|
HC HTLV I II CONFIRMATION
|
Facility
|
IP
|
$161.16
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200276
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.75 |
| Max. Negotiated Rate |
$145.04 |
| Rate for Payer: Aetna Commercial |
$136.99
|
| Rate for Payer: BCBS Trust/PPO |
$131.55
|
| Rate for Payer: BCN Commercial |
$124.54
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cofinity Commercial |
$138.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.93
|
| Rate for Payer: Healthscope Commercial |
$145.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.99
|
| Rate for Payer: Nomi Health Commercial |
$132.15
|
| Rate for Payer: PHP Commercial |
$136.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.75
|
| Rate for Payer: Priority Health HMO/PPO |
$140.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.82
|
| Rate for Payer: UHC Core |
$134.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.87
|
|
|
HC HTLV I II CONFIRMATION
|
Facility
|
OP
|
$161.16
|
|
|
Service Code
|
CPT 86689
|
| Hospital Charge Code |
30200276
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$145.04 |
| Rate for Payer: Aetna Commercial |
$136.99
|
| Rate for Payer: Aetna Medicare |
$41.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.36
|
| Rate for Payer: BCBS Complete |
$14.69
|
| Rate for Payer: BCBS MAPPO |
$40.29
|
| Rate for Payer: BCBS Trust/PPO |
$132.49
|
| Rate for Payer: BCN Commercial |
$125.30
|
| Rate for Payer: BCN Medicare Advantage |
$40.29
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cofinity Commercial |
$138.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.29
|
| Rate for Payer: Healthscope Commercial |
$145.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.87
|
| Rate for Payer: Mclaren Medicaid |
$13.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.30
|
| Rate for Payer: Meridian Medicaid |
$14.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.99
|
| Rate for Payer: Nomi Health Commercial |
$132.15
|
| Rate for Payer: PACE Senior Care Partners |
$38.28
|
| Rate for Payer: PACE SWMI |
$40.29
|
| Rate for Payer: PHP Commercial |
$136.99
|
| Rate for Payer: PHP Medicare Advantage |
$40.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.75
|
| Rate for Payer: Priority Health HMO/PPO |
$140.21
|
| Rate for Payer: Priority Health Medicare |
$40.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.98
|
| Rate for Payer: Railroad Medicare Medicare |
$40.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.82
|
| Rate for Payer: UHC Core |
$134.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.29
|
| Rate for Payer: UHC Exchange |
$40.29
|
| Rate for Payer: UHC Medicare Advantage |
$40.29
|
| Rate for Payer: UHCCP Medicaid |
$13.99
|
| Rate for Payer: VA VA |
$40.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.87
|
|
|
HC HUM/AEROSOL CONTINUOUS
|
Facility
|
OP
|
$379.19
|
|
| Hospital Charge Code |
27000115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.06 |
| Max. Negotiated Rate |
$341.27 |
| Rate for Payer: Aetna Commercial |
$322.31
|
| Rate for Payer: Aetna Medicare |
$98.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.50
|
| Rate for Payer: BCBS Complete |
$151.68
|
| Rate for Payer: BCBS MAPPO |
$94.80
|
| Rate for Payer: BCBS Trust/PPO |
$311.73
|
| Rate for Payer: BCN Commercial |
$294.82
|
| Rate for Payer: BCN Medicare Advantage |
$94.80
|
| Rate for Payer: Cash Price |
$303.35
|
| Rate for Payer: Cofinity Commercial |
$326.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.80
|
| Rate for Payer: Healthscope Commercial |
$341.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.31
|
| Rate for Payer: Nomi Health Commercial |
$310.94
|
| Rate for Payer: PACE Senior Care Partners |
$90.06
|
| Rate for Payer: PACE SWMI |
$94.80
|
| Rate for Payer: PHP Commercial |
$322.31
|
| Rate for Payer: PHP Medicare Advantage |
$94.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.47
|
| Rate for Payer: Priority Health HMO/PPO |
$329.90
|
| Rate for Payer: Priority Health Medicare |
$95.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.06
|
| Rate for Payer: Railroad Medicare Medicare |
$94.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.69
|
| Rate for Payer: UHC Core |
$316.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.80
|
| Rate for Payer: UHC Exchange |
$94.80
|
| Rate for Payer: UHC Medicare Advantage |
$94.80
|
| Rate for Payer: VA VA |
$94.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.39
|
|
|
HC HUM/AEROSOL CONTINUOUS
|
Facility
|
IP
|
$379.19
|
|
| Hospital Charge Code |
27000115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$341.27 |
| Rate for Payer: Aetna Commercial |
$322.31
|
| Rate for Payer: BCBS Trust/PPO |
$309.53
|
| Rate for Payer: BCN Commercial |
$293.04
|
| Rate for Payer: Cash Price |
$303.35
|
| Rate for Payer: Cofinity Commercial |
$326.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.35
|
| Rate for Payer: Healthscope Commercial |
$341.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.31
|
| Rate for Payer: Nomi Health Commercial |
$310.94
|
| Rate for Payer: PHP Commercial |
