|
HC IUPC ASSIST
|
Facility
|
OP
|
$122.11
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.53 |
| Max. Negotiated Rate |
$109.90 |
| Rate for Payer: Aetna Commercial |
$103.79
|
| Rate for Payer: Aetna Medicare |
$31.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.16
|
| Rate for Payer: BCBS Complete |
$22.60
|
| Rate for Payer: BCBS MAPPO |
$30.53
|
| Rate for Payer: BCBS Trust/PPO |
$100.39
|
| Rate for Payer: BCN Commercial |
$100.39
|
| Rate for Payer: BCN Medicare Advantage |
$30.53
|
| Rate for Payer: Cash Price |
$97.69
|
| Rate for Payer: Cofinity Commercial |
$105.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.53
|
| Rate for Payer: Healthscope Commercial |
$109.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.58
|
| Rate for Payer: Mclaren Medicaid |
$21.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.05
|
| Rate for Payer: Meridian Medicaid |
$22.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.79
|
| Rate for Payer: Nomi Health Commercial |
$100.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.58
|
| Rate for Payer: PACE Senior Care Partners |
$29.00
|
| Rate for Payer: PACE SWMI |
$30.53
|
| Rate for Payer: PHP Commercial |
$103.79
|
| Rate for Payer: PHP Medicare Advantage |
$30.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$106.24
|
| Rate for Payer: Priority Health Medicare |
$30.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.99
|
| Rate for Payer: Railroad Medicare Medicare |
$30.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.46
|
| Rate for Payer: UHC Core |
$101.96
|
| Rate for Payer: UHC Exchange |
$30.53
|
| Rate for Payer: UHC Medicaid |
$21.53
|
| Rate for Payer: UHC Medicare Advantage |
$30.53
|
| Rate for Payer: UHCCP Medicaid |
$21.53
|
| Rate for Payer: VA VA |
$30.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.58
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
OP
|
$207.64
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$36.61 |
| Max. Negotiated Rate |
$186.88 |
| Rate for Payer: Aetna Commercial |
$176.49
|
| Rate for Payer: Aetna Medicare |
$53.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.89
|
| Rate for Payer: BCBS Complete |
$38.43
|
| Rate for Payer: BCBS MAPPO |
$51.91
|
| Rate for Payer: BCBS Trust/PPO |
$170.70
|
| Rate for Payer: BCN Commercial |
$170.70
|
| Rate for Payer: BCN Medicare Advantage |
$51.91
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cofinity Commercial |
$178.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.91
|
| Rate for Payer: Healthscope Commercial |
$186.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.73
|
| Rate for Payer: Mclaren Medicaid |
$36.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.51
|
| Rate for Payer: Meridian Medicaid |
$38.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.49
|
| Rate for Payer: Nomi Health Commercial |
$170.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.73
|
| Rate for Payer: PACE Senior Care Partners |
$49.31
|
| Rate for Payer: PACE SWMI |
$51.91
|
| Rate for Payer: PHP Commercial |
$176.49
|
| Rate for Payer: PHP Medicare Advantage |
$51.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$180.65
|
| Rate for Payer: Priority Health Medicare |
$52.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.52
|
| Rate for Payer: Railroad Medicare Medicare |
$51.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.72
|
| Rate for Payer: UHC Core |
$173.38
|
| Rate for Payer: UHC Exchange |
$51.91
|
| Rate for Payer: UHC Medicaid |
$36.61
|
| Rate for Payer: UHC Medicare Advantage |
$51.91
|
| Rate for Payer: UHCCP Medicaid |
$36.61
|
| Rate for Payer: VA VA |
$51.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.73
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
IP
|
$207.64
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$144.52 |
| Max. Negotiated Rate |
$186.88 |
| Rate for Payer: Aetna Commercial |
$176.49
|
| Rate for Payer: BCBS Trust/PPO |
$171.49
|
| Rate for Payer: BCN Commercial |
$171.49
|
| Rate for Payer: Cash Price |
$166.11
|
| Rate for Payer: Cofinity Commercial |
$178.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.11
|
| Rate for Payer: Healthscope Commercial |
$186.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.49
|
| Rate for Payer: Nomi Health Commercial |
$170.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.73
|
| Rate for Payer: PHP Commercial |
$176.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$180.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.72
|
| Rate for Payer: UHC Core |
