|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
OP
|
$2,396.52
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$422.51 |
| Max. Negotiated Rate |
$2,156.87 |
| Rate for Payer: Aetna Commercial |
$2,037.04
|
| Rate for Payer: Aetna Medicare |
$623.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$748.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$748.91
|
| Rate for Payer: BCBS Complete |
$443.60
|
| Rate for Payer: BCBS MAPPO |
$599.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,970.18
|
| Rate for Payer: BCN Commercial |
$1,970.18
|
| Rate for Payer: BCN Medicare Advantage |
$599.13
|
| Rate for Payer: Cash Price |
$1,917.22
|
| Rate for Payer: Cofinity Commercial |
$2,061.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.13
|
| Rate for Payer: Healthscope Commercial |
$2,156.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,797.39
|
| Rate for Payer: Mclaren Medicaid |
$422.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.09
|
| Rate for Payer: Meridian Medicaid |
$443.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$659.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.04
|
| Rate for Payer: Nomi Health Commercial |
$1,965.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,797.39
|
| Rate for Payer: PACE Senior Care Partners |
$569.17
|
| Rate for Payer: PACE SWMI |
$599.13
|
| Rate for Payer: PHP Commercial |
$2,037.04
|
| Rate for Payer: PHP Medicare Advantage |
$599.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$422.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,084.97
|
| Rate for Payer: Priority Health Medicare |
$605.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,667.98
|
| Rate for Payer: Railroad Medicare Medicare |
$599.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,108.94
|
| Rate for Payer: UHC Core |
$2,001.09
|
| Rate for Payer: UHC Exchange |
$599.13
|
| Rate for Payer: UHC Medicaid |
$422.51
|
| Rate for Payer: UHC Medicare Advantage |
$599.13
|
| Rate for Payer: UHCCP Medicaid |
$422.51
|
| Rate for Payer: VA VA |
$599.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,797.39
|
|
|
HC INJECTION LUMBAR DISKOGRAPHY
|
Facility
|
IP
|
$2,396.52
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
36100282
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,667.98 |
| Max. Negotiated Rate |
$2,156.87 |
| Rate for Payer: Aetna Commercial |
$2,037.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,979.29
|
| Rate for Payer: BCN Commercial |
$1,979.29
|
| Rate for Payer: Cash Price |
$1,917.22
|
| Rate for Payer: Cofinity Commercial |
$2,061.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,917.22
|
| Rate for Payer: Healthscope Commercial |
$2,156.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,797.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.04
|
| Rate for Payer: Nomi Health Commercial |
$1,965.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,797.39
|
| Rate for Payer: PHP Commercial |
$2,037.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,084.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,667.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,108.94
|
| Rate for Payer: UHC Core |
$2,001.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,797.39
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: BCBS Trust/PPO |
$0.88
|
| Rate for Payer: BCN Commercial |
$0.88
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cofinity Commercial |
$0.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$0.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.90
|
| Rate for Payer: Nomi Health Commercial |
$0.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.80
|
| Rate for Payer: PHP Commercial |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.93
|
| Rate for Payer: UHC Core |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.80
|
|
|
HC INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
CPT J1050
|
| Hospital Charge Code |
63600096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare |
$0.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.33
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS MAPPO |
$0.27
|
| Rate for Payer: BCBS Trust/PPO |
$0.87
|
| Rate for Payer: BCN Commercial |
$0.87
|
| Rate for Payer: BCN Medicare Advantage |
$0.27
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cofinity Commercial |
$0.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.27
|
| Rate for Payer: Healthscope Commercial |
$0.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.80
|
