|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
OP
|
$1,175.24
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.19 |
| Max. Negotiated Rate |
$1,057.72 |
| Rate for Payer: Aetna Commercial |
$998.95
|
| Rate for Payer: Aetna Medicare |
$305.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$367.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$367.26
|
| Rate for Payer: BCBS Complete |
$217.54
|
| Rate for Payer: BCBS MAPPO |
$293.81
|
| Rate for Payer: BCBS Trust/PPO |
$966.16
|
| Rate for Payer: BCN Commercial |
$966.16
|
| Rate for Payer: BCN Medicare Advantage |
$293.81
|
| Rate for Payer: Cash Price |
$940.19
|
| Rate for Payer: Cofinity Commercial |
$1,010.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.81
|
| Rate for Payer: Healthscope Commercial |
$1,057.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$881.43
|
| Rate for Payer: Mclaren Medicaid |
$207.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$308.50
|
| Rate for Payer: Meridian Medicaid |
$217.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$323.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.95
|
| Rate for Payer: Nomi Health Commercial |
$963.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$881.43
|
| Rate for Payer: PACE Senior Care Partners |
$279.12
|
| Rate for Payer: PACE SWMI |
$293.81
|
| Rate for Payer: PHP Commercial |
$998.95
|
| Rate for Payer: PHP Medicare Advantage |
$293.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,022.46
|
| Rate for Payer: Priority Health Medicare |
$296.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$817.97
|
| Rate for Payer: Railroad Medicare Medicare |
$293.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,034.21
|
| Rate for Payer: UHC Core |
$981.33
|
| Rate for Payer: UHC Exchange |
$293.81
|
| Rate for Payer: UHC Medicaid |
$207.19
|
| Rate for Payer: UHC Medicare Advantage |
$293.81
|
| Rate for Payer: UHCCP Medicaid |
$207.19
|
| Rate for Payer: VA VA |
$293.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$881.43
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
OP
|
$380.84
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.14 |
| Max. Negotiated Rate |
$342.76 |
| Rate for Payer: Aetna Commercial |
$323.71
|
| Rate for Payer: Aetna Medicare |
$99.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.01
|
| Rate for Payer: BCBS Complete |
$70.49
|
| Rate for Payer: BCBS MAPPO |
$95.21
|
| Rate for Payer: BCBS Trust/PPO |
$313.09
|
| Rate for Payer: BCN Commercial |
$313.09
|
| Rate for Payer: BCN Medicare Advantage |
$95.21
|
| Rate for Payer: Cash Price |
$304.67
|
| Rate for Payer: Cash Price |
$304.67
|
| Rate for Payer: Cofinity Commercial |
$327.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.21
|
| Rate for Payer: Healthscope Commercial |
$342.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.63
|
| Rate for Payer: Mclaren Medicaid |
$67.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.97
|
| Rate for Payer: Meridian Medicaid |
$70.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.71
|
| Rate for Payer: Nomi Health Commercial |
$312.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.63
|
| Rate for Payer: PACE Senior Care Partners |
$90.45
|
| Rate for Payer: PACE SWMI |
$95.21
|
| Rate for Payer: PHP Commercial |
$323.71
|
| Rate for Payer: PHP Medicare Advantage |
$95.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$331.33
|
| Rate for Payer: Priority Health Medicare |
$96.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.06
|
| Rate for Payer: Railroad Medicare Medicare |
$95.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.14
|
| Rate for Payer: UHC Core |
$318.00
|
| Rate for Payer: UHC Exchange |
$95.21
|
| Rate for Payer: UHC Medicaid |
$67.14
|
| Rate for Payer: UHC Medicare Advantage |
$95.21
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$95.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.63
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
IP
|
$380.84
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.06 |
| Max. Negotiated Rate |
$342.76 |
| Rate for Payer: Aetna Commercial |
$323.71
|
| Rate for Payer: BCBS Trust/PPO |
$314.54
|
| Rate for Payer: BCN Commercial |
$314.54
|
| Rate for Payer: Cash Price |
$304.67
|
| Rate for Payer: Cofinity Commercial |
$327.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.67
|
| Rate for Payer: Healthscope Commercial |
$342.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.71
|
| Rate for Payer: Nomi Health Commercial |
$312.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.63
|
| Rate for Payer: PHP Commercial |
$323.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$331.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.14
|
| Rate for Payer: UHC Core |
$318.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.63
