|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
OP
|
$500.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$118.81 |
| Max. Negotiated Rate |
$450.22 |
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: Aetna Medicare |
$130.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.32
|
| Rate for Payer: BCBS Complete |
$147.63
|
| Rate for Payer: BCBS MAPPO |
$125.06
|
| Rate for Payer: BCBS Trust/PPO |
$388.94
|
| Rate for Payer: BCN Commercial |
$388.94
|
| Rate for Payer: BCN Medicare Advantage |
$125.06
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cofinity Commercial |
$430.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.06
|
| Rate for Payer: Healthscope Commercial |
$450.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.18
|
| Rate for Payer: Mclaren Medicaid |
$140.60
|
| Rate for Payer: Meridian Medicaid |
$147.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.20
|
| Rate for Payer: PACE Senior Care Partners |
$118.81
|
| Rate for Payer: PACE SWMI |
$125.06
|
| Rate for Payer: PHP Commercial |
$425.20
|
| Rate for Payer: PHP Medicare Advantage |
$125.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.21
|
| Rate for Payer: Priority Health Medicare |
$125.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.10
|
| Rate for Payer: Railroad Medicare Medicare |
$125.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.21
|
| Rate for Payer: UHC Core |
$417.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.06
|
| Rate for Payer: UHC Medicare Advantage |
$128.81
|
| Rate for Payer: VA VA |
$125.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.18
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
IP
|
$126.49
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$77.15 |
| Max. Negotiated Rate |
$113.84 |
| Rate for Payer: Aetna Commercial |
$107.52
|
| Rate for Payer: BCBS Trust/PPO |
$97.75
|
| Rate for Payer: BCN Commercial |
$97.75
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cofinity Commercial |
$108.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.19
|
| Rate for Payer: Healthscope Commercial |
$113.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.52
|
| Rate for Payer: PHP Commercial |
$107.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.31
|
| Rate for Payer: UHC Core |
$105.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.87
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
OP
|
$126.49
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.04 |
| Max. Negotiated Rate |
$113.84 |
| Rate for Payer: Aetna Commercial |
$107.52
|
| Rate for Payer: Aetna Medicare |
$32.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.53
|
| Rate for Payer: BCBS Complete |
$32.72
|
| Rate for Payer: BCBS MAPPO |
$31.62
|
| Rate for Payer: BCBS Trust/PPO |
$98.35
|
| Rate for Payer: BCN Commercial |
$98.35
|
| Rate for Payer: BCN Medicare Advantage |
$31.62
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cofinity Commercial |
$108.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$113.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.87
|
| Rate for Payer: Mclaren Medicaid |
$31.16
|
| Rate for Payer: Meridian Medicaid |
$32.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.52
|
| Rate for Payer: PACE Senior Care Partners |
$30.04
|
| Rate for Payer: PACE SWMI |
$31.62
|
| Rate for Payer: PHP Commercial |
$107.52
|
| Rate for Payer: PHP Medicare Advantage |
$31.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.05
|
| Rate for Payer: Priority Health Medicare |
$31.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.15
|
| Rate for Payer: Railroad Medicare Medicare |
$31.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.31
|
| Rate for Payer: UHC Core |
$105.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.62
|
| Rate for Payer: UHC Medicare Advantage |
$32.57
|
| Rate for Payer: VA VA |
$31.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.87
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
IP
|
$265.62
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$239.06 |
| Rate for Payer: Aetna Commercial |
$225.78
|
| Rate for Payer: BCBS Trust/PPO |
$205.27
|
| Rate for Payer: BCN Commercial |
$205.27
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cofinity Commercial |
$228.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.50
|
| Rate for Payer: Healthscope Commercial |
$239.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.78
|
| Rate for Payer: PHP Commercial |
$225.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.75
|
| Rate for Payer: UHC Core |
$221.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.22
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
OP
|
$265.62
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$63.08 |
| Max. Negotiated Rate |
$239.06 |
| Rate for Payer: Aetna Commercial |
$225.78
|
| Rate for Payer: Aetna Medicare |
$69.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.01
|
| Rate for Payer: BCBS Complete |
$147.63
|
| Rate for Payer: BCBS MAPPO |
$66.40
|
| Rate for Payer: BCBS Trust/PPO |
$206.52
|
| Rate for Payer: BCN Commercial |
$206.52
|
| Rate for Payer: BCN Medicare Advantage |
$66.40
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cofinity Commercial |
$228.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.40
|
| Rate for Payer: Healthscope Commercial |