| Rate for Payer: Mclaren Medicaid |
$0.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.28
|
| Rate for Payer: Meridian Medicaid |
$0.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.90
|
| Rate for Payer: Nomi Health Commercial |
$0.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.80
|
| Rate for Payer: PACE Senior Care Partners |
$0.25
|
| Rate for Payer: PACE SWMI |
$0.27
|
| Rate for Payer: PHP Commercial |
$0.90
|
| Rate for Payer: PHP Medicare Advantage |
$0.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.92
|
| Rate for Payer: Priority Health Medicare |
$0.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.74
|
| Rate for Payer: Railroad Medicare Medicare |
$0.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.93
|
| Rate for Payer: UHC Core |
$0.89
|
| Rate for Payer: UHC Exchange |
$0.27
|
| Rate for Payer: UHC Medicaid |
$0.19
|
| Rate for Payer: UHC Medicare Advantage |
$0.27
|
| Rate for Payer: UHCCP Medicaid |
$0.19
|
| Rate for Payer: VA VA |
$0.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.80
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
OP
|
$10.61
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: Aetna Medicare |
$2.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.32
|
| Rate for Payer: BCBS Complete |
$1.96
|
| Rate for Payer: BCBS MAPPO |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$8.72
|
| Rate for Payer: BCN Commercial |
$8.72
|
| Rate for Payer: BCN Medicare Advantage |
$2.65
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$9.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: Mclaren Medicaid |
$1.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.79
|
| Rate for Payer: Meridian Medicaid |
$1.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PACE Senior Care Partners |
$2.52
|
| Rate for Payer: PACE SWMI |
$2.65
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: PHP Medicare Advantage |
$2.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$2.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.34
|
| Rate for Payer: UHC Core |
$8.86
|
| Rate for Payer: UHC Exchange |
$2.65
|
| Rate for Payer: UHC Medicaid |
$1.87
|
| Rate for Payer: UHC Medicare Advantage |
$2.65
|
| Rate for Payer: UHCCP Medicaid |
$1.87
|
| Rate for Payer: VA VA |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
|
Facility
|
IP
|
$10.61
|
|
|
Service Code
|
CPT J1020
|
| Hospital Charge Code |
63600093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: BCBS Trust/PPO |
$8.76
|
| Rate for Payer: BCN Commercial |
$8.76
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$9.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.34
|
| Rate for Payer: UHC Core |
$8.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: BCBS Trust/PPO |
$13.15
|
| Rate for Payer: BCN Commercial |
$13.15
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.01
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.94
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.97
|
| Rate for Payer: BCBS Complete |
$2.95
|
| Rate for Payer: BCBS MAPPO |
$3.98
|
| Rate for Payer: BCBS Trust/PPO |
$13.09
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: BCN Medicare Advantage |
$3.98
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.94
|
| Rate for Payer: Mclaren Medicaid |
$2.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.18
|
| Rate for Payer: Meridian Medicaid |
$2.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PACE Senior Care Partners |
$3.78
|
| Rate for Payer: PACE SWMI |
$3.98
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: PHP Medicare Advantage |
$3.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.85
|
| Rate for Payer: Priority Health Medicare |
$4.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.01
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: UHC Exchange |
$3.98
|
| Rate for Payer: UHC Medicaid |
$2.81
|
| Rate for Payer: UHC Medicare Advantage |
$3.98
|
| Rate for Payer: UHCCP Medicaid |
$2.81
|
| Rate for Payer: VA VA |
$3.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.94
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: BCBS Trust/PPO |
$21.91
|
| Rate for Payer: BCN Commercial |
$21.91
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.35
|
| Rate for Payer: UHC Core |
$22.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$6.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.29
|
| Rate for Payer: BCBS Complete |
$4.91
|
| Rate for Payer: BCBS MAPPO |
$6.63
|
| Rate for Payer: BCBS Trust/PPO |
$21.81
|
| Rate for Payer: BCN Commercial |
