|
HC INJECTION FACET JOINT L OR S 1ST LEVEL BIL
|
Facility
|
OP
|
$2,525.86
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
36100629
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$445.31 |
| Max. Negotiated Rate |
$2,273.27 |
| Rate for Payer: Aetna Commercial |
$2,146.98
|
| Rate for Payer: Aetna Medicare |
$656.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$789.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$789.33
|
| Rate for Payer: BCBS Complete |
$467.54
|
| Rate for Payer: BCBS MAPPO |
$631.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.51
|
| Rate for Payer: BCN Commercial |
$2,076.51
|
| Rate for Payer: BCN Medicare Advantage |
$631.47
|
| Rate for Payer: Cash Price |
$2,020.69
|
| Rate for Payer: Cofinity Commercial |
$2,172.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,020.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$631.47
|
| Rate for Payer: Healthscope Commercial |
$2,273.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,894.39
|
| Rate for Payer: Mclaren Medicaid |
$445.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$663.04
|
| Rate for Payer: Meridian Medicaid |
$467.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$726.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$694.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,146.98
|
| Rate for Payer: Nomi Health Commercial |
$2,071.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,894.39
|
| Rate for Payer: PACE Senior Care Partners |
$599.89
|
| Rate for Payer: PACE SWMI |
$631.47
|
| Rate for Payer: PHP Commercial |
$2,146.98
|
| Rate for Payer: PHP Medicare Advantage |
$631.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,197.50
|
| Rate for Payer: Priority Health Medicare |
$637.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,758.00
|
| Rate for Payer: Railroad Medicare Medicare |
$631.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,222.76
|
| Rate for Payer: UHC Core |
$2,109.09
|
| Rate for Payer: UHC Exchange |
$631.47
|
| Rate for Payer: UHC Medicaid |
$445.31
|
| Rate for Payer: UHC Medicare Advantage |
$631.47
|
| Rate for Payer: UHCCP Medicaid |
$445.31
|
| Rate for Payer: VA VA |
$631.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,894.39
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
IP
|
$420.05
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.35 |
| Max. Negotiated Rate |
$378.05 |
| Rate for Payer: Aetna Commercial |
$357.04
|
| Rate for Payer: BCBS Trust/PPO |
$346.92
|
| Rate for Payer: BCN Commercial |
$346.92
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cofinity Commercial |
$361.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.04
|
| Rate for Payer: Healthscope Commercial |
$378.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.04
|
| Rate for Payer: Nomi Health Commercial |
$344.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.04
|
| Rate for Payer: PHP Commercial |
$357.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.64
|
| Rate for Payer: UHC Core |
$350.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.04
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL
|
Facility
|
OP
|
$420.05
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$74.05 |
| Max. Negotiated Rate |
$378.05 |
| Rate for Payer: Aetna Commercial |
$357.04
|
| Rate for Payer: Aetna Medicare |
$109.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.27
|
| Rate for Payer: BCBS Complete |
$77.75
|
| Rate for Payer: BCBS MAPPO |
$105.01
|
| Rate for Payer: BCBS Trust/PPO |
$345.32
|
| Rate for Payer: BCN Commercial |
$345.32
|
| Rate for Payer: BCN Medicare Advantage |
$105.01
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cofinity Commercial |
$361.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.01
|
| Rate for Payer: Healthscope Commercial |
$378.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.04
|
| Rate for Payer: Mclaren Medicaid |
$74.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.26
|
| Rate for Payer: Meridian Medicaid |
$77.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.04
|
| Rate for Payer: Nomi Health Commercial |
$344.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.04
|
| Rate for Payer: PACE Senior Care Partners |
$99.76
|
| Rate for Payer: PACE SWMI |
$105.01
|
| Rate for Payer: PHP Commercial |
$357.04
|
| Rate for Payer: PHP Medicare Advantage |
$105.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.44
|
| Rate for Payer: Priority Health Medicare |
$106.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.35
|
| Rate for Payer: Railroad Medicare Medicare |
