|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
IP
|
$1,125.53
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$783.37 |
| Max. Negotiated Rate |
$1,012.98 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: BCBS Trust/PPO |
$929.58
|
| Rate for Payer: BCN Commercial |
$929.58
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Commercial |
$967.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Healthscope Commercial |
$1,012.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$844.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$922.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PHP Commercial |
$956.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$979.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.47
|
| Rate for Payer: UHC Core |
$939.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$844.15
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
OP
|
$1,125.53
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$198.43 |
| Max. Negotiated Rate |
$1,012.98 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna Medicare |
$292.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$351.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$351.73
|
| Rate for Payer: BCBS Complete |
$208.34
|
| Rate for Payer: BCBS MAPPO |
$281.38
|
| Rate for Payer: BCBS Trust/PPO |
$925.30
|
| Rate for Payer: BCN Commercial |
$925.30
|
| Rate for Payer: BCN Medicare Advantage |
$281.38
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Commercial |
$967.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.38
|
| Rate for Payer: Healthscope Commercial |
$1,012.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$844.15
|
| Rate for Payer: Mclaren Medicaid |
$198.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$295.45
|
| Rate for Payer: Meridian Medicaid |
$208.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$309.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$922.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PACE Senior Care Partners |
$267.31
|
| Rate for Payer: PACE SWMI |
$281.38
|
| Rate for Payer: PHP Commercial |
$956.70
|
| Rate for Payer: PHP Medicare Advantage |
$281.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$979.21
|
| Rate for Payer: Priority Health Medicare |
$284.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.37
|
| Rate for Payer: Railroad Medicare Medicare |
$281.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.47
|
| Rate for Payer: UHC Core |
$939.82
|
| Rate for Payer: UHC Exchange |
$281.38
|
| Rate for Payer: UHC Medicaid |
$198.43
|
| Rate for Payer: UHC Medicare Advantage |
$281.38
|
| Rate for Payer: UHCCP Medicaid |
$198.43
|
| Rate for Payer: VA VA |
$281.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$844.15
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
IP
|
$1,125.53
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$783.37 |
| Max. Negotiated Rate |
$1,012.98 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: BCBS Trust/PPO |
$929.58
|
| Rate for Payer: BCN Commercial |
$929.58
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Commercial |
$967.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Healthscope Commercial |
$1,012.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$844.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$922.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PHP Commercial |
$956.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$979.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.47
|
| Rate for Payer: UHC Core |
$939.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$844.15
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
OP
|
$1,125.53
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$198.43 |
| Max. Negotiated Rate |
$1,012.98 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna Medicare |
$292.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$351.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$351.73
|
| Rate for Payer: BCBS Complete |
$208.34
|
| Rate for Payer: BCBS MAPPO |
$281.38
|
| Rate for Payer: BCBS Trust/PPO |
$925.30
|
| Rate for Payer: BCN Commercial |
$925.30
|
| Rate for Payer: BCN Medicare Advantage |
$281.38
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Commercial |
$967.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.38
|
| Rate for Payer: Healthscope Commercial |
$1,012.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$844.15
|
| Rate for Payer: Mclaren Medicaid |
$198.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$295.45
|
| Rate for Payer: Meridian Medicaid |
$208.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$309.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$922.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PACE Senior Care Partners |
$267.31
|
| Rate for Payer: PACE SWMI |