$239.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.22
|
| Rate for Payer: Mclaren Medicaid |
$140.60
|
| Rate for Payer: Meridian Medicaid |
$147.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.78
|
| Rate for Payer: PACE Senior Care Partners |
$63.08
|
| Rate for Payer: PACE SWMI |
$66.40
|
| Rate for Payer: PHP Commercial |
$225.78
|
| Rate for Payer: PHP Medicare Advantage |
$66.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.09
|
| Rate for Payer: Priority Health Medicare |
$66.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.00
|
| Rate for Payer: Railroad Medicare Medicare |
$66.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.75
|
| Rate for Payer: UHC Core |
$221.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.40
|
| Rate for Payer: UHC Medicare Advantage |
$68.40
|
| Rate for Payer: VA VA |
$66.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.22
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
OP
|
$674.68
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$607.21 |
| Rate for Payer: Aetna Commercial |
$573.48
|
| Rate for Payer: Aetna Medicare |
$175.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.84
|
| Rate for Payer: BCBS Complete |
$147.63
|
| Rate for Payer: BCBS MAPPO |
$168.67
|
| Rate for Payer: BCBS Trust/PPO |
$524.56
|
| Rate for Payer: BCN Commercial |
$524.56
|
| Rate for Payer: BCN Medicare Advantage |
$168.67
|
| Rate for Payer: Cash Price |
$539.74
|
| Rate for Payer: Cash Price |
$539.74
|
| Rate for Payer: Cofinity Commercial |
$580.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.67
|
| Rate for Payer: Healthscope Commercial |
$607.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.01
|
| Rate for Payer: Mclaren Medicaid |
$140.60
|
| Rate for Payer: Meridian Medicaid |
$147.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.48
|
| Rate for Payer: PACE Senior Care Partners |
$160.24
|
| Rate for Payer: PACE SWMI |
$168.67
|
| Rate for Payer: PHP Commercial |
$573.48
|
| Rate for Payer: PHP Medicare Advantage |
$168.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.97
|
| Rate for Payer: Priority Health Medicare |
$168.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.49
|
| Rate for Payer: Railroad Medicare Medicare |
$168.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.72
|
| Rate for Payer: UHC Core |
$563.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.67
|
| Rate for Payer: UHC Medicare Advantage |
$173.73
|
| Rate for Payer: VA VA |
$168.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.01
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
IP
|
$674.68
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$411.49 |
| Max. Negotiated Rate |
$607.21 |
| Rate for Payer: Aetna Commercial |
$573.48
|
| Rate for Payer: BCBS Trust/PPO |
$521.39
|
| Rate for Payer: BCN Commercial |
$521.39
|
| Rate for Payer: Cash Price |
$539.74
|
| Rate for Payer: Cofinity Commercial |
$580.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.74
|
| Rate for Payer: Healthscope Commercial |
$607.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.48
|
| Rate for Payer: PHP Commercial |
$573.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.72
|
| Rate for Payer: UHC Core |
$563.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.01
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$124.52 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna Medicare |
$136.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$163.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$163.84
|
| Rate for Payer: BCBS Complete |
$325.67
|
| Rate for Payer: BCBS MAPPO |
$131.07
|
| Rate for Payer: BCBS Trust/PPO |
$407.63
|
| Rate for Payer: BCN Commercial |
$407.63
|
| Rate for Payer: BCN Medicare Advantage |
$131.07
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.07
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.21
|
| Rate for Payer: Mclaren Medicaid |
$310.17
|
| Rate for Payer: Meridian Medicaid |
$325.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Senior Care Partners |
$124.52
|
| Rate for Payer: PACE SWMI |
$131.07
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: PHP Medicare Advantage |
$131.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.12
|
| Rate for Payer: Priority Health Medicare |
$131.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.76
|
| Rate for Payer: Railroad Medicare Medicare |
$131.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.37
|
| Rate for Payer: UHC Core |
$437.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.07
|
| Rate for Payer: UHC Medicare Advantage |
$135.00
|
| Rate for Payer: VA VA |
$131.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.21
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$319.76 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: BCBS Trust/PPO |
$405.16
|
| Rate for Payer: BCN Commercial |
$405.16
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.37
|
| Rate for Payer: UHC Core |
$437.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.21
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$124.52 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna Medicare |
$136.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$163.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$163.84
|