$105.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.64
|
| Rate for Payer: UHC Core |
$350.74
|
| Rate for Payer: UHC Exchange |
$105.01
|
| Rate for Payer: UHC Medicaid |
$74.05
|
| Rate for Payer: UHC Medicare Advantage |
$105.01
|
| Rate for Payer: UHCCP Medicaid |
$74.05
|
| Rate for Payer: VA VA |
$105.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.04
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
IP
|
$630.06
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$438.52 |
| Max. Negotiated Rate |
$567.05 |
| Rate for Payer: Aetna Commercial |
$535.55
|
| Rate for Payer: BCBS Trust/PPO |
$520.37
|
| Rate for Payer: BCN Commercial |
$520.37
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cofinity Commercial |
$541.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.05
|
| Rate for Payer: Healthscope Commercial |
$567.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.55
|
| Rate for Payer: Nomi Health Commercial |
$516.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.55
|
| Rate for Payer: PHP Commercial |
$535.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$548.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.45
|
| Rate for Payer: UHC Core |
$526.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.55
|
|
|
HC INJECTION FACET JOINT L OR S 2ND LEVEL BIL
|
Facility
|
OP
|
$630.06
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
36100630
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.08 |
| Max. Negotiated Rate |
$567.05 |
| Rate for Payer: Aetna Commercial |
$535.55
|
| Rate for Payer: Aetna Medicare |
$163.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$196.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$196.89
|
| Rate for Payer: BCBS Complete |
$116.62
|
| Rate for Payer: BCBS MAPPO |
$157.51
|
| Rate for Payer: BCBS Trust/PPO |
$517.97
|
| Rate for Payer: BCN Commercial |
$517.97
|
| Rate for Payer: BCN Medicare Advantage |
$157.51
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cofinity Commercial |
$541.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.51
|
| Rate for Payer: Healthscope Commercial |
$567.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.55
|
| Rate for Payer: Mclaren Medicaid |
$111.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.39
|
| Rate for Payer: Meridian Medicaid |
$116.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$173.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.55
|
| Rate for Payer: Nomi Health Commercial |
$516.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.55
|
| Rate for Payer: PACE Senior Care Partners |
$149.64
|
| Rate for Payer: PACE SWMI |
$157.51
|
| Rate for Payer: PHP Commercial |
$535.55
|
| Rate for Payer: PHP Medicare Advantage |
$157.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$548.15
|
| Rate for Payer: Priority Health Medicare |
$159.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.52
|
| Rate for Payer: Railroad Medicare Medicare |
$157.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.45
|
| Rate for Payer: UHC Core |
$526.10
|
| Rate for Payer: UHC Exchange |
$157.51
|
| Rate for Payer: UHC Medicaid |
$111.08
|
| Rate for Payer: UHC Medicare Advantage |
$157.51
|
| Rate for Payer: UHCCP Medicaid |
$111.08
|
| Rate for Payer: VA VA |
$157.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.55
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
IP
|
$420.05
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.35 |
| Max. Negotiated Rate |
$378.05 |
| Rate for Payer: Aetna Commercial |
$357.04
|
| Rate for Payer: BCBS Trust/PPO |
$346.92
|
| Rate for Payer: BCN Commercial |
$346.92
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cofinity Commercial |
$361.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.04
|
| Rate for Payer: Healthscope Commercial |
$378.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.04
|
| Rate for Payer: Nomi Health Commercial |
$344.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.04
|
| Rate for Payer: PHP Commercial |
$357.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.64
|
| Rate for Payer: UHC Core |
$350.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.04
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LE
|
Facility
|
OP
|
$420.05
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$74.05 |
| Max. Negotiated Rate |
$378.05 |
| Rate for Payer: Aetna Commercial |
$357.04
|
| Rate for Payer: Aetna Medicare |
$109.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.27
|
| Rate for Payer: BCBS Complete |
$77.75
|
| Rate for Payer: BCBS MAPPO |
$105.01
|
| Rate for Payer: BCBS Trust/PPO |