$281.38
|
| Rate for Payer: PHP Commercial |
$956.70
|
| Rate for Payer: PHP Medicare Advantage |
$281.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$979.21
|
| Rate for Payer: Priority Health Medicare |
$284.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.37
|
| Rate for Payer: Railroad Medicare Medicare |
$281.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.47
|
| Rate for Payer: UHC Core |
$939.82
|
| Rate for Payer: UHC Exchange |
$281.38
|
| Rate for Payer: UHC Medicaid |
$198.43
|
| Rate for Payer: UHC Medicare Advantage |
$281.38
|
| Rate for Payer: UHCCP Medicaid |
$198.43
|
| Rate for Payer: VA VA |
$281.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$844.15
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
IP
|
$1,125.53
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$783.37 |
| Max. Negotiated Rate |
$1,012.98 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: BCBS Trust/PPO |
$929.58
|
| Rate for Payer: BCN Commercial |
$929.58
|
| Rate for Payer: Cash Price |
$900.42
|
| Rate for Payer: Cofinity Commercial |
$967.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.42
|
| Rate for Payer: Healthscope Commercial |
$1,012.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$844.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.70
|
| Rate for Payer: Nomi Health Commercial |
$922.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$844.15
|
| Rate for Payer: PHP Commercial |
$956.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$979.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$783.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.47
|
| Rate for Payer: UHC Core |
$939.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$844.15
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: BCBS Trust/PPO |
$55.86
|
| Rate for Payer: BCN Commercial |
$55.86
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.51
|
| Rate for Payer: UHC Core |
$56.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$17.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.13
|
| Rate for Payer: BCBS Complete |
$12.52
|
| Rate for Payer: BCBS MAPPO |
$16.91
|
| Rate for Payer: BCBS Trust/PPO |
$55.60
|
| Rate for Payer: BCN Commercial |
$55.60
|
| Rate for Payer: BCN Medicare Advantage |
$16.91
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Mclaren Medicaid |
$11.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.75
|
| Rate for Payer: Meridian Medicaid |
$12.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Senior Care Partners |
$16.06
|
| Rate for Payer: PACE SWMI |
$16.91
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$16.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.84
|
| Rate for Payer: Priority Health Medicare |
$17.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.07
|
| Rate for Payer: Railroad Medicare Medicare |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.51
|
| Rate for Payer: UHC Core |
$56.47
|
| Rate for Payer: UHC Exchange |
$16.91
|
| Rate for Payer: UHC Medicaid |
$11.92
|
| Rate for Payer: UHC Medicare Advantage |
$16.91
|
| Rate for Payer: UHCCP Medicaid |
$11.92
|
| Rate for Payer: VA VA |
$16.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
IP
|
$368.24
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.30 |
| Max. Negotiated Rate |
$331.42 |
| Rate for Payer: Aetna Commercial |
$313.00
|
| Rate for Payer: BCBS Trust/PPO |
$304.13
|
| Rate for Payer: BCN Commercial |
$304.13
|
| Rate for Payer: Cash Price |
$294.59
|
| Rate for Payer: Cofinity Commercial |
$316.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.59
|
| Rate for Payer: Healthscope Commercial |
$331.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.00
|
| Rate for Payer: Nomi Health Commercial |
$301.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.18
|
| Rate for Payer: PHP Commercial |
$313.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$320.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.05
|
| Rate for Payer: UHC Core |
$307.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.18
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
OP
|
$368.24
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.92 |
| Max. Negotiated Rate |
$331.42 |
| Rate for Payer: Aetna Commercial |
$313.00
|
| Rate for Payer: Aetna Medicare |
$95.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.08
|
| Rate for Payer: BCBS Complete |
$68.16
|
| Rate for Payer: BCBS MAPPO |
$92.06
|
| Rate for Payer: BCBS Trust/PPO |
$302.73
|
| Rate for Payer: BCN Commercial |
$302.73
|
| Rate for Payer: BCN Medicare Advantage |
$92.06
|
| Rate for Payer: Cash Price |
$294.59
|
| Rate for Payer: Cofinity Commercial |
$316.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.06
|
| Rate for Payer: Healthscope Commercial |
$331.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.18