$173.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.73
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
OP
|
$520.44
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$91.75 |
| Max. Negotiated Rate |
$468.40 |
| Rate for Payer: Aetna Commercial |
$442.37
|
| Rate for Payer: Aetna Medicare |
$135.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.64
|
| Rate for Payer: BCBS Complete |
$96.33
|
| Rate for Payer: BCBS MAPPO |
$130.11
|
| Rate for Payer: BCBS Trust/PPO |
$427.85
|
| Rate for Payer: BCN Commercial |
$427.85
|
| Rate for Payer: BCN Medicare Advantage |
$130.11
|
| Rate for Payer: Cash Price |
$416.35
|
| Rate for Payer: Cofinity Commercial |
$447.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.11
|
| Rate for Payer: Healthscope Commercial |
$468.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.33
|
| Rate for Payer: Mclaren Medicaid |
$91.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.62
|
| Rate for Payer: Meridian Medicaid |
$96.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.37
|
| Rate for Payer: Nomi Health Commercial |
$426.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.33
|
| Rate for Payer: PACE Senior Care Partners |
$123.60
|
| Rate for Payer: PACE SWMI |
$130.11
|
| Rate for Payer: PHP Commercial |
$442.37
|
| Rate for Payer: PHP Medicare Advantage |
$130.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$452.78
|
| Rate for Payer: Priority Health Medicare |
$131.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.23
|
| Rate for Payer: Railroad Medicare Medicare |
$130.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.99
|
| Rate for Payer: UHC Core |
$434.57
|
| Rate for Payer: UHC Exchange |
$130.11
|
| Rate for Payer: UHC Medicaid |
$91.75
|
| Rate for Payer: UHC Medicare Advantage |
$130.11
|
| Rate for Payer: UHCCP Medicaid |
$91.75
|
| Rate for Payer: VA VA |
$130.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.33
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
IP
|
$520.44
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$362.23 |
| Max. Negotiated Rate |
$468.40 |
| Rate for Payer: Aetna Commercial |
$442.37
|
| Rate for Payer: BCBS Trust/PPO |
$429.83
|
| Rate for Payer: BCN Commercial |
$429.83
|
| Rate for Payer: Cash Price |
$416.35
|
| Rate for Payer: Cofinity Commercial |
$447.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.35
|
| Rate for Payer: Healthscope Commercial |
$468.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.37
|
| Rate for Payer: Nomi Health Commercial |
$426.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.33
|
| Rate for Payer: PHP Commercial |
$442.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$452.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.99
|
| Rate for Payer: UHC Core |
$434.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.33
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$34.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.12
|
| Rate for Payer: BCBS Complete |
$24.36
|
| Rate for Payer: BCBS MAPPO |
$32.90
|
| Rate for Payer: BCBS Trust/PPO |
$108.19
|
| Rate for Payer: BCN Commercial |
$108.19
|
| Rate for Payer: BCN Medicare Advantage |
$32.90
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.90
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Mclaren Medicaid |
$23.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.55
|
| Rate for Payer: Meridian Medicaid |
$24.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Nomi Health Commercial |
$107.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PACE Senior Care Partners |
$31.25
|
| Rate for Payer: PACE SWMI |
$32.90
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: PHP Medicare Advantage |
$32.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.49
|
| Rate for Payer: Priority Health Medicare |
$33.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.59
|
| Rate for Payer: Railroad Medicare Medicare |
$32.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.81
|
| Rate for Payer: UHC Core |
$109.89
|
| Rate for Payer: UHC Exchange |
$32.90
|
| Rate for Payer: UHC Medicaid |
$23.20
|
| Rate for Payer: UHC Medicare Advantage |
$32.90
|
| Rate for Payer: UHCCP Medicaid |
$23.20
|
| Rate for Payer: VA VA |
$32.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$91.59 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: BCBS Trust/PPO |
$108.69
|
| Rate for Payer: BCN Commercial |
$108.69
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Nomi Health Commercial |
$107.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$114.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.81