$345.32
|
| Rate for Payer: BCN Commercial |
$345.32
|
| Rate for Payer: BCN Medicare Advantage |
$105.01
|
| Rate for Payer: Cash Price |
$336.04
|
| Rate for Payer: Cofinity Commercial |
$361.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.01
|
| Rate for Payer: Healthscope Commercial |
$378.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.04
|
| Rate for Payer: Mclaren Medicaid |
$74.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.26
|
| Rate for Payer: Meridian Medicaid |
$77.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.04
|
| Rate for Payer: Nomi Health Commercial |
$344.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.04
|
| Rate for Payer: PACE Senior Care Partners |
$99.76
|
| Rate for Payer: PACE SWMI |
$105.01
|
| Rate for Payer: PHP Commercial |
$357.04
|
| Rate for Payer: PHP Medicare Advantage |
$105.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.44
|
| Rate for Payer: Priority Health Medicare |
$106.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.35
|
| Rate for Payer: Railroad Medicare Medicare |
$105.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.64
|
| Rate for Payer: UHC Core |
$350.74
|
| Rate for Payer: UHC Exchange |
$105.01
|
| Rate for Payer: UHC Medicaid |
$74.05
|
| Rate for Payer: UHC Medicare Advantage |
$105.01
|
| Rate for Payer: UHCCP Medicaid |
$74.05
|
| Rate for Payer: VA VA |
$105.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.04
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
OP
|
$630.06
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$111.08 |
| Max. Negotiated Rate |
$567.05 |
| Rate for Payer: Aetna Commercial |
$535.55
|
| Rate for Payer: Aetna Medicare |
$163.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$196.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$196.89
|
| Rate for Payer: BCBS Complete |
$116.62
|
| Rate for Payer: BCBS MAPPO |
$157.51
|
| Rate for Payer: BCBS Trust/PPO |
$517.97
|
| Rate for Payer: BCN Commercial |
$517.97
|
| Rate for Payer: BCN Medicare Advantage |
$157.51
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cofinity Commercial |
$541.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.51
|
| Rate for Payer: Healthscope Commercial |
$567.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.55
|
| Rate for Payer: Mclaren Medicaid |
$111.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.39
|
| Rate for Payer: Meridian Medicaid |
$116.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$173.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.55
|
| Rate for Payer: Nomi Health Commercial |
$516.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.55
|
| Rate for Payer: PACE Senior Care Partners |
$149.64
|
| Rate for Payer: PACE SWMI |
$157.51
|
| Rate for Payer: PHP Commercial |
$535.55
|
| Rate for Payer: PHP Medicare Advantage |
$157.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$548.15
|
| Rate for Payer: Priority Health Medicare |
$159.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.52
|
| Rate for Payer: Railroad Medicare Medicare |
$157.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.45
|
| Rate for Payer: UHC Core |
$526.10
|
| Rate for Payer: UHC Exchange |
$157.51
|
| Rate for Payer: UHC Medicaid |
$111.08
|
| Rate for Payer: UHC Medicare Advantage |
$157.51
|
| Rate for Payer: UHCCP Medicaid |
$111.08
|
| Rate for Payer: VA VA |
$157.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.55
|
|
|
HC INJECTION FACET JOINT L OR S 3RD + LEVEL BIL
|
Facility
|
IP
|
$630.06
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
36100631
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$438.52 |
| Max. Negotiated Rate |
$567.05 |
| Rate for Payer: Aetna Commercial |
$535.55
|
| Rate for Payer: BCBS Trust/PPO |
$520.37
|
| Rate for Payer: BCN Commercial |
$520.37
|
| Rate for Payer: Cash Price |
$504.05
|
| Rate for Payer: Cofinity Commercial |
$541.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.05
|
| Rate for Payer: Healthscope Commercial |
$567.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.55
|
| Rate for Payer: Nomi Health Commercial |
$516.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.55
|
| Rate for Payer: PHP Commercial |
$535.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$548.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.45
|
| Rate for Payer: UHC Core |
$526.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.55
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
OP
|
$842.88
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.60 |
| Max. Negotiated Rate |
$758.59 |