$21.81
|
| Rate for Payer: BCN Medicare Advantage |
$6.63
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.63
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| Rate for Payer: Mclaren Medicaid |
$4.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.96
|
| Rate for Payer: Meridian Medicaid |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Senior Care Partners |
$6.30
|
| Rate for Payer: PACE SWMI |
$6.63
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$6.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.08
|
| Rate for Payer: Priority Health Medicare |
$6.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.46
|
| Rate for Payer: Railroad Medicare Medicare |
$6.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.35
|
| Rate for Payer: UHC Core |
$22.15
|
| Rate for Payer: UHC Exchange |
$6.63
|
| Rate for Payer: UHC Medicaid |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$6.63
|
| Rate for Payer: UHCCP Medicaid |
$4.68
|
| Rate for Payer: VA VA |
$6.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
OP
|
$1,088.69
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$191.94 |
| Max. Negotiated Rate |
$979.82 |
| Rate for Payer: Aetna Commercial |
$925.39
|
| Rate for Payer: Aetna Medicare |
$283.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$340.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$340.22
|
| Rate for Payer: BCBS Complete |
$201.52
|
| Rate for Payer: BCBS MAPPO |
$272.17
|
| Rate for Payer: BCBS Trust/PPO |
$895.01
|
| Rate for Payer: BCN Commercial |
$895.01
|
| Rate for Payer: BCN Medicare Advantage |
$272.17
|
| Rate for Payer: Cash Price |
$870.95
|
| Rate for Payer: Cofinity Commercial |
$936.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.17
|
| Rate for Payer: Healthscope Commercial |
$979.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.52
|
| Rate for Payer: Mclaren Medicaid |
$191.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.78
|
| Rate for Payer: Meridian Medicaid |
$201.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$299.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.39
|
| Rate for Payer: Nomi Health Commercial |
$892.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.52
|
| Rate for Payer: PACE Senior Care Partners |
$258.56
|
| Rate for Payer: PACE SWMI |
$272.17
|
| Rate for Payer: PHP Commercial |
$925.39
|
| Rate for Payer: PHP Medicare Advantage |
$272.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$947.16
|
| Rate for Payer: Priority Health Medicare |
$274.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$757.73
|
| Rate for Payer: Railroad Medicare Medicare |
$272.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$958.05
|
| Rate for Payer: UHC Core |
$909.06
|
| Rate for Payer: UHC Exchange |
$272.17
|
| Rate for Payer: UHC Medicaid |
$191.94
|
| Rate for Payer: UHC Medicare Advantage |
$272.17
|
| Rate for Payer: UHCCP Medicaid |
$191.94
|
| Rate for Payer: VA VA |
$272.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.52
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
IP
|
$1,088.69
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$757.73 |
| Max. Negotiated Rate |
$979.82 |
| Rate for Payer: Aetna Commercial |
$925.39
|
| Rate for Payer: BCBS Trust/PPO |
$899.15
|
| Rate for Payer: BCN Commercial |
$899.15
|
| Rate for Payer: Cash Price |
$870.95
|
| Rate for Payer: Cofinity Commercial |
$936.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.95
|
| Rate for Payer: Healthscope Commercial |
$979.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.39
|
| Rate for Payer: Nomi Health Commercial |
$892.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.52
|
| Rate for Payer: PHP Commercial |
$925.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$947.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$757.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$958.05
|
| Rate for Payer: UHC Core |
$909.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.52
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
IP
|
$358.69
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.65 |
| Max. Negotiated Rate |
$322.82 |
| Rate for Payer: Aetna Commercial |
$304.89
|
| Rate for Payer: BCBS Trust/PPO |
$296.24
|
| Rate for Payer: BCN Commercial |
$296.24
|
| Rate for Payer: Cash Price |
$286.95
|
| Rate for Payer: Cofinity Commercial |
$308.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.95
|
| Rate for Payer: Healthscope Commercial |
$322.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.89