|
| Rate for Payer: UHC Core |
$109.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
IP
|
$276.35
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$192.34 |
| Max. Negotiated Rate |
$248.72 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: BCBS Trust/PPO |
$228.24
|
| Rate for Payer: BCN Commercial |
$228.24
|
| Rate for Payer: Cash Price |
$221.08
|
| Rate for Payer: Cofinity Commercial |
$237.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.08
|
| Rate for Payer: Healthscope Commercial |
$248.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.90
|
| Rate for Payer: Nomi Health Commercial |
$226.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.26
|
| Rate for Payer: PHP Commercial |
$234.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.19
|
| Rate for Payer: UHC Core |
$230.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.26
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
OP
|
$276.35
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$48.72 |
| Max. Negotiated Rate |
$248.72 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Medicare |
$71.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.36
|
| Rate for Payer: BCBS Complete |
$51.15
|
| Rate for Payer: BCBS MAPPO |
$69.09
|
| Rate for Payer: BCBS Trust/PPO |
$227.19
|
| Rate for Payer: BCN Commercial |
$227.19
|
| Rate for Payer: BCN Medicare Advantage |
$69.09
|
| Rate for Payer: Cash Price |
$221.08
|
| Rate for Payer: Cofinity Commercial |
$237.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.09
|
| Rate for Payer: Healthscope Commercial |
$248.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.26
|
| Rate for Payer: Mclaren Medicaid |
$48.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.54
|
| Rate for Payer: Meridian Medicaid |
$51.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.90
|
| Rate for Payer: Nomi Health Commercial |
$226.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.26
|
| Rate for Payer: PACE Senior Care Partners |
$65.63
|
| Rate for Payer: PACE SWMI |
$69.09
|
| Rate for Payer: PHP Commercial |
$234.90
|
| Rate for Payer: PHP Medicare Advantage |
$69.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$240.42
|
| Rate for Payer: Priority Health Medicare |
$69.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.34
|
| Rate for Payer: Railroad Medicare Medicare |
$69.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.19
|
| Rate for Payer: UHC Core |
$230.75
|
| Rate for Payer: UHC Exchange |
$69.09
|
| Rate for Payer: UHC Medicaid |
$48.72
|
| Rate for Payer: UHC Medicare Advantage |
$69.09
|
| Rate for Payer: UHCCP Medicaid |
$48.72
|
| Rate for Payer: VA VA |
$69.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.26
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
IP
|
$701.93
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$488.54 |
| Max. Negotiated Rate |
$631.74 |
| Rate for Payer: Aetna Commercial |
$596.64
|
| Rate for Payer: BCBS Trust/PPO |
$579.72
|
| Rate for Payer: BCN Commercial |
$579.72
|
| Rate for Payer: Cash Price |
$561.54
|
| Rate for Payer: Cofinity Commercial |
$603.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.54
|
| Rate for Payer: Healthscope Commercial |
$631.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.64
|
| Rate for Payer: Nomi Health Commercial |
$575.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.45
|
| Rate for Payer: PHP Commercial |
$596.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$610.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.70
|
| Rate for Payer: UHC Core |
$586.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.45
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
OP
|
$701.93
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$631.74 |
| Rate for Payer: Aetna Commercial |
$596.64
|
| Rate for Payer: Aetna Medicare |
$182.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$219.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$219.35
|
| Rate for Payer: BCBS Complete |
$129.93
|
| Rate for Payer: BCBS MAPPO |
$175.48
|
| Rate for Payer: BCBS Trust/PPO |
$577.06
|
| Rate for Payer: BCN Commercial |
$577.06
|
| Rate for Payer: BCN Medicare Advantage |
$175.48
|
| Rate for Payer: Cash Price |
$561.54
|
| Rate for Payer: Cofinity Commercial |
$603.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.48
|
| Rate for Payer: Healthscope Commercial |
$631.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$526.45
|
| Rate for Payer: Mclaren Medicaid |
$123.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.26