| Rate for Payer: BCBS Complete |
$325.67
|
| Rate for Payer: BCBS MAPPO |
$131.07
|
| Rate for Payer: BCBS Trust/PPO |
$407.63
|
| Rate for Payer: BCN Commercial |
$407.63
|
| Rate for Payer: BCN Medicare Advantage |
$131.07
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.07
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.21
|
| Rate for Payer: Mclaren Medicaid |
$310.17
|
| Rate for Payer: Meridian Medicaid |
$325.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Senior Care Partners |
$124.52
|
| Rate for Payer: PACE SWMI |
$131.07
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: PHP Medicare Advantage |
$131.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.12
|
| Rate for Payer: Priority Health Medicare |
$131.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.76
|
| Rate for Payer: Railroad Medicare Medicare |
$131.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.37
|
| Rate for Payer: UHC Core |
$437.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.07
|
| Rate for Payer: UHC Medicare Advantage |
$135.00
|
| Rate for Payer: VA VA |
$131.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.21
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$319.76 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: BCBS Trust/PPO |
$405.16
|
| Rate for Payer: BCN Commercial |
$405.16
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.37
|
| Rate for Payer: UHC Core |
$437.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.21
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
OP
|
$170.26
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$153.23 |
| Rate for Payer: Aetna Commercial |
$144.72
|
| Rate for Payer: Aetna Medicare |
$44.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.21
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$42.56
|
| Rate for Payer: BCBS Trust/PPO |
$132.38
|
| Rate for Payer: BCN Commercial |
$132.38
|
| Rate for Payer: BCN Medicare Advantage |
$42.56
|
| Rate for Payer: Cash Price |
$136.21
|
| Rate for Payer: Cofinity Commercial |
$146.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.56
|
| Rate for Payer: Healthscope Commercial |
$153.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.72
|
| Rate for Payer: PACE Senior Care Partners |
$40.44
|
| Rate for Payer: PACE SWMI |
$42.56
|
| Rate for Payer: PHP Commercial |
$144.72
|
| Rate for Payer: PHP Medicare Advantage |
$42.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.13
|
| Rate for Payer: Priority Health Medicare |
$42.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.84
|
| Rate for Payer: Railroad Medicare Medicare |
$42.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.83
|
| Rate for Payer: UHC Core |
$142.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.56
|
| Rate for Payer: UHC Medicare Advantage |
$43.84
|
| Rate for Payer: VA VA |
$42.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.70
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
IP
|
$170.26
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$103.84 |
| Max. Negotiated Rate |
$153.23 |
| Rate for Payer: Aetna Commercial |
$144.72
|
| Rate for Payer: BCBS Trust/PPO |
$131.58
|
| Rate for Payer: BCN Commercial |
$131.58
|
| Rate for Payer: Cash Price |
$136.21
|
| Rate for Payer: Cofinity Commercial |
$146.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.21
|
| Rate for Payer: Healthscope Commercial |
$153.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.72
|
| Rate for Payer: PHP Commercial |
$144.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.83
|
| Rate for Payer: UHC Core |
$142.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.70
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
IP
|
$190.73
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$116.33 |
| Max. Negotiated Rate |
$171.66 |
| Rate for Payer: Aetna Commercial |
$162.12
|
| Rate for Payer: BCBS Trust/PPO |
$147.40
|
| Rate for Payer: BCN Commercial |
$147.40
|
| Rate for Payer: Cash Price |
$152.58
|
| Rate for Payer: Cofinity Commercial |
$164.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.58
|
| Rate for Payer: Healthscope Commercial |
$171.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.12
|
| Rate for Payer: PHP Commercial |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.84
|
| Rate for Payer: UHC Core |
$159.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.05
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
OP
|
$190.73
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$171.66 |
| Rate for Payer: Aetna Commercial |
$162.12
|
| Rate for Payer: Aetna Medicare |
$49.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.60
|
| Rate for Payer: BCBS Complete |
$32.72
|
| Rate for Payer: BCBS MAPPO |
$47.68
|
| Rate for Payer: BCBS Trust/PPO |
$148.29
|
| Rate for Payer: BCN Commercial |
$148.29
|
| Rate for Payer: BCN Medicare Advantage |
$47.68
|
| Rate for Payer: Cash Price |
$152.58
|
| Rate for Payer: Cash Price |
$152.58
|
| Rate for Payer: Cofinity Commercial |
$164.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.68
|
| Rate for Payer: Healthscope Commercial |
$171.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.05
|
| Rate for Payer: Mclaren Medicaid |
$31.16
|
| Rate for Payer: Meridian Medicaid |
$32.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.12
