$7.88
|
| Rate for Payer: BCN Commercial |
$7.88
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.98
|
| Rate for Payer: UHC Core |
$8.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.65
|
|
|
HC INJ, VIT B12 CYANCOBALAMIN, UP TO 1000MCG
|
Facility
|
IP
|
$5.10
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$3.94
|
| Rate for Payer: BCN Commercial |
$3.94
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.34
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.49
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
|
HC INJ, VIT B12 CYANCOBALAMIN, UP TO 1000MCG
|
Facility
|
OP
|
$5.10
|
|
|
Service Code
|
CPT J3420
|
| Hospital Charge Code |
63600104
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$4.59 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.59
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: BCBS MAPPO |
$1.28
|
| Rate for Payer: BCBS Trust/PPO |
$3.97
|
| Rate for Payer: BCN Commercial |
$3.97
|
| Rate for Payer: BCN Medicare Advantage |
$1.28
|
| Rate for Payer: Cash Price |
$4.08
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.28
|
| Rate for Payer: Healthscope Commercial |
$4.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.34
|
| Rate for Payer: PACE Senior Care Partners |
$1.21
|
| Rate for Payer: PACE SWMI |
$1.28
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: PHP Medicare Advantage |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.44
|
| Rate for Payer: Priority Health Medicare |
$1.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.11
|
| Rate for Payer: Railroad Medicare Medicare |
$1.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.49
|
| Rate for Payer: UHC Core |
$4.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.28
|
| Rate for Payer: UHC Medicare Advantage |
$1.31
|
| Rate for Payer: VA VA |
$1.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.82
|
|
|
HC INSECT VENOM ALLERGY PANEL
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC INSECT VENOM ALLERGY PANEL
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200115
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC INSERT CATH COMPLICATED
|
Facility
|
OP
|
$490.51
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
45000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.47 |
| Max. Negotiated Rate |
$441.46 |
| Rate for Payer: Aetna Commercial |
$416.93
|
| Rate for Payer: Aetna Medicare |
$127.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.28
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$122.63
|
| Rate for Payer: BCBS Trust/PPO |
$381.37
|
| Rate for Payer: BCN Commercial |
$381.37
|
| Rate for Payer: BCN Medicare Advantage |
$122.63
|
| Rate for Payer: Cash Price |
$392.41
|
| Rate for Payer: Cash Price |
$392.41
|
| Rate for Payer: Cofinity Commercial |
$421.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.63
|
| Rate for Payer: Healthscope Commercial |
$441.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.88
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.93
|
| Rate for Payer: PACE Senior Care Partners |
$116.50
|
| Rate for Payer: PACE SWMI |
$122.63
|
| Rate for Payer: PHP Commercial |
$416.93
|
| Rate for Payer: PHP Medicare Advantage |
$122.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$426.74
|
| Rate for Payer: Priority Health Medicare |
$122.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.16
|
| Rate for Payer: Railroad Medicare Medicare |
$122.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.65
|
| Rate for Payer: UHC Core |
$409.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.63
|
| Rate for Payer: UHC Medicare Advantage |
$126.31
|
| Rate for Payer: VA VA |
$122.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.88
|
|