|
| Rate for Payer: Meridian Medicaid |
$129.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.64
|
| Rate for Payer: Nomi Health Commercial |
$575.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.45
|
| Rate for Payer: PACE Senior Care Partners |
$166.71
|
| Rate for Payer: PACE SWMI |
$175.48
|
| Rate for Payer: PHP Commercial |
$596.64
|
| Rate for Payer: PHP Medicare Advantage |
$175.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$610.68
|
| Rate for Payer: Priority Health Medicare |
$177.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$488.54
|
| Rate for Payer: Railroad Medicare Medicare |
$175.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.70
|
| Rate for Payer: UHC Core |
$586.11
|
| Rate for Payer: UHC Exchange |
$175.48
|
| Rate for Payer: UHC Medicaid |
$123.75
|
| Rate for Payer: UHC Medicare Advantage |
$175.48
|
| Rate for Payer: UHCCP Medicaid |
$123.75
|
| Rate for Payer: VA VA |
$175.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$526.45
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$96.17 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna Medicare |
$141.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.46
|
| Rate for Payer: BCBS Complete |
$100.97
|
| Rate for Payer: BCBS MAPPO |
$136.37
|
| Rate for Payer: BCBS Trust/PPO |
$448.43
|
| Rate for Payer: BCN Commercial |
$448.43
|
| Rate for Payer: BCN Medicare Advantage |
$136.37
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.37
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.10
|
| Rate for Payer: Mclaren Medicaid |
$96.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.19
|
| Rate for Payer: Meridian Medicaid |
$100.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PACE Senior Care Partners |
$129.55
|
| Rate for Payer: PACE SWMI |
$136.37
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: PHP Medicare Advantage |
$136.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.56
|
| Rate for Payer: Priority Health Medicare |
$137.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: Railroad Medicare Medicare |
$136.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.01
|
| Rate for Payer: UHC Core |
$455.47
|
| Rate for Payer: UHC Exchange |
$136.37
|
| Rate for Payer: UHC Medicaid |
$96.17
|
| Rate for Payer: UHC Medicare Advantage |
$136.37
|
| Rate for Payer: UHCCP Medicaid |
$96.17
|
| Rate for Payer: VA VA |
$136.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.10
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$379.65 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: BCBS Trust/PPO |
$450.50
|
| Rate for Payer: BCN Commercial |
$450.50
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.01
|
| Rate for Payer: UHC Core |
$455.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.10
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
OP
|
$545.47
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$96.17 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: Aetna Medicare |
$141.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.46
|
| Rate for Payer: BCBS Complete |
$100.97
|
| Rate for Payer: BCBS MAPPO |
$136.37
|
| Rate for Payer: BCBS Trust/PPO |
$448.43
|
| Rate for Payer: BCN Commercial |
$448.43
|
| Rate for Payer: BCN Medicare Advantage |
$136.37
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.37
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.10
|
| Rate for Payer: Mclaren Medicaid |
$96.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.19
|
| Rate for Payer: Meridian Medicaid |
$100.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PACE Senior Care Partners |
$129.55
|
| Rate for Payer: PACE SWMI |
$136.37
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: PHP Medicare Advantage |
$136.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.56
|
| Rate for Payer: Priority Health Medicare |
$137.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: Railroad Medicare Medicare |
$136.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.01
|
| Rate for Payer: UHC Core |
$455.47
|
| Rate for Payer: UHC Exchange |
$136.37
|
| Rate for Payer: UHC Medicaid |
$96.17
|
| Rate for Payer: UHC Medicare Advantage |
$136.37
|
| Rate for Payer: UHCCP Medicaid |
$96.17
|
| Rate for Payer: VA VA |
$136.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.10
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
IP
|
$545.47
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$379.65 |
| Max. Negotiated Rate |
$490.92 |
| Rate for Payer: Aetna Commercial |
$463.65
|