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
OP
|
$2,836.51
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.08 |
| Max. Negotiated Rate |
$2,552.86 |
| Rate for Payer: Aetna Commercial |
$2,411.03
|
| Rate for Payer: Aetna Medicare |
$737.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$886.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$886.41
|
| Rate for Payer: BCBS Complete |
$525.04
|
| Rate for Payer: BCBS MAPPO |
$709.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,331.89
|
| Rate for Payer: BCN Commercial |
$2,331.89
|
| Rate for Payer: BCN Medicare Advantage |
$709.13
|
| Rate for Payer: Cash Price |
$2,269.21
|
| Rate for Payer: Cofinity Commercial |
$2,439.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,269.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$709.13
|
| Rate for Payer: Healthscope Commercial |
$2,552.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,127.38
|
| Rate for Payer: Mclaren Medicaid |
$500.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$744.58
|
| Rate for Payer: Meridian Medicaid |
$525.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$815.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$780.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,411.03
|
| Rate for Payer: Nomi Health Commercial |
$2,325.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,127.38
|
| Rate for Payer: PACE Senior Care Partners |
$673.67
|
| Rate for Payer: PACE SWMI |
$709.13
|
| Rate for Payer: PHP Commercial |
$2,411.03
|
| Rate for Payer: PHP Medicare Advantage |
$709.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,467.76
|
| Rate for Payer: Priority Health Medicare |
$716.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,974.21
|
| Rate for Payer: Railroad Medicare Medicare |
$709.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,496.13
|
| Rate for Payer: UHC Core |
$2,368.49
|
| Rate for Payer: UHC Exchange |
$709.13
|
| Rate for Payer: UHC Medicaid |
$500.08
|
| Rate for Payer: UHC Medicare Advantage |
$709.13
|
| Rate for Payer: UHCCP Medicaid |
$500.08
|
| Rate for Payer: VA VA |
$709.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,127.38
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
IP
|
$2,836.51
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,974.21 |
| Max. Negotiated Rate |
$2,552.86 |
| Rate for Payer: Aetna Commercial |
$2,411.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,342.67
|
| Rate for Payer: BCN Commercial |
$2,342.67
|
| Rate for Payer: Cash Price |
$2,269.21
|
| Rate for Payer: Cofinity Commercial |
$2,439.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,269.21
|
| Rate for Payer: Healthscope Commercial |
$2,552.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,127.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,411.03
|
| Rate for Payer: Nomi Health Commercial |
$2,325.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,127.38
|
| Rate for Payer: PHP Commercial |
$2,411.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,467.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,974.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,496.13
|
| Rate for Payer: UHC Core |
$2,368.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,127.38
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
OP
|
$368.37
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.94 |
| Max. Negotiated Rate |
$331.53 |
| Rate for Payer: Aetna Commercial |
$313.11
|
| Rate for Payer: Aetna Medicare |
$95.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.12
|
| Rate for Payer: BCBS Complete |
$68.19
|
| Rate for Payer: BCBS MAPPO |
$92.09
|
| Rate for Payer: BCBS Trust/PPO |
$302.84
|
| Rate for Payer: BCN Commercial |
$302.84
|
| Rate for Payer: BCN Medicare Advantage |
$92.09
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Commercial |
$316.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.09
|
| Rate for Payer: Healthscope Commercial |
$331.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.28
|
| Rate for Payer: Mclaren Medicaid |
$64.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.70
|
| Rate for Payer: Meridian Medicaid |
$68.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$302.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PACE Senior Care Partners |
$87.49
|
| Rate for Payer: PACE SWMI |
$92.09
|
| Rate for Payer: PHP Commercial |
$313.11
|
| Rate for Payer: PHP Medicare Advantage |
$92.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$320.48
|
| Rate for Payer: Priority Health Medicare |
$93.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.39
|
| Rate for Payer: Railroad Medicare Medicare |
$92.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.17
|
| Rate for Payer: UHC Core |
$307.59
|
| Rate for Payer: UHC Exchange |
$92.09
|
| Rate for Payer: UHC Medicaid |
$64.94
|
| Rate for Payer: UHC Medicare Advantage |