|
| Rate for Payer: Mclaren Medicaid |
$64.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.66
|
| Rate for Payer: Meridian Medicaid |
$68.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.00
|
| Rate for Payer: Nomi Health Commercial |
$301.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.18
|
| Rate for Payer: PACE Senior Care Partners |
$87.46
|
| Rate for Payer: PACE SWMI |
$92.06
|
| Rate for Payer: PHP Commercial |
$313.00
|
| Rate for Payer: PHP Medicare Advantage |
$92.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$320.37
|
| Rate for Payer: Priority Health Medicare |
$92.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.30
|
| Rate for Payer: Railroad Medicare Medicare |
$92.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.05
|
| Rate for Payer: UHC Core |
$307.48
|
| Rate for Payer: UHC Exchange |
$92.06
|
| Rate for Payer: UHC Medicaid |
$64.92
|
| Rate for Payer: UHC Medicare Advantage |
$92.06
|
| Rate for Payer: UHCCP Medicaid |
$64.92
|
| Rate for Payer: VA VA |
$92.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.18
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
IP
|
$11.22
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Aetna Commercial |
$9.54
|
| Rate for Payer: BCBS Trust/PPO |
$9.27
|
| Rate for Payer: BCN Commercial |
$9.27
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cofinity Commercial |
$9.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.98
|
| Rate for Payer: Healthscope Commercial |
$10.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.54
|
| Rate for Payer: Nomi Health Commercial |
$9.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.41
|
| Rate for Payer: PHP Commercial |
$9.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.87
|
| Rate for Payer: UHC Core |
$9.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.41
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
OP
|
$11.22
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$10.10 |
| Rate for Payer: Aetna Commercial |
$9.54
|
| Rate for Payer: Aetna Medicare |
$2.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.51
|
| Rate for Payer: BCBS Complete |
$2.08
|
| Rate for Payer: BCBS MAPPO |
$2.81
|
| Rate for Payer: BCBS Trust/PPO |
$9.22
|
| Rate for Payer: BCN Commercial |
$9.22
|
| Rate for Payer: BCN Medicare Advantage |
$2.81
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Cofinity Commercial |
$9.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.81
|
| Rate for Payer: Healthscope Commercial |
$10.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.41
|
| Rate for Payer: Mclaren Medicaid |
$1.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.95
|
| Rate for Payer: Meridian Medicaid |
$2.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.54
|
| Rate for Payer: Nomi Health Commercial |
$9.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.41
|
| Rate for Payer: PACE Senior Care Partners |
$2.66
|
| Rate for Payer: PACE SWMI |
$2.81
|
| Rate for Payer: PHP Commercial |
$9.54
|
| Rate for Payer: PHP Medicare Advantage |
$2.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.76
|
| Rate for Payer: Priority Health Medicare |
$2.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.87
|
| Rate for Payer: UHC Core |
$9.37
|
| Rate for Payer: UHC Exchange |
$2.81
|
| Rate for Payer: UHC Medicaid |
$1.98
|
| Rate for Payer: UHC Medicare Advantage |
$2.81
|
| Rate for Payer: UHCCP Medicaid |
$1.98
|
| Rate for Payer: VA VA |
$2.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.41
|
|
|
HC INJ, DENOSUMAB-BMWO, 1 MG
|
Facility
|
IP
|
$24.17
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
63600286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: BCBS Trust/PPO |
$19.96
|
| Rate for Payer: BCN Commercial |
$19.96
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: Nomi Health Commercial |
$19.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.13
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.27
|
| Rate for Payer: UHC Core |
$20.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.13
|
|
|
HC INJ, DENOSUMAB-BMWO, 1 MG
|
Facility
|
OP
|
$24.17
|
|
|
Service Code
|
HCPCS Q5157
|
| Hospital Charge Code |
63600286
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Medicare |
$6.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.55
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS MAPPO |
$6.04
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$19.87
|
| Rate for Payer: BCN Medicare Advantage |
$6.04
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.04
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.13
|
| Rate for Payer: Mclaren Medicaid |
$4.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.34
|
| Rate for Payer: Meridian Medicaid |
$4.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: Nomi Health Commercial |