$322.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.47
|
| Rate for Payer: Priority Health HMO/PPO |
$329.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.69
|
| Rate for Payer: UHC Core |
$316.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.39
|
|
|
HC HUMAN HERPESVIRUS 6 (HHV-6)
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
30600272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC HUMAN HERPESVIRUS 6 (HHV-6)
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87532
|
| Hospital Charge Code |
30600272
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.01
|
| Rate for Payer: UHC Exchange |
$13.01
|
| Rate for Payer: UHC Medicare Advantage |
$13.01
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC HUMAN PAPILLOMAVIRUS HIGH RISK
|
Facility
|
OP
|
$99.07
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
30600221
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$89.16 |
| Rate for Payer: Aetna Commercial |
$84.21
|
| Rate for Payer: Aetna Medicare |
$25.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.96
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$24.77
|
| Rate for Payer: BCBS Trust/PPO |
$81.45
|
| Rate for Payer: BCN Commercial |
$77.03
|
| Rate for Payer: BCN Medicare Advantage |
$24.77
|
| Rate for Payer: Cash Price |
$79.26
|
| Rate for Payer: Cash Price |
$79.26
|
| Rate for Payer: Cofinity Commercial |
$85.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.77
|
| Rate for Payer: Healthscope Commercial |
$89.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.30
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.01
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.21
|
| Rate for Payer: Nomi Health Commercial |
$81.24
|
| Rate for Payer: PACE Senior Care Partners |
$23.53
|
| Rate for Payer: PACE SWMI |
$24.77
|
| Rate for Payer: PHP Commercial |
$84.21
|
| Rate for Payer: PHP Medicare Advantage |
$24.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health HMO/PPO |
$86.19
|
| Rate for Payer: Priority Health Medicare |
$25.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.38
|
| Rate for Payer: Railroad Medicare Medicare |
$24.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.18
|
| Rate for Payer: UHC Core |
$82.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.77
|
| Rate for Payer: UHC Exchange |
$24.77
|
| Rate for Payer: UHC Medicare Advantage |
$24.77
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$24.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.30
|
|
|
HC HUMAN PAPILLOMAVIRUS HIGH RISK
|
Facility
|
IP
|
$99.07
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
30600221
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$89.16 |
| Rate for Payer: Aetna Commercial |
$84.21
|
| Rate for Payer: BCBS Trust/PPO |
$80.87
|
| Rate for Payer: BCN Commercial |
$76.56
|
| Rate for Payer: Cash Price |
$79.26
|
| Rate for Payer: Cofinity Commercial |
$85.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.26
|
| Rate for Payer: Healthscope Commercial |
$89.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.21
|
| Rate for Payer: Nomi Health Commercial |
$81.24
|
| Rate for Payer: PHP Commercial |
$84.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health HMO/PPO |
$86.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.18
|
| Rate for Payer: UHC Core |
$82.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.30
|
|
|
HC HUMAN PARECHOVIRUS
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600273
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC HUMAN PARECHOVIRUS
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600273
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.01
|
| Rate for Payer: UHC Exchange |
$13.01
|
| Rate for Payer: UHC Medicare Advantage |
$13.01
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC HYALUORAN OR DERIVATIVE, SYN OR SYN1, INTRA-ARTICULAR INJ, 1MG
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
63600107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC HYALUORAN OR DERIVATIVE, SYN OR SYN1, INTRA-ARTICULAR INJ, 1MG
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT J7325
|
| Hospital Charge Code |
63600107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$6.04
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$5.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$6.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.01
|
| Rate for Payer: UHC Exchange |
$13.01
|
| Rate for Payer: UHC Medicare Advantage |
$13.01
|
| Rate for Payer: UHCCP Medicaid |
$5.75
|
| Rate for Payer: VA VA |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC HYALURONAN FOR IA INJ PER DOSE
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.85 |
| Max. Negotiated Rate |
$278.10 |
| Rate for Payer: Aetna Commercial |
$262.65
|
| Rate for Payer: BCBS Trust/PPO |
$252.24
|
| Rate for Payer: BCN Commercial |
$238.80
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cofinity Commercial |
$265.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.20
|
| Rate for Payer: Healthscope Commercial |
$278.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.65
|
| Rate for Payer: Nomi Health Commercial |