|
| Rate for Payer: PACE Senior Care Partners |
$45.30
|
| Rate for Payer: PACE SWMI |
$47.68
|
| Rate for Payer: PHP Commercial |
$162.12
|
| Rate for Payer: PHP Medicare Advantage |
$47.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.94
|
| Rate for Payer: Priority Health Medicare |
$47.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.33
|
| Rate for Payer: Railroad Medicare Medicare |
$47.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.84
|
| Rate for Payer: UHC Core |
$159.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.68
|
| Rate for Payer: UHC Medicare Advantage |
$49.11
|
| Rate for Payer: VA VA |
$47.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.05
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
OP
|
$524.29
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$124.52 |
| Max. Negotiated Rate |
$471.86 |
| Rate for Payer: Aetna Commercial |
$445.65
|
| Rate for Payer: Aetna Medicare |
$136.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$163.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$163.84
|
| Rate for Payer: BCBS Complete |
$147.63
|
| Rate for Payer: BCBS MAPPO |
$131.07
|
| Rate for Payer: BCBS Trust/PPO |
$407.64
|
| Rate for Payer: BCN Commercial |
$407.64
|
| Rate for Payer: BCN Medicare Advantage |
$131.07
|
| Rate for Payer: Cash Price |
$419.43
|
| Rate for Payer: Cash Price |
$419.43
|
| Rate for Payer: Cofinity Commercial |
$450.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.07
|
| Rate for Payer: Healthscope Commercial |
$471.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.22
|
| Rate for Payer: Mclaren Medicaid |
$140.60
|
| Rate for Payer: Meridian Medicaid |
$147.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.65
|
| Rate for Payer: PACE Senior Care Partners |
$124.52
|
| Rate for Payer: PACE SWMI |
$131.07
|
| Rate for Payer: PHP Commercial |
$445.65
|
| Rate for Payer: PHP Medicare Advantage |
$131.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.13
|
| Rate for Payer: Priority Health Medicare |
$131.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.76
|
| Rate for Payer: Railroad Medicare Medicare |
$131.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.38
|
| Rate for Payer: UHC Core |
$437.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.07
|
| Rate for Payer: UHC Medicare Advantage |
$135.00
|
| Rate for Payer: VA VA |
$131.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.22
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
IP
|
$524.29
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$319.76 |
| Max. Negotiated Rate |
$471.86 |
| Rate for Payer: Aetna Commercial |
$445.65
|
| Rate for Payer: BCBS Trust/PPO |
$405.17
|
| Rate for Payer: BCN Commercial |
$405.17
|
| Rate for Payer: Cash Price |
$419.43
|
| Rate for Payer: Cofinity Commercial |
$450.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.43
|
| Rate for Payer: Healthscope Commercial |
$471.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.65
|
| Rate for Payer: PHP Commercial |
$445.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.38
|
| Rate for Payer: UHC Core |
$437.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.22
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
IP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: BCBS Trust/PPO |
$64.71
|
| Rate for Payer: BCN Commercial |
$64.71
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.69
|
| Rate for Payer: UHC Core |
$69.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.80
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
OP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: Aetna Medicare |
$21.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.17
|
| Rate for Payer: BCBS Complete |
$33.50
|
| Rate for Payer: BCBS MAPPO |
$20.94
|
| Rate for Payer: BCBS Trust/PPO |
$65.11
|
| Rate for Payer: BCN Commercial |
$65.11
|
| Rate for Payer: BCN Medicare Advantage |
$20.94
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: PACE Senior Care Partners |
$19.89
|
| Rate for Payer: PACE SWMI |
$20.94
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: PHP Medicare Advantage |
$20.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.85
|
| Rate for Payer: Priority Health Medicare |
$20.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.07
|
| Rate for Payer: Railroad Medicare Medicare |
$20.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.69
|
| Rate for Payer: UHC Core |
$69.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.94
|
| Rate for Payer: UHC Medicare Advantage |
$21.56
|
| Rate for Payer: VA VA |
$20.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.80
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
IP
|
$85.72
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.28 |
| Max. Negotiated Rate |
$77.15 |
| Rate for Payer: Aetna Commercial |
$72.86
|
| Rate for Payer: BCBS Trust/PPO |
$66.24
|
| Rate for Payer: BCN Commercial |
$66.24
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$73.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$77.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.86
|
| Rate for Payer: PHP Commercial |
$72.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.43
|
| Rate for Payer: UHC Core |
$71.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.29