| Rate for Payer: Aetna Commercial |
$716.45
|
| Rate for Payer: Aetna Medicare |
$219.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$263.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$263.40
|
| Rate for Payer: BCBS Complete |
$156.02
|
| Rate for Payer: BCBS MAPPO |
$210.72
|
| Rate for Payer: BCBS Trust/PPO |
$692.93
|
| Rate for Payer: BCN Commercial |
$692.93
|
| Rate for Payer: BCN Medicare Advantage |
$210.72
|
| Rate for Payer: Cash Price |
$674.30
|
| Rate for Payer: Cofinity Commercial |
$724.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.72
|
| Rate for Payer: Healthscope Commercial |
$758.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$632.16
|
| Rate for Payer: Mclaren Medicaid |
$148.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.26
|
| Rate for Payer: Meridian Medicaid |
$156.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$231.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.45
|
| Rate for Payer: Nomi Health Commercial |
$691.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$632.16
|
| Rate for Payer: PACE Senior Care Partners |
$200.18
|
| Rate for Payer: PACE SWMI |
$210.72
|
| Rate for Payer: PHP Commercial |
$716.45
|
| Rate for Payer: PHP Medicare Advantage |
$210.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$733.31
|
| Rate for Payer: Priority Health Medicare |
$212.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.64
|
| Rate for Payer: Railroad Medicare Medicare |
$210.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$741.73
|
| Rate for Payer: UHC Core |
$703.80
|
| Rate for Payer: UHC Exchange |
$210.72
|
| Rate for Payer: UHC Medicaid |
$148.60
|
| Rate for Payer: UHC Medicare Advantage |
$210.72
|
| Rate for Payer: UHCCP Medicaid |
$148.60
|
| Rate for Payer: VA VA |
$210.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$632.16
|
|
|
HC INJECTION FOR CEREBRAL SHUNT
|
Facility
|
IP
|
$842.88
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
36100270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$586.64 |
| Max. Negotiated Rate |
$758.59 |
| Rate for Payer: Aetna Commercial |
$716.45
|
| Rate for Payer: BCBS Trust/PPO |
$696.13
|
| Rate for Payer: BCN Commercial |
$696.13
|
| Rate for Payer: Cash Price |
$674.30
|
| Rate for Payer: Cofinity Commercial |
$724.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.30
|
| Rate for Payer: Healthscope Commercial |
$758.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$632.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.45
|
| Rate for Payer: Nomi Health Commercial |
$691.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$632.16
|
| Rate for Payer: PHP Commercial |
$716.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$733.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$741.73
|
| Rate for Payer: UHC Core |
$703.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$632.16
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$669.62
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$466.06 |
| Max. Negotiated Rate |
$602.66 |
| Rate for Payer: Aetna Commercial |
$569.18
|
| Rate for Payer: BCBS Trust/PPO |
$553.04
|
| Rate for Payer: BCN Commercial |
$553.04
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cofinity Commercial |
$575.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.70
|
| Rate for Payer: Healthscope Commercial |
$602.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.18
|
| Rate for Payer: Nomi Health Commercial |
$549.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$502.21
|
| Rate for Payer: PHP Commercial |
$569.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$582.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$466.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$589.27
|
| Rate for Payer: UHC Core |
$559.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.21
|
|
|
HC INJECTION FOR HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$669.62
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
36100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.05 |
| Max. Negotiated Rate |
$602.66 |
| Rate for Payer: Aetna Commercial |
$569.18
|
| Rate for Payer: Aetna Medicare |
$174.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.26
|
| Rate for Payer: BCBS Complete |
$123.95
|
| Rate for Payer: BCBS MAPPO |
$167.41
|
| Rate for Payer: BCBS Trust/PPO |
$550.49
|
| Rate for Payer: BCN Commercial |
$550.49
|
| Rate for Payer: BCN Medicare Advantage |
$167.41
|
| Rate for Payer: Cash Price |
$535.70
|
| Rate for Payer: Cofinity Commercial |
$575.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.41
|