$253.38
|
| Rate for Payer: PHP Commercial |
$262.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: Priority Health HMO/PPO |
$268.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.92
|
| Rate for Payer: UHC Core |
$258.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.75
|
|
|
HC HYALURONAN FOR IA INJ PER DOSE
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
63600157
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.39 |
| Max. Negotiated Rate |
$278.10 |
| Rate for Payer: Aetna Commercial |
$262.65
|
| Rate for Payer: Aetna Medicare |
$80.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.56
|
| Rate for Payer: BCBS Complete |
$123.60
|
| Rate for Payer: BCBS MAPPO |
$77.25
|
| Rate for Payer: BCBS Trust/PPO |
$254.03
|
| Rate for Payer: BCN Commercial |
$240.25
|
| Rate for Payer: BCN Medicare Advantage |
$77.25
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cofinity Commercial |
$265.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.25
|
| Rate for Payer: Healthscope Commercial |
$278.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.65
|
| Rate for Payer: Nomi Health Commercial |
$253.38
|
| Rate for Payer: PACE Senior Care Partners |
$73.39
|
| Rate for Payer: PACE SWMI |
$77.25
|
| Rate for Payer: PHP Commercial |
$262.65
|
| Rate for Payer: PHP Medicare Advantage |
$77.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: Priority Health HMO/PPO |
$268.83
|
| Rate for Payer: Priority Health Medicare |
$78.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.03
|
| Rate for Payer: Railroad Medicare Medicare |
$77.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.92
|
| Rate for Payer: UHC Core |
$258.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.25
|
| Rate for Payer: UHC Exchange |
$77.25
|
| Rate for Payer: UHC Medicare Advantage |
$77.25
|
| Rate for Payer: VA VA |
$77.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.75
|
|
|
HC HYALURONAN OR DERIVATIVE, DURALONE, INTRAARTICULAR INJ, 1MG
|
Facility
|
OP
|
$21.50
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: Aetna Medicare |
$5.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.72
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS MAPPO |
$5.38
|
| Rate for Payer: BCBS Trust/PPO |
$17.68
|
| Rate for Payer: BCN Commercial |
$16.72
|
| Rate for Payer: BCN Medicare Advantage |
$5.38
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Mclaren Medicaid |
$4.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.64
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Nomi Health Commercial |
$17.63
|
| Rate for Payer: PACE Senior Care Partners |
$5.11
|
| Rate for Payer: PACE SWMI |
$5.38
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.97
|
| Rate for Payer: Priority Health HMO/PPO |
$18.70
|
| Rate for Payer: Priority Health Medicare |
$5.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.40
|
| Rate for Payer: Railroad Medicare Medicare |
$5.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.92
|
| Rate for Payer: UHC Core |
$17.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.38
|
| Rate for Payer: UHC Exchange |
$5.38
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UHCCP Medicaid |
$4.89
|
| Rate for Payer: VA VA |
$5.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
|
|
HC HYALURONAN OR DERIVATIVE, DURALONE, INTRAARTICULAR INJ, 1MG
|
Facility
|
IP
|
$21.50
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
63600163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: BCBS Trust/PPO |
$17.55
|
| Rate for Payer: BCN Commercial |
$16.62
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Nomi Health Commercial |
$17.63
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.97
|
| Rate for Payer: Priority Health HMO/PPO |
$18.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.92
|
| Rate for Payer: UHC Core |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
|
|
HC HYALURONAN OR DERIVATIVE, GEL 1, INTRA-ARTICULAR INJ PER DOSE
|
Facility
|
OP
|
$1,394.14
|
|
|
Service Code
|
CPT J7326
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$331.11 |
| Max. Negotiated Rate |
$1,254.73 |
| Rate for Payer: Aetna Commercial |
$1,185.02
|
| Rate for Payer: Aetna Medicare |
$362.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$435.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$435.67
|
| Rate for Payer: BCBS Complete |
$401.81
|
| Rate for Payer: BCBS MAPPO |
$348.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,146.12
|
| Rate for Payer: BCN Commercial |
$1,083.94
|
| Rate for Payer: BCN Medicare Advantage |
$348.54
|
| Rate for Payer: Cash Price |
$1,115.31
|
| Rate for Payer: Cash Price |
$1,115.31
|
| Rate for Payer: Cofinity Commercial |
$1,198.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,115.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.54
|
| Rate for Payer: Healthscope Commercial |
$1,254.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,045.61
|
| Rate for Payer: Mclaren Medicaid |
$382.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.96
|
| Rate for Payer: Meridian Medicaid |