| Rate for Payer: BCBS Trust/PPO |
$450.50
|
| Rate for Payer: BCN Commercial |
$450.50
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.10
|
| Rate for Payer: PHP Commercial |
$463.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.01
|
| Rate for Payer: UHC Core |
$455.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.10
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
IP
|
$177.14
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$123.29 |
| Max. Negotiated Rate |
$159.43 |
| Rate for Payer: Aetna Commercial |
$150.57
|
| Rate for Payer: BCBS Trust/PPO |
$146.30
|
| Rate for Payer: BCN Commercial |
$146.30
|
| Rate for Payer: Cash Price |
$141.71
|
| Rate for Payer: Cofinity Commercial |
$152.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.71
|
| Rate for Payer: Healthscope Commercial |
$159.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.57
|
| Rate for Payer: Nomi Health Commercial |
$145.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.85
|
| Rate for Payer: PHP Commercial |
$150.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$154.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.88
|
| Rate for Payer: UHC Core |
$147.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.85
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
OP
|
$177.14
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.23 |
| Max. Negotiated Rate |
$159.43 |
| Rate for Payer: Aetna Commercial |
$150.57
|
| Rate for Payer: Aetna Medicare |
$46.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.36
|
| Rate for Payer: BCBS Complete |
$32.79
|
| Rate for Payer: BCBS MAPPO |
$44.28
|
| Rate for Payer: BCBS Trust/PPO |
$145.63
|
| Rate for Payer: BCN Commercial |
$145.63
|
| Rate for Payer: BCN Medicare Advantage |
$44.28
|
| Rate for Payer: Cash Price |
$141.71
|
| Rate for Payer: Cofinity Commercial |
$152.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.28
|
| Rate for Payer: Healthscope Commercial |
$159.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.85
|
| Rate for Payer: Mclaren Medicaid |
$31.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.50
|
| Rate for Payer: Meridian Medicaid |
$32.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.57
|
| Rate for Payer: Nomi Health Commercial |
$145.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.85
|
| Rate for Payer: PACE Senior Care Partners |
$42.07
|
| Rate for Payer: PACE SWMI |
$44.28
|
| Rate for Payer: PHP Commercial |
$150.57
|
| Rate for Payer: PHP Medicare Advantage |
$44.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$154.11
|
| Rate for Payer: Priority Health Medicare |
$44.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.29
|
| Rate for Payer: Railroad Medicare Medicare |
$44.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.88
|
| Rate for Payer: UHC Core |
$147.91
|
| Rate for Payer: UHC Exchange |
$44.28
|
| Rate for Payer: UHC Medicaid |
$31.23
|
| Rate for Payer: UHC Medicare Advantage |
$44.28
|
| Rate for Payer: UHCCP Medicaid |
$31.23
|
| Rate for Payer: VA VA |
$44.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.85
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
OP
|
$198.43
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$34.98 |
| Max. Negotiated Rate |
$178.59 |
| Rate for Payer: Aetna Commercial |
$168.67
|
| Rate for Payer: Aetna Medicare |
$51.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.01
|
| Rate for Payer: BCBS Complete |
$36.73
|
| Rate for Payer: BCBS MAPPO |
$49.61
|
| Rate for Payer: BCBS Trust/PPO |
$163.13
|
| Rate for Payer: BCN Commercial |
$163.13
|
| Rate for Payer: BCN Medicare Advantage |
$49.61
|
| Rate for Payer: Cash Price |
$158.74
|
| Rate for Payer: Cofinity Commercial |
$170.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.61
|
| Rate for Payer: Healthscope Commercial |
$178.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.82
|
| Rate for Payer: Mclaren Medicaid |
$34.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.09
|
| Rate for Payer: Meridian Medicaid |
$36.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.67
|
| Rate for Payer: Nomi Health Commercial |
$162.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.82
|
| Rate for Payer: PACE Senior Care Partners |
$47.13
|
| Rate for Payer: PACE SWMI |
$49.61
|
| Rate for Payer: PHP Commercial |
$168.67
|
| Rate for Payer: PHP Medicare Advantage |
$49.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$172.63
|
| Rate for Payer: Priority Health Medicare |
$50.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.11
|