|
| Rate for Payer: Nomi Health Commercial |
$294.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.02
|
| Rate for Payer: PHP Commercial |
$304.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$312.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.65
|
| Rate for Payer: UHC Core |
$299.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.02
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
OP
|
$358.69
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.24 |
| Max. Negotiated Rate |
$322.82 |
| Rate for Payer: Aetna Commercial |
$304.89
|
| Rate for Payer: Aetna Medicare |
$93.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.09
|
| Rate for Payer: BCBS Complete |
$66.39
|
| Rate for Payer: BCBS MAPPO |
$89.67
|
| Rate for Payer: BCBS Trust/PPO |
$294.88
|
| Rate for Payer: BCN Commercial |
$294.88
|
| Rate for Payer: BCN Medicare Advantage |
$89.67
|
| Rate for Payer: Cash Price |
$286.95
|
| Rate for Payer: Cofinity Commercial |
$308.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.67
|
| Rate for Payer: Healthscope Commercial |
$322.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.02
|
| Rate for Payer: Mclaren Medicaid |
$63.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.16
|
| Rate for Payer: Meridian Medicaid |
$66.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.89
|
| Rate for Payer: Nomi Health Commercial |
$294.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.02
|
| Rate for Payer: PACE Senior Care Partners |
$85.19
|
| Rate for Payer: PACE SWMI |
$89.67
|
| Rate for Payer: PHP Commercial |
$304.89
|
| Rate for Payer: PHP Medicare Advantage |
$89.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$312.06
|
| Rate for Payer: Priority Health Medicare |
$90.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.65
|
| Rate for Payer: Railroad Medicare Medicare |
$89.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.65
|
| Rate for Payer: UHC Core |
$299.51
|
| Rate for Payer: UHC Exchange |
$89.67
|
| Rate for Payer: UHC Medicaid |
$63.24
|
| Rate for Payer: UHC Medicare Advantage |
$89.67
|
| Rate for Payer: UHCCP Medicaid |
$63.24
|
| Rate for Payer: VA VA |
$89.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.02
|
|
|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
OP
|
$538.03
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.85 |
| Max. Negotiated Rate |
$484.23 |
| Rate for Payer: Aetna Commercial |
$457.33
|
| Rate for Payer: Aetna Medicare |
$139.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.13
|
| Rate for Payer: BCBS Complete |
$99.59
|
| Rate for Payer: BCBS MAPPO |
$134.51
|
| Rate for Payer: BCBS Trust/PPO |
$442.31
|
| Rate for Payer: BCN Commercial |
$442.31
|
| Rate for Payer: BCN Medicare Advantage |
$134.51
|
| Rate for Payer: Cash Price |
$430.42
|
| Rate for Payer: Cofinity Commercial |
$462.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.51
|
| Rate for Payer: Healthscope Commercial |
$484.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.52
|
| Rate for Payer: Mclaren Medicaid |
$94.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.23
|
| Rate for Payer: Meridian Medicaid |
$99.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.33
|
| Rate for Payer: Nomi Health Commercial |
$441.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$403.52
|
| Rate for Payer: PACE Senior Care Partners |
$127.78
|
| Rate for Payer: PACE SWMI |
$134.51
|
| Rate for Payer: PHP Commercial |
$457.33
|
| Rate for Payer: PHP Medicare Advantage |
$134.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$468.09
|
| Rate for Payer: Priority Health Medicare |
$135.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$374.47
|
| Rate for Payer: Railroad Medicare Medicare |
$134.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.47
|
| Rate for Payer: UHC Core |
$449.26
|
| Rate for Payer: UHC Exchange |
$134.51
|
| Rate for Payer: UHC Medicaid |
$94.85
|
| Rate for Payer: UHC Medicare Advantage |
$134.51
|
| Rate for Payer: UHCCP Medicaid |
$94.85
|
| Rate for Payer: VA VA |
$134.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.52
|
|
|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
IP
|
$538.03
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.47 |
| Max. Negotiated Rate |
$484.23 |
| Rate for Payer: Aetna Commercial |
$457.33
|
| Rate for Payer: BCBS Trust/PPO |
$444.36
|
| Rate for Payer: BCN Commercial |
$444.36
|
| Rate for Payer: Cash Price |
$430.42
|
| Rate for Payer: Cofinity Commercial |