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
OP
|
$85.72
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$77.15 |
| Rate for Payer: Aetna Commercial |
$72.86
|
| Rate for Payer: Aetna Medicare |
$22.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.79
|
| Rate for Payer: BCBS Complete |
$34.29
|
| Rate for Payer: BCBS MAPPO |
$21.43
|
| Rate for Payer: BCBS Trust/PPO |
$66.65
|
| Rate for Payer: BCN Commercial |
$66.65
|
| Rate for Payer: BCN Medicare Advantage |
$21.43
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$73.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.43
|
| Rate for Payer: Healthscope Commercial |
$77.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.86
|
| Rate for Payer: PACE Senior Care Partners |
$20.36
|
| Rate for Payer: PACE SWMI |
$21.43
|
| Rate for Payer: PHP Commercial |
$72.86
|
| Rate for Payer: PHP Medicare Advantage |
$21.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.58
|
| Rate for Payer: Priority Health Medicare |
$21.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: Railroad Medicare Medicare |
$21.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.43
|
| Rate for Payer: UHC Core |
$71.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.43
|
| Rate for Payer: UHC Medicare Advantage |
$22.07
|
| Rate for Payer: VA VA |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.29
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
OP
|
$164.43
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$147.99 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Aetna Medicare |
$42.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.38
|
| Rate for Payer: BCBS Complete |
$32.72
|
| Rate for Payer: BCBS MAPPO |
$41.11
|
| Rate for Payer: BCBS Trust/PPO |
$127.84
|
| Rate for Payer: BCN Commercial |
$127.84
|
| Rate for Payer: BCN Medicare Advantage |
$41.11
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$141.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.11
|
| Rate for Payer: Healthscope Commercial |
$147.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.32
|
| Rate for Payer: Mclaren Medicaid |
$31.16
|
| Rate for Payer: Meridian Medicaid |
$32.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.77
|
| Rate for Payer: PACE Senior Care Partners |
$39.05
|
| Rate for Payer: PACE SWMI |
$41.11
|
| Rate for Payer: PHP Commercial |
$139.77
|
| Rate for Payer: PHP Medicare Advantage |
$41.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.05
|
| Rate for Payer: Priority Health Medicare |
$41.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.29
|
| Rate for Payer: Railroad Medicare Medicare |
$41.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.70
|
| Rate for Payer: UHC Core |
$137.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.11
|
| Rate for Payer: UHC Medicare Advantage |
$42.34
|
| Rate for Payer: VA VA |
$41.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.32
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
IP
|
$164.43
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.29 |
| Max. Negotiated Rate |
$147.99 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: BCBS Trust/PPO |
$127.07
|
| Rate for Payer: BCN Commercial |
$127.07
|
| Rate for Payer: Cash Price |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$141.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.54
|
| Rate for Payer: Healthscope Commercial |
$147.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.77
|
| Rate for Payer: PHP Commercial |
$139.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.70
|
| Rate for Payer: UHC Core |
$137.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.32
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
OP
|
$151.79
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna Medicare |
$39.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.43
|
| Rate for Payer: BCBS Complete |
$60.72
|
| Rate for Payer: BCBS MAPPO |
$37.95
|
| Rate for Payer: BCBS Trust/PPO |
$118.02
|
| Rate for Payer: BCN Commercial |
$118.02
|
| Rate for Payer: BCN Medicare Advantage |
$37.95
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.95
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.02
|
| Rate for Payer: PACE Senior Care Partners |
$36.05
|
| Rate for Payer: PACE SWMI |
$37.95
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: PHP Medicare Advantage |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.06
|
| Rate for Payer: Priority Health Medicare |
$37.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.58
|
| Rate for Payer: Railroad Medicare Medicare |
$37.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.58
|
| Rate for Payer: UHC Core |
$126.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.95
|
| Rate for Payer: UHC Medicare Advantage |
$39.09
|
| Rate for Payer: VA VA |
$37.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.84
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
IP
|
$151.79
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.58 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: BCBS Trust/PPO |
$117.30
|
| Rate for Payer: BCN Commercial |
$117.30
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.02
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.58
|
| Rate for Payer: UHC Core |
$126.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.84
|
|