| Rate for Payer: Railroad Medicare Medicare |
$49.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.62
|
| Rate for Payer: UHC Core |
$165.69
|
| Rate for Payer: UHC Exchange |
$49.61
|
| Rate for Payer: UHC Medicaid |
$34.98
|
| Rate for Payer: UHC Medicare Advantage |
$49.61
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$49.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.82
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
IP
|
$198.43
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$138.11 |
| Max. Negotiated Rate |
$178.59 |
| Rate for Payer: Aetna Commercial |
$168.67
|
| Rate for Payer: BCBS Trust/PPO |
$163.88
|
| Rate for Payer: BCN Commercial |
$163.88
|
| Rate for Payer: Cash Price |
$158.74
|
| Rate for Payer: Cofinity Commercial |
$170.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.74
|
| Rate for Payer: Healthscope Commercial |
$178.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.67
|
| Rate for Payer: Nomi Health Commercial |
$162.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.82
|
| Rate for Payer: PHP Commercial |
$168.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$172.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.62
|
| Rate for Payer: UHC Core |
$165.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.82
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
IP
|
$545.48
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$379.65 |
| Max. Negotiated Rate |
$490.93 |
| Rate for Payer: Aetna Commercial |
$463.66
|
| Rate for Payer: BCBS Trust/PPO |
$450.51
|
| Rate for Payer: BCN Commercial |
$450.51
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Healthscope Commercial |
$490.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.66
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.11
|
| Rate for Payer: PHP Commercial |
$463.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.02
|
| Rate for Payer: UHC Core |
$455.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.11
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
OP
|
$545.48
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$96.17 |
| Max. Negotiated Rate |
$490.93 |
| Rate for Payer: Aetna Commercial |
$463.66
|
| Rate for Payer: Aetna Medicare |
$141.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.46
|
| Rate for Payer: BCBS Complete |
$100.97
|
| Rate for Payer: BCBS MAPPO |
$136.37
|
| Rate for Payer: BCBS Trust/PPO |
$448.44
|
| Rate for Payer: BCN Commercial |
$448.44
|
| Rate for Payer: BCN Medicare Advantage |
$136.37
|
| Rate for Payer: Cash Price |
$436.38
|
| Rate for Payer: Cofinity Commercial |
$469.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.37
|
| Rate for Payer: Healthscope Commercial |
$490.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.11
|
| Rate for Payer: Mclaren Medicaid |
$96.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.19
|
| Rate for Payer: Meridian Medicaid |
$100.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.66
|
| Rate for Payer: Nomi Health Commercial |
$447.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.11
|
| Rate for Payer: PACE Senior Care Partners |
$129.55
|
| Rate for Payer: PACE SWMI |
$136.37
|
| Rate for Payer: PHP Commercial |
$463.66
|
| Rate for Payer: PHP Medicare Advantage |
$136.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.57
|
| Rate for Payer: Priority Health Medicare |
$137.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.65
|
| Rate for Payer: Railroad Medicare Medicare |
$136.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.02
|
| Rate for Payer: UHC Core |
$455.48
|
| Rate for Payer: UHC Exchange |
$136.37
|
| Rate for Payer: UHC Medicaid |
$96.17
|
| Rate for Payer: UHC Medicare Advantage |
$136.37
|
| Rate for Payer: UHCCP Medicaid |
$96.17
|
| Rate for Payer: VA VA |
$136.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.11
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
IP
|
$85.41
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.45 |
| Max. Negotiated Rate |
$76.87 |
| Rate for Payer: Aetna Commercial |
$72.60
|
| Rate for Payer: BCBS Trust/PPO |
$70.54
|
| Rate for Payer: BCN Commercial |
$70.54
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cofinity Commercial |
$73.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$76.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.60
|
| Rate for Payer: Nomi Health Commercial |
$70.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.06
|
| Rate for Payer: PHP Commercial |
$72.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.16
|
| Rate for Payer: UHC Core |