$462.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.42
|
| Rate for Payer: Healthscope Commercial |
$484.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.33
|
| Rate for Payer: Nomi Health Commercial |
$441.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$403.52
|
| Rate for Payer: PHP Commercial |
$457.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$468.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$374.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.47
|
| Rate for Payer: UHC Core |
$449.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.52
|
|
|
HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
IP
|
$821.92
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.06 |
| Max. Negotiated Rate |
$739.73 |
| Rate for Payer: Aetna Commercial |
$698.63
|
| Rate for Payer: BCBS Trust/PPO |
$678.82
|
| Rate for Payer: BCN Commercial |
$678.82
|
| Rate for Payer: Cash Price |
$657.54
|
| Rate for Payer: Cofinity Commercial |
$706.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.54
|
| Rate for Payer: Healthscope Commercial |
$739.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.63
|
| Rate for Payer: Nomi Health Commercial |
$673.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$616.44
|
| Rate for Payer: PHP Commercial |
$698.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$715.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$572.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$723.29
|
| Rate for Payer: UHC Core |
$686.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.44
|
|
|
HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
OP
|
$821.92
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.90 |
| Max. Negotiated Rate |
$739.73 |
| Rate for Payer: Aetna Commercial |
$698.63
|
| Rate for Payer: Aetna Medicare |
$213.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.85
|
| Rate for Payer: BCBS Complete |
$152.14
|
| Rate for Payer: BCBS MAPPO |
$205.48
|
| Rate for Payer: BCBS Trust/PPO |
$675.70
|
| Rate for Payer: BCN Commercial |
$675.70
|
| Rate for Payer: BCN Medicare Advantage |
$205.48
|
| Rate for Payer: Cash Price |
$657.54
|
| Rate for Payer: Cofinity Commercial |
$706.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.48
|
| Rate for Payer: Healthscope Commercial |
$739.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.44
|
| Rate for Payer: Mclaren Medicaid |
$144.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.75
|
| Rate for Payer: Meridian Medicaid |
$152.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$226.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.63
|
| Rate for Payer: Nomi Health Commercial |
$673.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$616.44
|
| Rate for Payer: PACE Senior Care Partners |
$195.21
|
| Rate for Payer: PACE SWMI |
$205.48
|
| Rate for Payer: PHP Commercial |
$698.63
|
| Rate for Payer: PHP Medicare Advantage |
$205.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$715.07
|
| Rate for Payer: Priority Health Medicare |
$207.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$572.06
|
| Rate for Payer: Railroad Medicare Medicare |
$205.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$723.29
|
| Rate for Payer: UHC Core |
$686.30
|
| Rate for Payer: UHC Exchange |
$205.48
|
| Rate for Payer: UHC Medicaid |
$144.90
|
| Rate for Payer: UHC Medicare Advantage |
$205.48
|
| Rate for Payer: UHCCP Medicaid |
$144.90
|
| Rate for Payer: VA VA |
$205.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.44
|
|
|
HC INJECTION PROC CYSTOGRAPHY VOIDING
|
Facility
|
IP
|
$1,336.55
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$930.24 |
| Max. Negotiated Rate |
$1,202.89 |
| Rate for Payer: Aetna Commercial |
$1,136.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,103.86
|
| Rate for Payer: BCN Commercial |
$1,103.86
|
| Rate for Payer: Cash Price |
$1,069.24
|
| Rate for Payer: Cofinity Commercial |
$1,149.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.24
|
| Rate for Payer: Healthscope Commercial |
$1,202.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,002.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.07
|
| Rate for Payer: Nomi Health Commercial |
$1,095.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,002.41
|
| Rate for Payer: PHP Commercial |
$1,136.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,162.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$930.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,176.16
|
| Rate for Payer: UHC Core |