$92.09
|
| Rate for Payer: UHCCP Medicaid |
$64.94
|
| Rate for Payer: VA VA |
$92.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.28
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
IP
|
$368.37
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.39 |
| Max. Negotiated Rate |
$331.53 |
| Rate for Payer: Aetna Commercial |
$313.11
|
| Rate for Payer: BCBS Trust/PPO |
$304.24
|
| Rate for Payer: BCN Commercial |
$304.24
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Commercial |
$316.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Healthscope Commercial |
$331.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$302.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PHP Commercial |
$313.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$320.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.17
|
| Rate for Payer: UHC Core |
$307.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.28
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
OP
|
$381.62
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.28 |
| Max. Negotiated Rate |
$343.46 |
| Rate for Payer: Aetna Commercial |
$324.38
|
| Rate for Payer: Aetna Medicare |
$99.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.26
|
| Rate for Payer: BCBS Complete |
$70.64
|
| Rate for Payer: BCBS MAPPO |
$95.41
|
| Rate for Payer: BCBS Trust/PPO |
$313.73
|
| Rate for Payer: BCN Commercial |
$313.73
|
| Rate for Payer: BCN Medicare Advantage |
$95.41
|
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cofinity Commercial |
$328.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.41
|
| Rate for Payer: Healthscope Commercial |
$343.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.21
|
| Rate for Payer: Mclaren Medicaid |
$67.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.18
|
| Rate for Payer: Meridian Medicaid |
$70.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.38
|
| Rate for Payer: Nomi Health Commercial |
$312.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.21
|
| Rate for Payer: PACE Senior Care Partners |
$90.63
|
| Rate for Payer: PACE SWMI |
$95.41
|
| Rate for Payer: PHP Commercial |
$324.38
|
| Rate for Payer: PHP Medicare Advantage |
$95.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$332.01
|
| Rate for Payer: Priority Health Medicare |
$96.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.61
|
| Rate for Payer: Railroad Medicare Medicare |
$95.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.83
|
| Rate for Payer: UHC Core |
$318.65
|
| Rate for Payer: UHC Exchange |
$95.41
|
| Rate for Payer: UHC Medicaid |
$67.28
|
| Rate for Payer: UHC Medicare Advantage |
$95.41
|
| Rate for Payer: UHCCP Medicaid |
$67.28
|
| Rate for Payer: VA VA |
$95.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.21
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
IP
|
$381.62
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.61 |
| Max. Negotiated Rate |
$343.46 |
| Rate for Payer: Aetna Commercial |
$324.38
|
| Rate for Payer: BCBS Trust/PPO |
$315.18
|
| Rate for Payer: BCN Commercial |
$315.18
|
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cofinity Commercial |
$328.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.30
|
| Rate for Payer: Healthscope Commercial |
$343.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.38
|
| Rate for Payer: Nomi Health Commercial |
$312.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.21
|
| Rate for Payer: PHP Commercial |
$324.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$332.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.83
|
| Rate for Payer: UHC Core |
$318.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.21
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
IP
|
$497.42
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.20 |
| Max. Negotiated Rate |
$447.68 |
| Rate for Payer: Aetna Commercial |
$422.81
|
| Rate for Payer: BCBS Trust/PPO |
$410.82
|
| Rate for Payer: BCN Commercial |
$410.82
|
| Rate for Payer: Cash Price |
$397.94
|
| Rate for Payer: Cofinity Commercial |
$427.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.94
|
| Rate for Payer: Healthscope Commercial |
$447.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.81
|
| Rate for Payer: Nomi Health Commercial |
$407.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.06
|
| Rate for Payer: PHP Commercial |
$422.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$432.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$437.73
|
| Rate for Payer: UHC Core |
$415.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.06
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
OP
|
$497.42
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.70 |
| Max. Negotiated Rate |
$447.68 |
| Rate for Payer: Aetna Commercial |
$422.81
|
| Rate for Payer: Aetna Medicare |
