|
HC INJ BEBTELOVIMAB
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
HCPCS M0222
|
| Hospital Charge Code |
77100034
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$115.19 |
| Max. Negotiated Rate |
$436.50 |
| Rate for Payer: Aetna Commercial |
$412.25
|
| Rate for Payer: Aetna Medicare |
$126.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.56
|
| Rate for Payer: BCBS Complete |
$260.72
|
| Rate for Payer: BCBS MAPPO |
$121.25
|
| Rate for Payer: BCBS Trust/PPO |
$398.72
|
| Rate for Payer: BCN Commercial |
$377.09
|
| Rate for Payer: BCN Medicare Advantage |
$121.25
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$417.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.25
|
| Rate for Payer: Healthscope Commercial |
$436.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.75
|
| Rate for Payer: Mclaren Medicaid |
$248.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.31
|
| Rate for Payer: Meridian Medicaid |
$260.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.25
|
| Rate for Payer: Nomi Health Commercial |
$397.70
|
| Rate for Payer: PACE Senior Care Partners |
$115.19
|
| Rate for Payer: PACE SWMI |
$121.25
|
| Rate for Payer: PHP Commercial |
$412.25
|
| Rate for Payer: PHP Medicare Advantage |
$121.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$248.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health HMO/PPO |
$421.95
|
| Rate for Payer: Priority Health Medicare |
$122.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.95
|
| Rate for Payer: Railroad Medicare Medicare |
$121.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.80
|
| Rate for Payer: UHC Core |
$404.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.25
|
| Rate for Payer: UHC Exchange |
$121.25
|
| Rate for Payer: UHC Medicare Advantage |
$121.25
|
| Rate for Payer: UHCCP Medicaid |
$248.29
|
| Rate for Payer: VA VA |
$121.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.75
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC INJ,BETAMETHASONE ACT 3MG AND BETAMETASONE NA PHOS 3 MG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT J0702
|
| Hospital Charge Code |
63600089
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.07 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna Medicare |
$286.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$344.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$344.83
|
| Rate for Payer: BCBS Complete |
$662.24
|
| Rate for Payer: BCBS MAPPO |
$275.86
|
| Rate for Payer: BCBS Trust/PPO |
$907.15
|
| Rate for Payer: BCN Commercial |
$857.94
|
| Rate for Payer: BCN Medicare Advantage |
$275.86
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.86
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Mclaren Medicaid |
$630.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.66
|
| Rate for Payer: Meridian Medicaid |
$662.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PACE Senior Care Partners |
$262.07
|
| Rate for Payer: PACE SWMI |
$275.86
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: PHP Medicare Advantage |
$275.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO |
$960.01
|
| Rate for Payer: Priority Health Medicare |
$278.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.32
|
| Rate for Payer: Railroad Medicare Medicare |
$275.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.04
|
| Rate for Payer: UHC Core |
$921.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.86
|
| Rate for Payer: UHC Exchange |
$275.86
|
| Rate for Payer: UHC Medicare Advantage |
$275.86
|
| Rate for Payer: UHCCP Medicaid |
$630.67
|
| Rate for Payer: VA VA |
$275.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$717.25 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: BCBS Trust/PPO |
$900.75
|
| Rate for Payer: BCN Commercial |
$852.75
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO |
$960.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.04
|
| Rate for Payer: UHC Core |
$921.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$717.25 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: BCBS Trust/PPO |
$900.75
|
| Rate for Payer: BCN Commercial |
$852.75
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO |
$960.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.04
|
| Rate for Payer: UHC Core |
$921.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.07 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna Medicare |
$286.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$344.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$344.83
|
| Rate for Payer: BCBS Complete |
$662.24
|
| Rate for Payer: BCBS MAPPO |
$275.86
|
| Rate for Payer: BCBS Trust/PPO |
$907.15
|
| Rate for Payer: BCN Commercial |
$857.94
|
| Rate for Payer: BCN Medicare Advantage |
$275.86
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.86
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Mclaren Medicaid |
$630.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.66
|
| Rate for Payer: Meridian Medicaid |
$662.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PACE Senior Care Partners |
$262.07
|
| Rate for Payer: PACE SWMI |