$19.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.13
|
| Rate for Payer: PACE Senior Care Partners |
$5.74
|
| Rate for Payer: PACE SWMI |
$6.04
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.03
|
| Rate for Payer: Priority Health Medicare |
$6.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.82
|
| Rate for Payer: Railroad Medicare Medicare |
$6.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.27
|
| Rate for Payer: UHC Core |
$20.18
|
| Rate for Payer: UHC Exchange |
$6.04
|
| Rate for Payer: UHC Medicaid |
$4.26
|
| Rate for Payer: UHC Medicare Advantage |
$6.04
|
| Rate for Payer: UHCCP Medicaid |
$4.26
|
| Rate for Payer: VA VA |
$6.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.13
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$893.87
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.59 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$759.79
|
| Rate for Payer: Aetna Medicare |
$232.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$279.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$279.33
|
| Rate for Payer: BCBS Complete |
$165.46
|
| Rate for Payer: BCBS MAPPO |
$223.47
|
| Rate for Payer: BCBS Trust/PPO |
$734.85
|
| Rate for Payer: BCN Commercial |
$734.85
|
| Rate for Payer: BCN Medicare Advantage |
$223.47
|
| Rate for Payer: Cash Price |
$715.10
|
| Rate for Payer: Cofinity Commercial |
$768.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.47
|
| Rate for Payer: Healthscope Commercial |
$804.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.40
|
| Rate for Payer: Mclaren Medicaid |
$157.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.64
|
| Rate for Payer: Meridian Medicaid |
$165.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$245.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.79
|
| Rate for Payer: Nomi Health Commercial |
$732.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.40
|
| Rate for Payer: PACE Senior Care Partners |
$212.29
|
| Rate for Payer: PACE SWMI |
$223.47
|
| Rate for Payer: PHP Commercial |
$759.79
|
| Rate for Payer: PHP Medicare Advantage |
$223.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$777.67
|
| Rate for Payer: Priority Health Medicare |
$225.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$622.13
|
| Rate for Payer: Railroad Medicare Medicare |
$223.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$786.61
|
| Rate for Payer: UHC Core |
$746.38
|
| Rate for Payer: UHC Exchange |
$223.47
|
| Rate for Payer: UHC Medicaid |
$157.59
|
| Rate for Payer: UHC Medicare Advantage |
$223.47
|
| Rate for Payer: UHCCP Medicaid |
$157.59
|
| Rate for Payer: VA VA |
$223.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.40
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$893.87
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$622.13 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$759.79
|
| Rate for Payer: BCBS Trust/PPO |
$738.25
|
| Rate for Payer: BCN Commercial |
$738.25
|
| Rate for Payer: Cash Price |
$715.10
|
| Rate for Payer: Cofinity Commercial |
$768.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.10
|
| Rate for Payer: Healthscope Commercial |
$804.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.79
|
| Rate for Payer: Nomi Health Commercial |
$732.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.40
|
| Rate for Payer: PHP Commercial |
$759.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$777.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$622.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$786.61
|
| Rate for Payer: UHC Core |
$746.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.40
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$966.17
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.34 |
| Max. Negotiated Rate |
$869.55 |
| Rate for Payer: Aetna Commercial |
$821.24
|
| Rate for Payer: Aetna Medicare |
$251.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$301.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$301.93
|
| Rate for Payer: BCBS Complete |
$178.84
|
| Rate for Payer: BCBS MAPPO |
$241.54
|
| Rate for Payer: BCBS Trust/PPO |
$794.29
|
| Rate for Payer: BCN Commercial |
$794.29
|
| Rate for Payer: BCN Medicare Advantage |
$241.54
|
| Rate for Payer: Cash Price |
$772.94
|
| Rate for Payer: Cofinity Commercial |
$830.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.54
|
| Rate for Payer: Healthscope Commercial |
$869.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$724.63
|
| Rate for Payer: Mclaren Medicaid |
$170.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.62
|
| Rate for Payer: Meridian Medicaid |
$178.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.24
|
| Rate for Payer: Nomi Health Commercial |
$792.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$724.63
|