$129.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.44
|
| Rate for Payer: BCBS Complete |
$92.07
|
| Rate for Payer: BCBS MAPPO |
$124.36
|
| Rate for Payer: BCBS Trust/PPO |
$408.93
|
| Rate for Payer: BCN Commercial |
$408.93
|
| Rate for Payer: BCN Medicare Advantage |
$124.36
|
| Rate for Payer: Cash Price |
$397.94
|
| Rate for Payer: Cofinity Commercial |
$427.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.36
|
| Rate for Payer: Healthscope Commercial |
$447.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$373.06
|
| Rate for Payer: Mclaren Medicaid |
$87.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.57
|
| Rate for Payer: Meridian Medicaid |
$92.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.81
|
| Rate for Payer: Nomi Health Commercial |
$407.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$373.06
|
| Rate for Payer: PACE Senior Care Partners |
$118.14
|
| Rate for Payer: PACE SWMI |
$124.36
|
| Rate for Payer: PHP Commercial |
$422.81
|
| Rate for Payer: PHP Medicare Advantage |
$124.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$432.76
|
| Rate for Payer: Priority Health Medicare |
$125.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.20
|
| Rate for Payer: Railroad Medicare Medicare |
$124.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$437.73
|
| Rate for Payer: UHC Core |
$415.35
|
| Rate for Payer: UHC Exchange |
$124.36
|
| Rate for Payer: UHC Medicaid |
$87.70
|
| Rate for Payer: UHC Medicare Advantage |
$124.36
|
| Rate for Payer: UHCCP Medicaid |
$87.70
|
| Rate for Payer: VA VA |
$124.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$373.06
|
|
|
HC INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
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 INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
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 INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
OP
|
$346.44
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.08 |
| Max. Negotiated Rate |
$311.80 |
| Rate for Payer: Aetna Commercial |
$294.47
|
| Rate for Payer: Aetna Medicare |
$90.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.26
|
| Rate for Payer: BCBS Complete |
$64.13
|
| Rate for Payer: BCBS MAPPO |
$86.61
|
| Rate for Payer: BCBS Trust/PPO |
$284.81
|
| Rate for Payer: BCN Commercial |
$284.81
|
| Rate for Payer: BCN Medicare Advantage |
$86.61
|
| Rate for Payer: Cash Price |
$277.15
|
| Rate for Payer: Cofinity Commercial |
$297.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.61
|
| Rate for Payer: Healthscope Commercial |
$311.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.83
|
| Rate for Payer: Mclaren Medicaid |
$61.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.94
|
| Rate for Payer: Meridian Medicaid |
$64.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.47
|
| Rate for Payer: Nomi Health Commercial |
$284.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.83
|
| Rate for Payer: PACE Senior Care Partners |
$82.28
|
| Rate for Payer: PACE SWMI |
$86.61
|
| Rate for Payer: PHP Commercial |
$294.47
|
| Rate for Payer: PHP Medicare Advantage |
$86.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$301.40
|
| Rate for Payer: Priority Health Medicare |
$87.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.12
|
| Rate for Payer: Railroad Medicare Medicare |
$86.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.87
|
| Rate for Payer: UHC Core |
$289.28
|
| Rate for Payer: UHC Exchange |
$86.61
|
| Rate for Payer: UHC Medicaid |
$61.08
|
| Rate for Payer: UHC Medicare Advantage |
$86.61
|
| Rate for Payer: UHCCP Medicaid |
$61.08
|
| Rate for Payer: VA VA |
$86.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.83
|
|
|
HC INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
IP
|
$346.44
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.12 |
| Max. Negotiated Rate |
$311.80 |
| Rate for Payer: Aetna Commercial |
$294.47
|
| Rate for Payer: BCBS Trust/PPO |
$286.12
|
| Rate for Payer: BCN Commercial |
$286.12
|
| Rate for Payer: Cash Price |
$277.15
|
| Rate for Payer: Cofinity Commercial |
$297.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.15
|
| Rate for Payer: Healthscope Commercial |
$311.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.47
|
| Rate for Payer: Nomi Health Commercial |
$284.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.83
|
| Rate for Payer: PHP Commercial |
$294.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$301.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.87
|
| Rate for Payer: UHC Core |
$289.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.83
|
|
|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
IP
|
$1.06
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
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 INJ HEPARIN SODIUM PER 1000U