$1,116.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,002.41
|
|
|
HC INJECTION PROC CYSTOGRAPHY VOIDING
|
Facility
|
OP
|
$1,336.55
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$235.63 |
| Max. Negotiated Rate |
$1,202.89 |
| Rate for Payer: Aetna Commercial |
$1,136.07
|
| Rate for Payer: Aetna Medicare |
$347.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$417.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$417.67
|
| Rate for Payer: BCBS Complete |
$247.40
|
| Rate for Payer: BCBS MAPPO |
$334.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.78
|
| Rate for Payer: BCN Commercial |
$1,098.78
|
| Rate for Payer: BCN Medicare Advantage |
$334.14
|
| Rate for Payer: Cash Price |
$1,069.24
|
| Rate for Payer: Cofinity Commercial |
$1,149.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,069.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.14
|
| Rate for Payer: Healthscope Commercial |
$1,202.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,002.41
|
| Rate for Payer: Mclaren Medicaid |
$235.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$350.84
|
| Rate for Payer: Meridian Medicaid |
$247.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$384.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$367.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.07
|
| Rate for Payer: Nomi Health Commercial |
$1,095.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,002.41
|
| Rate for Payer: PACE Senior Care Partners |
$317.43
|
| Rate for Payer: PACE SWMI |
$334.14
|
| Rate for Payer: PHP Commercial |
$1,136.07
|
| Rate for Payer: PHP Medicare Advantage |
$334.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,162.80
|
| Rate for Payer: Priority Health Medicare |
$337.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$930.24
|
| Rate for Payer: Railroad Medicare Medicare |
$334.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,176.16
|
| Rate for Payer: UHC Core |
$1,116.02
|
| Rate for Payer: UHC Exchange |
$334.14
|
| Rate for Payer: UHC Medicaid |
$235.63
|
| Rate for Payer: UHC Medicare Advantage |
$334.14
|
| Rate for Payer: UHCCP Medicaid |
$235.63
|
| Rate for Payer: VA VA |
$334.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,002.41
|
|
|
HC INJECTION PROCEDURE
|
Facility
|
IP
|
$615.55
|
|
| Hospital Charge Code |
36000085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$428.42 |
| Max. Negotiated Rate |
$554.00 |
| Rate for Payer: Aetna Commercial |
$523.22
|
| Rate for Payer: BCBS Trust/PPO |
$508.38
|
| Rate for Payer: BCN Commercial |
$508.38
|
| Rate for Payer: Cash Price |
$492.44
|
| Rate for Payer: Cofinity Commercial |
$529.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.44
|
| Rate for Payer: Healthscope Commercial |
$554.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.22
|
| Rate for Payer: Nomi Health Commercial |
$504.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$461.66
|
| Rate for Payer: PHP Commercial |
$523.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$535.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$428.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.68
|
| Rate for Payer: UHC Core |
$513.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.66
|
|
|
HC INJECTION PROCEDURE
|
Facility
|
OP
|
$615.55
|
|
| Hospital Charge Code |
36000085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$108.52 |
| Max. Negotiated Rate |
$554.00 |
| Rate for Payer: Aetna Commercial |
$523.22
|
| Rate for Payer: Aetna Medicare |
$160.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$113.94
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCBS Trust/PPO |
$506.04
|
| Rate for Payer: BCN Commercial |
$506.04
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$492.44
|
| Rate for Payer: Cofinity Commercial |
$529.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$554.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.66
|
| Rate for Payer: Mclaren Medicaid |
$108.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$113.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$169.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.22
|
| Rate for Payer: Nomi Health Commercial |
$504.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$461.66
|
| Rate for Payer: PACE Senior Care Partners |
$146.19
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$523.22
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$535.53
|
| Rate for Payer: Priority Health Medicare |
$155.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$428.42