$401.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$400.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.02
|
| Rate for Payer: Nomi Health Commercial |
$1,143.19
|
| Rate for Payer: PACE Senior Care Partners |
$331.11
|
| Rate for Payer: PACE SWMI |
$348.54
|
| Rate for Payer: PHP Commercial |
$1,185.02
|
| Rate for Payer: PHP Medicare Advantage |
$348.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$382.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$906.19
|
| Rate for Payer: Priority Health HMO/PPO |
$1,212.90
|
| Rate for Payer: Priority Health Medicare |
$352.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$934.07
|
| Rate for Payer: Railroad Medicare Medicare |
$348.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,226.84
|
| Rate for Payer: UHC Core |
$1,164.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.54
|
| Rate for Payer: UHC Exchange |
$348.54
|
| Rate for Payer: UHC Medicare Advantage |
$348.54
|
| Rate for Payer: UHCCP Medicaid |
$382.65
|
| Rate for Payer: VA VA |
$348.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,045.61
|
|
|
HC HYALURONAN OR DERIVATIVE, GEL 1, INTRA-ARTICULAR INJ PER DOSE
|
Facility
|
IP
|
$1,394.14
|
|
|
Service Code
|
CPT J7326
|
| Hospital Charge Code |
63600108
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$906.19 |
| Max. Negotiated Rate |
$1,254.73 |
| Rate for Payer: Aetna Commercial |
$1,185.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,138.04
|
| Rate for Payer: BCN Commercial |
$1,077.39
|
| Rate for Payer: Cash Price |
$1,115.31
|
| Rate for Payer: Cofinity Commercial |
$1,198.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,115.31
|
| Rate for Payer: Healthscope Commercial |
$1,254.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,045.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.02
|
| Rate for Payer: Nomi Health Commercial |
$1,143.19
|
| Rate for Payer: PHP Commercial |
$1,185.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$906.19
|
| Rate for Payer: Priority Health HMO/PPO |
$1,212.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$934.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,226.84
|
| Rate for Payer: UHC Core |
$1,164.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,045.61
|
|
|
HC HYDROCODONE AND MTB, FREE
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Medicare |
$25.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.24
|
| Rate for Payer: BCBS Complete |
$39.98
|
| Rate for Payer: BCBS MAPPO |
$24.99
|
| Rate for Payer: BCBS Trust/PPO |
$82.18
|
| Rate for Payer: BCN Commercial |
$77.72
|
| Rate for Payer: BCN Medicare Advantage |
$24.99
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| Rate for Payer: PACE Senior Care Partners |
$23.74
|
| Rate for Payer: PACE SWMI |
$24.99
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: PHP Medicare Advantage |
$24.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health HMO/PPO |
$86.97
|
| Rate for Payer: Priority Health Medicare |
$25.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.97
|
| Rate for Payer: Railroad Medicare Medicare |
$24.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.96
|
| Rate for Payer: UHC Core |
$83.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.99
|
| Rate for Payer: UHC Exchange |
$24.99
|
| Rate for Payer: UHC Medicare Advantage |
$24.99
|
| Rate for Payer: VA VA |
$24.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.97
|
|
|
HC HYDROCODONE AND MTB, FREE
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100685
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: BCBS Trust/PPO |
$81.60
|
| Rate for Payer: BCN Commercial |
$77.25
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health HMO/PPO |
$86.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.96
|
| Rate for Payer: UHC Core |
$83.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.97
|
|
|
HC HYDROCORTIZONE CREAM
|
Facility
|
OP
|
$9.92
|
|
| Hospital Charge Code |
27000116
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Aetna Commercial |
$8.43
|
| Rate for Payer: Aetna Medicare |
$2.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.10
|
| Rate for Payer: BCBS Complete |
$3.97
|
| Rate for Payer: BCBS MAPPO |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$8.16
|
| Rate for Payer: BCN Commercial |
$7.71
|
| Rate for Payer: BCN Medicare Advantage |
$2.48
|
| Rate for Payer: Cash Price |
$7.94
|
| Rate for Payer: Cofinity Commercial |
$8.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.48
|
| Rate for Payer: Healthscope Commercial |
$8.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.43
|
| Rate for Payer: Nomi Health Commercial |
$8.13
|
| Rate for Payer: PACE Senior Care Partners |
$2.36
|
| Rate for Payer: PACE SWMI |
$2.48
|
| Rate for Payer: PHP Commercial |
$8.43
|
| Rate for Payer: PHP Medicare Advantage |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.45
|
| Rate for Payer: Priority Health HMO/PPO |
$8.63
|
| Rate for Payer: Priority Health Medicare |
$2.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.65
|
| Rate for Payer: Railroad Medicare Medicare |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.73