|
Facility
|
OP
|
$1.06
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
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 INJ HYDROCORTISONE NA SUCCINATE, UP TO 100MG
|
Facility
|
IP
|
$43.70
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
63600241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: BCBS Trust/PPO |
$36.09
|
| Rate for Payer: BCN Commercial |
$36.09
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$37.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.46
|
| Rate for Payer: UHC Core |
$36.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.77
|
|
|
HC INJ HYDROCORTISONE NA SUCCINATE, UP TO 100MG
|
Facility
|
OP
|
$43.70
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
63600241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$39.33 |
| Rate for Payer: Aetna Commercial |
$37.15
|
| Rate for Payer: Aetna Medicare |
$11.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.66
|
| Rate for Payer: BCBS Complete |
$8.09
|
| Rate for Payer: BCBS MAPPO |
$10.93
|
| Rate for Payer: BCBS Trust/PPO |
$35.93
|
| Rate for Payer: BCN Commercial |
$35.93
|
| Rate for Payer: BCN Medicare Advantage |
$10.93
|
| Rate for Payer: Cash Price |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$37.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$7.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.47
|
| Rate for Payer: Meridian Medicaid |
$8.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.15
|
| Rate for Payer: Nomi Health Commercial |
$35.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.77
|
| Rate for Payer: PACE Senior Care Partners |
$10.38
|
| Rate for Payer: PACE SWMI |
$10.93
|
| Rate for Payer: PHP Commercial |
$37.15
|
| Rate for Payer: PHP Medicare Advantage |
$10.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.02
|
| Rate for Payer: Priority Health Medicare |
$11.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.42
|
| Rate for Payer: Railroad Medicare Medicare |
$10.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.46
|
| Rate for Payer: UHC Core |
$36.49
|
| Rate for Payer: UHC Exchange |
$10.93
|
| Rate for Payer: UHC Medicaid |
$7.70
|
| Rate for Payer: UHC Medicare Advantage |
$10.93
|
| Rate for Payer: UHCCP Medicaid |
$7.70
|
| Rate for Payer: VA VA |
$10.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.77
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$451.01 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: BCBS Trust/PPO |
$535.18
|
| Rate for Payer: BCN Commercial |
$535.18
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cofinity Commercial |
$557.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.40
|
| Rate for Payer: Healthscope Commercial |
$583.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$486.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.80
|
| Rate for Payer: Nomi Health Commercial |
$531.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$486.00
|
| Rate for Payer: PHP Commercial |
$550.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$563.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$570.24
|
| Rate for Payer: UHC Core |
$541.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$486.00
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.24 |
| Max. Negotiated Rate |
$583.20 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Medicare |
$168.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.50
|
| Rate for Payer: BCBS Complete |
$119.94
|
| Rate for Payer: BCBS MAPPO |
$162.00
|
| Rate for Payer: BCBS Trust/PPO |
$532.72
|
| Rate for Payer: BCN Commercial |
$532.72
|
| Rate for Payer: BCN Medicare Advantage |
$162.00
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cofinity Commercial |
$557.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.00
|
| Rate for Payer: Healthscope Commercial |
$583.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$486.00
|
| Rate for Payer: Mclaren Medicaid |
$114.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.10
|
| Rate for Payer: Meridian Medicaid |
$119.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.80
|
| Rate for Payer: Nomi Health Commercial |
$531.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$486.00
|
| Rate for Payer: PACE Senior Care Partners |
$153.90
|
| Rate for Payer: PACE SWMI |
$162.00
|
| Rate for Payer: PHP Commercial |
$550.80
|
| Rate for Payer: PHP Medicare Advantage |
$162.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$563.76
|
| Rate for Payer: Priority Health Medicare |
$163.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.01
|
| Rate for Payer: Railroad Medicare Medicare |
$162.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$570.24
|
| Rate for Payer: UHC Core |
$541.08
|
| Rate for Payer: UHC Exchange |
$162.00
|
| Rate for Payer: UHC Medicaid |
$114.24
|