| Rate for Payer: Healthscope Commercial |
$602.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.21
|
| Rate for Payer: Mclaren Medicaid |
$118.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.78
|
| Rate for Payer: Meridian Medicaid |
$123.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$184.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.18
|
| Rate for Payer: Nomi Health Commercial |
$549.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$502.21
|
| Rate for Payer: PACE Senior Care Partners |
$159.03
|
| Rate for Payer: PACE SWMI |
$167.41
|
| Rate for Payer: PHP Commercial |
$569.18
|
| Rate for Payer: PHP Medicare Advantage |
$167.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$582.57
|
| Rate for Payer: Priority Health Medicare |
$169.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$466.06
|
| Rate for Payer: Railroad Medicare Medicare |
$167.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$589.27
|
| Rate for Payer: UHC Core |
$559.13
|
| Rate for Payer: UHC Exchange |
$167.41
|
| Rate for Payer: UHC Medicaid |
$118.05
|
| Rate for Payer: UHC Medicare Advantage |
$167.41
|
| Rate for Payer: UHCCP Medicaid |
$118.05
|
| Rate for Payer: VA VA |
$167.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.21
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
OP
|
$1,335.42
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$235.43 |
| Max. Negotiated Rate |
$1,201.88 |
| Rate for Payer: Aetna Commercial |
$1,135.11
|
| Rate for Payer: Aetna Medicare |
$347.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$417.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$417.32
|
| Rate for Payer: BCBS Complete |
$247.19
|
| Rate for Payer: BCBS MAPPO |
$333.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,097.85
|
| Rate for Payer: BCN Commercial |
$1,097.85
|
| Rate for Payer: BCN Medicare Advantage |
$333.86
|
| Rate for Payer: Cash Price |
$1,068.34
|
| Rate for Payer: Cofinity Commercial |
$1,148.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,068.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$333.86
|
| Rate for Payer: Healthscope Commercial |
$1,201.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,001.57
|
| Rate for Payer: Mclaren Medicaid |
$235.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$350.55
|
| Rate for Payer: Meridian Medicaid |
$247.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$383.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$367.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,135.11
|
| Rate for Payer: Nomi Health Commercial |
$1,095.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,001.57
|
| Rate for Payer: PACE Senior Care Partners |
$317.16
|
| Rate for Payer: PACE SWMI |
$333.86
|
| Rate for Payer: PHP Commercial |
$1,135.11
|
| Rate for Payer: PHP Medicare Advantage |
$333.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,161.82
|
| Rate for Payer: Priority Health Medicare |
$337.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$929.45
|
| Rate for Payer: Railroad Medicare Medicare |
$333.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,175.17
|
| Rate for Payer: UHC Core |
$1,115.08
|
| Rate for Payer: UHC Exchange |
$333.86
|
| Rate for Payer: UHC Medicaid |
$235.43
|
| Rate for Payer: UHC Medicare Advantage |
$333.86
|
| Rate for Payer: UHCCP Medicaid |
$235.43
|
| Rate for Payer: VA VA |
$333.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,001.57
|
|
|
HC INJECTION HIP ARTHROGRAM
|
Facility
|
IP
|
$1,335.42
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100040
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$929.45 |
| Max. Negotiated Rate |
$1,201.88 |
| Rate for Payer: Aetna Commercial |
$1,135.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,102.92
|
| Rate for Payer: BCN Commercial |
$1,102.92
|
| Rate for Payer: Cash Price |
$1,068.34
|
| Rate for Payer: Cofinity Commercial |
$1,148.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,068.34
|
| Rate for Payer: Healthscope Commercial |
$1,201.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,001.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,135.11
|
| Rate for Payer: Nomi Health Commercial |
$1,095.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,001.57
|
| Rate for Payer: PHP Commercial |
$1,135.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,161.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$929.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,175.17
|
| Rate for Payer: UHC Core |
$1,115.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,001.57