$71.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.06
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
OP
|
$85.41
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$76.87 |
| Rate for Payer: Aetna Commercial |
$72.60
|
| Rate for Payer: Aetna Medicare |
$22.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.69
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: BCBS MAPPO |
$21.35
|
| Rate for Payer: BCBS Trust/PPO |
$70.22
|
| Rate for Payer: BCN Commercial |
$70.22
|
| Rate for Payer: BCN Medicare Advantage |
$21.35
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cofinity Commercial |
$73.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.35
|
| Rate for Payer: Healthscope Commercial |
$76.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.06
|
| Rate for Payer: Mclaren Medicaid |
$15.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.42
|
| Rate for Payer: Meridian Medicaid |
$15.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.60
|
| Rate for Payer: Nomi Health Commercial |
$70.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.06
|
| Rate for Payer: PACE Senior Care Partners |
$20.28
|
| Rate for Payer: PACE SWMI |
$21.35
|
| Rate for Payer: PHP Commercial |
$72.60
|
| Rate for Payer: PHP Medicare Advantage |
$21.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$74.31
|
| Rate for Payer: Priority Health Medicare |
$21.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.45
|
| Rate for Payer: Railroad Medicare Medicare |
$21.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.16
|
| Rate for Payer: UHC Core |
$71.32
|
| Rate for Payer: UHC Exchange |
$21.35
|
| Rate for Payer: UHC Medicaid |
$15.06
|
| Rate for Payer: UHC Medicare Advantage |
$21.35
|
| Rate for Payer: UHCCP Medicaid |
$15.06
|
| Rate for Payer: VA VA |
$21.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.06
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
OP
|
$87.43
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.41 |
| Max. Negotiated Rate |
$78.69 |
| Rate for Payer: Aetna Commercial |
$74.32
|
| Rate for Payer: Aetna Medicare |
$22.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.32
|
| Rate for Payer: BCBS Complete |
$16.18
|
| Rate for Payer: BCBS MAPPO |
$21.86
|
| Rate for Payer: BCBS Trust/PPO |
$71.88
|
| Rate for Payer: BCN Commercial |
$71.88
|
| Rate for Payer: BCN Medicare Advantage |
$21.86
|
| Rate for Payer: Cash Price |
$69.94
|
| Rate for Payer: Cofinity Commercial |
$75.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.86
|
| Rate for Payer: Healthscope Commercial |
$78.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.57
|
| Rate for Payer: Mclaren Medicaid |
$15.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.95
|
| Rate for Payer: Meridian Medicaid |
$16.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.32
|
| Rate for Payer: Nomi Health Commercial |
$71.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.57
|
| Rate for Payer: PACE Senior Care Partners |
$20.76
|
| Rate for Payer: PACE SWMI |
$21.86
|
| Rate for Payer: PHP Commercial |
$74.32
|
| Rate for Payer: PHP Medicare Advantage |
$21.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.06
|
| Rate for Payer: Priority Health Medicare |
$22.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.85
|
| Rate for Payer: Railroad Medicare Medicare |
$21.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.94
|
| Rate for Payer: UHC Core |
$73.00
|
| Rate for Payer: UHC Exchange |
$21.86
|
| Rate for Payer: UHC Medicaid |
$15.41
|
| Rate for Payer: UHC Medicare Advantage |
$21.86
|
| Rate for Payer: UHCCP Medicaid |
$15.41
|
| Rate for Payer: VA VA |
$21.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.57
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
IP
|
$87.43
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.85 |
| Max. Negotiated Rate |
$78.69 |
| Rate for Payer: Aetna Commercial |
$74.32
|
| Rate for Payer: BCBS Trust/PPO |
$72.21
|
| Rate for Payer: BCN Commercial |
$72.21
|
| Rate for Payer: Cash Price |
$69.94
|
| Rate for Payer: Cofinity Commercial |
$75.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.94
|
| Rate for Payer: Healthscope Commercial |
$78.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.32
|
| Rate for Payer: Nomi Health Commercial |
$71.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.57
|
| Rate for Payer: PHP Commercial |
$74.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.94
|
| Rate for Payer: UHC Core |
$73.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.57
|
|