|
| Rate for Payer: UHC Core |
$8.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.48
|
| Rate for Payer: UHC Exchange |
$2.48
|
| Rate for Payer: UHC Medicare Advantage |
$2.48
|
| Rate for Payer: VA VA |
$2.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.44
|
|
|
HC HYDROCORTIZONE CREAM
|
Facility
|
IP
|
$9.92
|
|
| Hospital Charge Code |
27000116
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Aetna Commercial |
$8.43
|
| Rate for Payer: BCBS Trust/PPO |
$8.10
|
| Rate for Payer: BCN Commercial |
$7.67
|
| Rate for Payer: Cash Price |
$7.94
|
| Rate for Payer: Cofinity Commercial |
$8.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.94
|
| Rate for Payer: Healthscope Commercial |
$8.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.43
|
| Rate for Payer: Nomi Health Commercial |
$8.13
|
| Rate for Payer: PHP Commercial |
$8.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.45
|
| Rate for Payer: Priority Health HMO/PPO |
$8.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.73
|
| Rate for Payer: UHC Core |
$8.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.44
|
|
|
HC HYDRODISSECTION TENDON LEG/ANKLE
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
76100417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$605.88 |
| Rate for Payer: Aetna Commercial |
$572.22
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: BCBS Complete |
$182.12
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$553.44
|
| Rate for Payer: BCN Commercial |
$523.41
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$578.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Healthscope Commercial |
$605.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.90
|
| Rate for Payer: Mclaren Medicaid |
$173.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Medicaid |
$182.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PACE Senior Care Partners |
$159.88
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PHP Commercial |
$572.22
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO |
$585.68
|
| Rate for Payer: Priority Health Medicare |
$169.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.04
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.42
|
| Rate for Payer: UHC Core |
$562.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Exchange |
$168.30
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: UHCCP Medicaid |
$173.43
|
| Rate for Payer: VA VA |
$168.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.90
|
|
|
HC HYDRODISSECTION TENDON LEG/ANKLE
|
Facility
|
IP
|
$673.20
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
76100417
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$605.88 |
| Rate for Payer: Aetna Commercial |
$572.22
|
| Rate for Payer: BCBS Trust/PPO |
$549.53
|
| Rate for Payer: BCN Commercial |
$520.25
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$578.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Healthscope Commercial |
$605.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PHP Commercial |
$572.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO |
$585.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.42
|
| Rate for Payer: UHC Core |
$562.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.90
|
|
|
HC HYDROXYPREGNENOLONE 17
|
Facility
|
OP
|
$88.74
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
30100399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$79.87 |
| Rate for Payer: Aetna Commercial |
$75.43
|
| Rate for Payer: Aetna Medicare |
$23.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.73
|
| Rate for Payer: BCBS Complete |
$17.32
|
| Rate for Payer: BCBS MAPPO |
$22.18
|
| Rate for Payer: BCBS Trust/PPO |
$72.95
|
| Rate for Payer: BCN Commercial |
$69.00
|
| Rate for Payer: BCN Medicare Advantage |
$22.18
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$76.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.18
|
| Rate for Payer: Healthscope Commercial |
$79.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.56
|
| Rate for Payer: Mclaren Medicaid |
$16.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.29
|
| Rate for Payer: Meridian Medicaid |
$17.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.43
|
| Rate for Payer: Nomi Health Commercial |
$72.77
|
| Rate for Payer: PACE Senior Care Partners |
$21.08
|
| Rate for Payer: PACE SWMI |
$22.18
|
| Rate for Payer: PHP Commercial |
$75.43
|
| Rate for Payer: PHP Medicare Advantage |
$22.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.68
|
| Rate for Payer: Priority Health HMO/PPO |
$77.20
|
| Rate for Payer: Priority Health Medicare |
$22.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.46
|
| Rate for Payer: Railroad Medicare Medicare |
$22.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.09
|
| Rate for Payer: UHC Core |
$74.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.18
|
| Rate for Payer: UHC Exchange |
$22.18
|
| Rate for Payer: UHC Medicare Advantage |
$22.18
|
| Rate for Payer: UHCCP Medicaid |
$16.49
|
| Rate for Payer: VA VA |
$22.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.56
|
|