| Rate for Payer: UHC Medicare Advantage |
$162.00
|
| Rate for Payer: UHCCP Medicaid |
$114.24
|
| Rate for Payer: VA VA |
$162.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$486.00
|
|
|
HC INJ LIDOCAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
63600262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.32
|
| Rate for Payer: BCBS Complete |
$0.19
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.84
|
| Rate for Payer: BCN Commercial |
$0.84
|
| Rate for Payer: BCN Medicare Advantage |
$0.26
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Mclaren Medicaid |
$0.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.27
|
| Rate for Payer: Meridian Medicaid |
$0.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.77
|
| Rate for Payer: PACE Senior Care Partners |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.26
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: PHP Medicare Advantage |
$0.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.89
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.71
|
| Rate for Payer: Railroad Medicare Medicare |
$0.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC Core |
$0.85
|
| Rate for Payer: UHC Exchange |
$0.26
|
| Rate for Payer: UHC Medicaid |
$0.18
|
| Rate for Payer: UHC Medicare Advantage |
$0.26
|
| Rate for Payer: UHCCP Medicaid |
$0.18
|
| Rate for Payer: VA VA |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
HC INJ LIDOCAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
63600262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$0.84
|
| Rate for Payer: BCN Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.77
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.90
|
| Rate for Payer: UHC Core |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
OP
|
$2,201.80
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$388.18 |
| Max. Negotiated Rate |
$1,981.62 |
| Rate for Payer: Aetna Commercial |
$1,871.53
|
| Rate for Payer: Aetna Medicare |
$572.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.06
|
| Rate for Payer: BCBS Complete |
$407.55
|
| Rate for Payer: BCBS MAPPO |
$550.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.10
|
| Rate for Payer: BCN Commercial |
$1,810.10
|
| Rate for Payer: BCN Medicare Advantage |
$550.45
|
| Rate for Payer: Cash Price |
$1,761.44
|
| Rate for Payer: Cofinity Commercial |
$1,893.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,761.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.45
|
| Rate for Payer: Healthscope Commercial |
$1,981.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,651.35
|
| Rate for Payer: Mclaren Medicaid |
$388.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$577.97
|
| Rate for Payer: Meridian Medicaid |
$407.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$605.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,871.53
|
| Rate for Payer: Nomi Health Commercial |
$1,805.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,651.35
|
| Rate for Payer: PACE Senior Care Partners |
$522.93
|
| Rate for Payer: PACE SWMI |
$550.45
|
| Rate for Payer: PHP Commercial |
$1,871.53
|
| Rate for Payer: PHP Medicare Advantage |
$550.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,915.57
|
| Rate for Payer: Priority Health Medicare |
$555.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,532.45
|
| Rate for Payer: Railroad Medicare Medicare |
$550.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,937.58
|
| Rate for Payer: UHC Core |
$1,838.50
|
| Rate for Payer: UHC Exchange |
$550.45
|
| Rate for Payer: UHC Medicaid |
$388.18
|
| Rate for Payer: UHC Medicare Advantage |
$550.45
|
| Rate for Payer: UHCCP Medicaid |
$388.18
|
| Rate for Payer: VA VA |
$550.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,651.35
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
IP
|
$2,201.80
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,532.45 |
| Max. Negotiated Rate |
$1,981.62 |
| Rate for Payer: Aetna Commercial |
$1,871.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,818.47
|
| Rate for Payer: BCN Commercial |
$1,818.47
|
| Rate for Payer: Cash Price |
$1,761.44
|
| Rate for Payer: Cofinity Commercial |
$1,893.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,761.44
|
| Rate for Payer: Healthscope Commercial |
$1,981.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,651.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,871.53
|
| Rate for Payer: Nomi Health Commercial |
$1,805.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,651.35
|
| Rate for Payer: PHP Commercial |
$1,871.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,915.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,532.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,937.58
|
| Rate for Payer: UHC Core |
$1,838.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,651.35
|
|