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.68
|
| Rate for Payer: UHC Core |
$513.98
|
| Rate for Payer: UHC Exchange |
$153.89
|
| Rate for Payer: UHC Medicaid |
$108.52
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$108.52
|
| Rate for Payer: VA VA |
$153.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.66
|
|
|
HC INJECTION PROCEDURE ILEAL CONDUIT
|
Facility
|
IP
|
$656.40
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
36100249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$456.85 |
| Max. Negotiated Rate |
$590.76 |
| Rate for Payer: Aetna Commercial |
$557.94
|
| Rate for Payer: BCBS Trust/PPO |
$542.12
|
| Rate for Payer: BCN Commercial |
$542.12
|
| Rate for Payer: Cash Price |
$525.12
|
| Rate for Payer: Cofinity Commercial |
$564.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.12
|
| Rate for Payer: Healthscope Commercial |
$590.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.94
|
| Rate for Payer: Nomi Health Commercial |
$538.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.30
|
| Rate for Payer: PHP Commercial |
$557.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$571.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$456.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$577.63
|
| Rate for Payer: UHC Core |
$548.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.30
|
|
|
HC INJECTION PROCEDURE ILEAL CONDUIT
|
Facility
|
OP
|
$656.40
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
36100249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$115.72 |
| Max. Negotiated Rate |
$590.76 |
| Rate for Payer: Aetna Commercial |
$557.94
|
| Rate for Payer: Aetna Medicare |
$170.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$205.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$205.12
|
| Rate for Payer: BCBS Complete |
$121.50
|
| Rate for Payer: BCBS MAPPO |
$164.10
|
| Rate for Payer: BCBS Trust/PPO |
$539.63
|
| Rate for Payer: BCN Commercial |
$539.63
|
| Rate for Payer: BCN Medicare Advantage |
$164.10
|
| Rate for Payer: Cash Price |
$525.12
|
| Rate for Payer: Cofinity Commercial |
$564.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.10
|
| Rate for Payer: Healthscope Commercial |
$590.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.30
|
| Rate for Payer: Mclaren Medicaid |
$115.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.31
|
| Rate for Payer: Meridian Medicaid |
$121.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$180.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.94
|
| Rate for Payer: Nomi Health Commercial |
$538.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.30
|
| Rate for Payer: PACE Senior Care Partners |
$155.90
|
| Rate for Payer: PACE SWMI |
$164.10
|
| Rate for Payer: PHP Commercial |
$557.94
|
| Rate for Payer: PHP Medicare Advantage |
$164.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$571.07
|
| Rate for Payer: Priority Health Medicare |
$165.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$456.85
|
| Rate for Payer: Railroad Medicare Medicare |
$164.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$577.63
|
| Rate for Payer: UHC Core |
$548.09
|
| Rate for Payer: UHC Exchange |
$164.10
|
| Rate for Payer: UHC Medicaid |
$115.72
|
| Rate for Payer: UHC Medicare Advantage |
$164.10
|
| Rate for Payer: UHCCP Medicaid |
$115.72
|
| Rate for Payer: VA VA |
$164.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.30
|
|
|
HC INJECTION PROC RETROGRAD CYSTOGRAPHY
|
Facility
|
IP
|
$874.10
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
36100252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$608.37 |
| Max. Negotiated Rate |
$786.69 |
| Rate for Payer: Aetna Commercial |
$742.99
|
| Rate for Payer: BCBS Trust/PPO |
$721.92
|
| Rate for Payer: BCN Commercial |
$721.92
|
| Rate for Payer: Cash Price |
$699.28
|
| Rate for Payer: Cofinity Commercial |
$751.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.28
|
| Rate for Payer: Healthscope Commercial |
$786.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$655.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$742.99
|
| Rate for Payer: Nomi Health Commercial |
$716.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.58
|
| Rate for Payer: PHP Commercial |
$742.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$760.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$608.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.21
|
| Rate for Payer: UHC Core |
$729.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$655.58
|
|