| Rate for Payer: PACE Senior Care Partners |
$229.47
|
| Rate for Payer: PACE SWMI |
$241.54
|
| Rate for Payer: PHP Commercial |
$821.24
|
| Rate for Payer: PHP Medicare Advantage |
$241.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$840.57
|
| Rate for Payer: Priority Health Medicare |
$243.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$672.45
|
| Rate for Payer: Railroad Medicare Medicare |
$241.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$850.23
|
| Rate for Payer: UHC Core |
$806.75
|
| Rate for Payer: UHC Exchange |
$241.54
|
| Rate for Payer: UHC Medicaid |
$170.34
|
| Rate for Payer: UHC Medicare Advantage |
$241.54
|
| Rate for Payer: UHCCP Medicaid |
$170.34
|
| Rate for Payer: VA VA |
$241.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$724.63
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$966.17
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$672.45 |
| Max. Negotiated Rate |
$869.55 |
| Rate for Payer: Aetna Commercial |
$821.24
|
| Rate for Payer: BCBS Trust/PPO |
$797.96
|
| Rate for Payer: BCN Commercial |
$797.96
|
| Rate for Payer: Cash Price |
$772.94
|
| Rate for Payer: Cofinity Commercial |
$830.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.94
|
| Rate for Payer: Healthscope Commercial |
$869.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$724.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$821.24
|
| Rate for Payer: Nomi Health Commercial |
$792.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$724.63
|
| Rate for Payer: PHP Commercial |
$821.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$840.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$672.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$850.23
|
| Rate for Payer: UHC Core |
$806.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$724.63
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$393.93
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.45 |
| Max. Negotiated Rate |
$354.54 |
| Rate for Payer: Aetna Commercial |
$334.84
|
| Rate for Payer: Aetna Medicare |
$102.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.10
|
| Rate for Payer: BCBS Complete |
$72.92
|
| Rate for Payer: BCBS MAPPO |
$98.48
|
| Rate for Payer: BCBS Trust/PPO |
$323.85
|
| Rate for Payer: BCN Commercial |
$323.85
|
| Rate for Payer: BCN Medicare Advantage |
$98.48
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Commercial |
$338.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.48
|
| Rate for Payer: Healthscope Commercial |
$354.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.45
|
| Rate for Payer: Mclaren Medicaid |
$69.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.41
|
| Rate for Payer: Meridian Medicaid |
$72.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$108.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$323.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PACE Senior Care Partners |
$93.56
|
| Rate for Payer: PACE SWMI |
$98.48
|
| Rate for Payer: PHP Commercial |
$334.84
|
| Rate for Payer: PHP Medicare Advantage |
$98.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$342.72
|
| Rate for Payer: Priority Health Medicare |
$99.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.18
|
| Rate for Payer: Railroad Medicare Medicare |
$98.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.66
|
| Rate for Payer: UHC Core |
$328.93
|
| Rate for Payer: UHC Exchange |
$98.48
|
| Rate for Payer: UHC Medicaid |
$69.45
|
| Rate for Payer: UHC Medicare Advantage |
$98.48
|
| Rate for Payer: UHCCP Medicaid |
$69.45
|
| Rate for Payer: VA VA |
$98.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.45
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$393.93
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.18 |
| Max. Negotiated Rate |
$354.54 |
| Rate for Payer: Aetna Commercial |
$334.84
|
| Rate for Payer: BCBS Trust/PPO |
$325.35
|
| Rate for Payer: BCN Commercial |
$325.35
|
| Rate for Payer: Cash Price |
$315.14
|
| Rate for Payer: Cofinity Commercial |
$338.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.14
|
| Rate for Payer: Healthscope Commercial |
$354.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.84
|
| Rate for Payer: Nomi Health Commercial |
$323.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.45
|
| Rate for Payer: PHP Commercial |
$334.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$342.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.66
|
| Rate for Payer: UHC Core |
$328.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.45
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
OP
|
$1,186.06
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.10 |
| Max. Negotiated Rate |
$1,067.45 |
| Rate for Payer: Aetna Commercial |
$1,008.15
|
| Rate for Payer: Aetna Commercial |
$672.10
|
| Rate for Payer: Aetna Medicare |