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
IP
|
$1,238.30
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$861.86 |
| Max. Negotiated Rate |
$1,114.47 |
| Rate for Payer: Aetna Commercial |
$1,052.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,022.71
|
| Rate for Payer: BCN Commercial |
$1,022.71
|
| Rate for Payer: Cash Price |
$990.64
|
| Rate for Payer: Cofinity Commercial |
$1,064.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.64
|
| Rate for Payer: Healthscope Commercial |
$1,114.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.56
|
| Rate for Payer: Nomi Health Commercial |
$1,015.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.73
|
| Rate for Payer: PHP Commercial |
$1,052.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,077.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$861.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,089.70
|
| Rate for Payer: UHC Core |
$1,033.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.73
|
|
|
HC INJECTION HIP ARTHROGRAM BIL
|
Facility
|
OP
|
$1,238.30
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
36100041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.31 |
| Max. Negotiated Rate |
$1,114.47 |
| Rate for Payer: Aetna Commercial |
$1,052.56
|
| Rate for Payer: Aetna Medicare |
$321.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$386.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$386.97
|
| Rate for Payer: BCBS Complete |
$229.21
|
| Rate for Payer: BCBS MAPPO |
$309.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,018.01
|
| Rate for Payer: BCN Commercial |
$1,018.01
|
| Rate for Payer: BCN Medicare Advantage |
$309.57
|
| Rate for Payer: Cash Price |
$990.64
|
| Rate for Payer: Cofinity Commercial |
$1,064.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.57
|
| Rate for Payer: Healthscope Commercial |
$1,114.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.73
|
| Rate for Payer: Mclaren Medicaid |
$218.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.05
|
| Rate for Payer: Meridian Medicaid |
$229.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$340.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,052.56
|
| Rate for Payer: Nomi Health Commercial |
$1,015.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.73
|
| Rate for Payer: PACE Senior Care Partners |
$294.10
|
| Rate for Payer: PACE SWMI |
$309.57
|
| Rate for Payer: PHP Commercial |
$1,052.56
|
| Rate for Payer: PHP Medicare Advantage |
$309.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,077.32
|
| Rate for Payer: Priority Health Medicare |
$312.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$861.86
|
| Rate for Payer: Railroad Medicare Medicare |
$309.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,089.70
|
| Rate for Payer: UHC Core |
$1,033.98
|
| Rate for Payer: UHC Exchange |
$309.57
|
| Rate for Payer: UHC Medicaid |
$218.31
|
| Rate for Payer: UHC Medicare Advantage |
$309.57
|
| Rate for Payer: UHCCP Medicaid |
$218.31
|
| Rate for Payer: VA VA |
$309.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.73
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
OP
|
$150.05
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$135.04 |
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: Aetna Medicare |
$39.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.89
|
| Rate for Payer: BCBS Complete |
$27.77
|
| Rate for Payer: BCBS MAPPO |
$37.51
|
| Rate for Payer: BCBS Trust/PPO |
$123.36
|
| Rate for Payer: BCN Commercial |
$123.36
|
| Rate for Payer: BCN Medicare Advantage |
$37.51
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Commercial |
$129.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$135.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.54
|
| Rate for Payer: Mclaren Medicaid |
$26.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.39
|
| Rate for Payer: Meridian Medicaid |
$27.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Nomi Health Commercial |
$123.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: PACE Senior Care Partners |
$35.64
|
| Rate for Payer: PACE SWMI |
$37.51
|
| Rate for Payer: PHP Commercial |
$127.54
|
| Rate for Payer: PHP Medicare Advantage |
$37.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.54
|
| Rate for Payer: Priority Health Medicare |
$37.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.43
|
| Rate for Payer: Railroad Medicare Medicare |
$37.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.04
|
| Rate for Payer: UHC Core |
$125.29
|
| Rate for Payer: UHC Exchange |
$37.51
|
| Rate for Payer: UHC Medicaid |
$26.45
|