$205.58
|
| Rate for Payer: Aetna Medicare |
$308.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.09
|
| Rate for Payer: BCBS Complete |
$219.54
|
| Rate for Payer: BCBS Complete |
$146.36
|
| Rate for Payer: BCBS MAPPO |
$296.51
|
| Rate for Payer: BCBS MAPPO |
$197.68
|
| Rate for Payer: BCBS Trust/PPO |
$975.06
|
| Rate for Payer: BCBS Trust/PPO |
$650.03
|
| Rate for Payer: BCN Commercial |
$650.03
|
| Rate for Payer: BCN Commercial |
$975.06
|
| Rate for Payer: BCN Medicare Advantage |
$197.68
|
| Rate for Payer: BCN Medicare Advantage |
$296.51
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cofinity Commercial |
$1,020.01
|
| Rate for Payer: Cofinity Commercial |
$680.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.51
|
| Rate for Payer: Healthscope Commercial |
$1,067.45
|
| Rate for Payer: Healthscope Commercial |
$711.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$889.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.02
|
| Rate for Payer: Mclaren Medicaid |
$139.40
|
| Rate for Payer: Mclaren Medicaid |
$209.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.34
|
| Rate for Payer: Meridian Medicaid |
$219.54
|
| Rate for Payer: Meridian Medicaid |
$146.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$217.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$326.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.15
|
| Rate for Payer: Nomi Health Commercial |
$648.37
|
| Rate for Payer: Nomi Health Commercial |
$972.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.02
|
| Rate for Payer: PACE Senior Care Partners |
$187.79
|
| Rate for Payer: PACE Senior Care Partners |
$281.69
|
| Rate for Payer: PACE SWMI |
$197.68
|
| Rate for Payer: PACE SWMI |
$296.51
|
| Rate for Payer: PHP Commercial |
$1,008.15
|
| Rate for Payer: PHP Commercial |
$672.10
|
| Rate for Payer: PHP Medicare Advantage |
$296.51
|
| Rate for Payer: PHP Medicare Advantage |
$197.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$687.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,031.87
|
| Rate for Payer: Priority Health Medicare |
$199.65
|
| Rate for Payer: Priority Health Medicare |
$299.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$825.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$550.33
|
| Rate for Payer: Railroad Medicare Medicare |
$296.51
|
| Rate for Payer: Railroad Medicare Medicare |
$197.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,043.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.82
|
| Rate for Payer: UHC Core |
$660.23
|
| Rate for Payer: UHC Core |
$990.36
|
| Rate for Payer: UHC Exchange |
$197.68
|
| Rate for Payer: UHC Exchange |
$296.51
|
| Rate for Payer: UHC Medicaid |
$139.40
|
| Rate for Payer: UHC Medicaid |
$209.10
|
| Rate for Payer: UHC Medicare Advantage |
$296.51
|
| Rate for Payer: UHC Medicare Advantage |
$197.68
|
| Rate for Payer: UHCCP Medicaid |
$209.10
|
| Rate for Payer: UHCCP Medicaid |
$139.40
|
| Rate for Payer: VA VA |
$296.51
|
| Rate for Payer: VA VA |
$197.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$889.54
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
IP
|
$1,186.06
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$825.50 |
| Max. Negotiated Rate |
$1,067.45 |
| Rate for Payer: Aetna Commercial |
$1,008.15
|
| Rate for Payer: Aetna Commercial |
$672.10
|
| Rate for Payer: BCBS Trust/PPO |
$979.57
|
| Rate for Payer: BCBS Trust/PPO |
$653.04
|
| Rate for Payer: BCN Commercial |
$979.57
|
| Rate for Payer: BCN Commercial |
$653.04
|
| Rate for Payer: Cash Price |
$948.85
|
| Rate for Payer: Cash Price |
$632.56
|
| Rate for Payer: Cofinity Commercial |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$1,020.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$632.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.85
|
| Rate for Payer: Healthscope Commercial |
$1,067.45
|
| Rate for Payer: Healthscope Commercial |
$711.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$889.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.10
|
| Rate for Payer: Nomi Health Commercial |
$972.57
|
| Rate for Payer: Nomi Health Commercial |
$648.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.02
|
| Rate for Payer: PHP Commercial |
$672.10
|
| Rate for Payer: PHP Commercial |
$1,008.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$687.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,031.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$825.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$550.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,043.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.82
|
| Rate for Payer: UHC Core |
$990.36
|
| Rate for Payer: UHC Core |
$660.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$889.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.02