| Rate for Payer: UHC Medicare Advantage |
$37.51
|
| Rate for Payer: UHCCP Medicaid |
$26.45
|
| Rate for Payer: VA VA |
$37.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.54
|
|
|
HC INJECTION INTRALESIONAL UP TO 7 LESIONS
|
Facility
|
IP
|
$150.05
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
76100134
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.43 |
| Max. Negotiated Rate |
$135.04 |
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: BCBS Trust/PPO |
$123.93
|
| Rate for Payer: BCN Commercial |
$123.93
|
| Rate for Payer: Cash Price |
$120.04
|
| Rate for Payer: Cofinity Commercial |
$129.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.04
|
| Rate for Payer: Healthscope Commercial |
$135.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.54
|
| Rate for Payer: Nomi Health Commercial |
$123.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.54
|
| Rate for Payer: PHP Commercial |
$127.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.04
|
| Rate for Payer: UHC Core |
$125.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.54
|
|
|
HC INJECTION, IRON DEXTRAN, 50 MG
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
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, IRON DEXTRAN, 50 MG
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT J1750
|
| Hospital Charge Code |
63600097
|
|
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
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$17.53
|
| Rate for Payer: BCN Commercial |
$17.53
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.68
|
| Rate for Payer: UHC Core |
$17.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT J1885
|
| Hospital Charge Code |
63600098
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$5.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.63
|
| Rate for Payer: BCBS Complete |
$3.93
|
| Rate for Payer: BCBS MAPPO |
$5.31
|
| Rate for Payer: BCBS Trust/PPO |
$17.45
|
| Rate for Payer: BCN Commercial |
$17.45
|
| Rate for Payer: BCN Medicare Advantage |
$5.31
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.31
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Mclaren Medicaid |
$3.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.57
|
| Rate for Payer: Meridian Medicaid |
$3.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Senior Care Partners |
$5.04
|
| Rate for Payer: PACE SWMI |
$5.31
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.47
|
| Rate for Payer: Priority Health Medicare |
$5.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.68
|
| Rate for Payer: UHC Core |
$17.73
|
| Rate for Payer: UHC Exchange |
$5.31
|
| Rate for Payer: UHC Medicaid |
$3.74
|
| Rate for Payer: UHC Medicare Advantage |
$5.31
|
| Rate for Payer: UHCCP Medicaid |
$3.74
|
| Rate for Payer: VA VA |
$5.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: Aetna Medicare |
$12.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.59
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS MAPPO |
$11.68
|
| Rate for Payer: BCBS Trust/PPO |
$38.39
|
| Rate for Payer: BCN Commercial |
$38.39
|
| Rate for Payer: BCN Medicare Advantage |
$11.68
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.68
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.02
|
| Rate for Payer: Mclaren Medicaid |
$8.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.26
|
| Rate for Payer: Meridian Medicaid |
$8.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PACE Senior Care Partners |
$11.09
|
| Rate for Payer: PACE SWMI |
$11.68
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: PHP Medicare Advantage |
$11.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.63
|
| Rate for Payer: Priority Health Medicare |
$11.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.50
|
| Rate for Payer: Railroad Medicare Medicare |
$11.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.10
|
| Rate for Payer: UHC Core |
$38.99
|
| Rate for Payer: UHC Exchange |
$11.68
|
| Rate for Payer: UHC Medicaid |
$8.23
|
| Rate for Payer: UHC Medicare Advantage |
$11.68
|
| Rate for Payer: UHCCP Medicaid |
$8.23
|
| Rate for Payer: VA VA |
$11.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.02
|
|
|
HC INJECTION, LINCOMYCIN HCL, UP TO 300 MG
|
Facility
|
IP
|
$46.70
|
|
|
Service Code
|
CPT J2010
|
| Hospital Charge Code |
63600099
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: BCBS Trust/PPO |
$38.57
|
| Rate for Payer: BCN Commercial |
$38.57
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.10
|
| Rate for Payer: UHC Core |
$38.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.02
|
|