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
OP
|
$3,183.62
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$561.27 |
| Max. Negotiated Rate |
$2,865.26 |
| Rate for Payer: Aetna Commercial |
$2,706.08
|
| Rate for Payer: Aetna Medicare |
$827.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$994.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$994.88
|
| Rate for Payer: BCBS Complete |
$589.29
|
| Rate for Payer: BCBS MAPPO |
$795.90
|
| Rate for Payer: BCBS Trust/PPO |
$2,617.25
|
| Rate for Payer: BCN Commercial |
$2,617.25
|
| Rate for Payer: BCN Medicare Advantage |
$795.90
|
| Rate for Payer: Cash Price |
$2,546.90
|
| Rate for Payer: Cofinity Commercial |
$2,737.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,546.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$795.90
|
| Rate for Payer: Healthscope Commercial |
$2,865.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,387.72
|
| Rate for Payer: Mclaren Medicaid |
$561.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$835.70
|
| Rate for Payer: Meridian Medicaid |
$589.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$915.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$875.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,706.08
|
| Rate for Payer: Nomi Health Commercial |
$2,610.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,387.72
|
| Rate for Payer: PACE Senior Care Partners |
$756.11
|
| Rate for Payer: PACE SWMI |
$795.90
|
| Rate for Payer: PHP Commercial |
$2,706.08
|
| Rate for Payer: PHP Medicare Advantage |
$795.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$561.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,769.75
|
| Rate for Payer: Priority Health Medicare |
$803.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,215.80
|
| Rate for Payer: Railroad Medicare Medicare |
$795.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,801.59
|
| Rate for Payer: UHC Core |
$2,658.32
|
| Rate for Payer: UHC Exchange |
$795.90
|
| Rate for Payer: UHC Medicaid |
$561.27
|
| Rate for Payer: UHC Medicare Advantage |
$795.90
|
| Rate for Payer: UHCCP Medicaid |
$561.27
|
| Rate for Payer: VA VA |
$795.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,387.72
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
IP
|
$3,183.62
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,215.80 |
| Max. Negotiated Rate |
$2,865.26 |
| Rate for Payer: Aetna Commercial |
$2,706.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,629.35
|
| Rate for Payer: BCN Commercial |
$2,629.35
|
| Rate for Payer: Cash Price |
$2,546.90
|
| Rate for Payer: Cofinity Commercial |
$2,737.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,546.90
|
| Rate for Payer: Healthscope Commercial |
$2,865.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,387.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,706.08
|
| Rate for Payer: Nomi Health Commercial |
$2,610.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,387.72
|
| Rate for Payer: PHP Commercial |
$2,706.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,769.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,215.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,801.59
|
| Rate for Payer: UHC Core |
$2,658.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,387.72
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.90
|
| Rate for Payer: BCBS Complete |
$11.79
|
| Rate for Payer: BCBS MAPPO |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$52.34
|
| Rate for Payer: BCN Commercial |
$52.34
|
| Rate for Payer: BCN Medicare Advantage |
$15.92
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$11.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.71
|
| Rate for Payer: Meridian Medicaid |
$11.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Senior Care Partners |
$15.12
|
| Rate for Payer: PACE SWMI |
$15.92
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: PHP Medicare Advantage |
$15.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.39
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.31
|
| Rate for Payer: Railroad Medicare Medicare |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.03
|
| Rate for Payer: UHC Core |
$53.16
|
| Rate for Payer: UHC Exchange |
$15.92
|
| Rate for Payer: UHC Medicaid |
$11.23
|
| Rate for Payer: UHC Medicare Advantage |
$15.92
|
| Rate for Payer: UHCCP Medicaid |
$11.23
|
| Rate for Payer: VA VA |
$15.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.75
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.31 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: BCBS Trust/PPO |
$52.59
|
| Rate for Payer: BCN Commercial |
$52.59
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.03
|
| Rate for Payer: UHC Core |
$53.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.75
|
|