$275.86
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: PHP Medicare Advantage |
$275.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO |
$960.01
|
| Rate for Payer: Priority Health Medicare |
$278.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.32
|
| Rate for Payer: Railroad Medicare Medicare |
$275.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.04
|
| Rate for Payer: UHC Core |
$921.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.86
|
| Rate for Payer: UHC Exchange |
$275.86
|
| Rate for Payer: UHC Medicare Advantage |
$275.86
|
| Rate for Payer: UHCCP Medicaid |
$630.67
|
| Rate for Payer: VA VA |
$275.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$262.07 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna Medicare |
$286.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$344.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$344.83
|
| Rate for Payer: BCBS Complete |
$662.24
|
| Rate for Payer: BCBS MAPPO |
$275.86
|
| Rate for Payer: BCBS Trust/PPO |
$907.15
|
| Rate for Payer: BCN Commercial |
$857.94
|
| Rate for Payer: BCN Medicare Advantage |
$275.86
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.86
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Mclaren Medicaid |
$630.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.66
|
| Rate for Payer: Meridian Medicaid |
$662.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PACE Senior Care Partners |
$262.07
|
| Rate for Payer: PACE SWMI |
$275.86
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: PHP Medicare Advantage |
$275.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO |
$960.01
|
| Rate for Payer: Priority Health Medicare |
$278.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.32
|
| Rate for Payer: Railroad Medicare Medicare |
$275.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.04
|
| Rate for Payer: UHC Core |
$921.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.86
|
| Rate for Payer: UHC Exchange |
$275.86
|
| Rate for Payer: UHC Medicare Advantage |
$275.86
|
| Rate for Payer: UHCCP Medicaid |
$630.67
|
| Rate for Payer: VA VA |
$275.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$717.25 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: BCBS Trust/PPO |
$900.75
|
| Rate for Payer: BCN Commercial |
$852.75
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: Nomi Health Commercial |
$904.84
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health HMO/PPO |
$960.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$739.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.04
|
| Rate for Payer: UHC Core |
$921.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.72
|
| Rate for Payer: BCBS Complete |
$53.82
|
| Rate for Payer: BCBS MAPPO |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$54.51
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: BCN Medicare Advantage |
$16.58
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Mclaren Medicaid |
$51.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.40
|
| Rate for Payer: Meridian Medicaid |
$53.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: PACE Senior Care Partners |
$15.75
|
| Rate for Payer: PACE SWMI |
$16.58
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health HMO/PPO |
$57.68
|
| Rate for Payer: Priority Health Medicare |
$16.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.42
|
| Rate for Payer: Railroad Medicare Medicare |
$16.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.58
|
| Rate for Payer: UHC Exchange |
$16.58
|
| Rate for Payer: UHC Medicare Advantage |
$16.58
|
| Rate for Payer: UHCCP Medicaid |
$51.25
|
| Rate for Payer: VA VA |
$16.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$54.12
|
| Rate for Payer: BCN Commercial |
$51.24
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health HMO/PPO |
$57.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
OP
|
$361.02
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.74 |
| Max. Negotiated Rate |
$324.92 |
| Rate for Payer: Aetna Commercial |
$306.87
|
| Rate for Payer: Aetna Medicare |
$93.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.82
|
| Rate for Payer: BCBS Complete |
$180.91
|
| Rate for Payer: BCBS MAPPO |
$90.26
|
| Rate for Payer: BCBS Trust/PPO |
$296.79
|
| Rate for Payer: BCN Commercial |
$280.69
|
| Rate for Payer: BCN Medicare Advantage |
$90.26
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cofinity Commercial |
$310.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.26
|
| Rate for Payer: Healthscope Commercial |
$324.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.76
|
| Rate for Payer: Mclaren Medicaid |
$172.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.77
|
| Rate for Payer: Meridian Medicaid |
$180.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.87
|
| Rate for Payer: Nomi Health Commercial |
$296.04
|
| Rate for Payer: PACE Senior Care Partners |
$85.74
|
| Rate for Payer: PACE SWMI |
$90.26
|
| Rate for Payer: PHP Commercial |
$306.87
|
| Rate for Payer: PHP Medicare Advantage |
$90.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.66
|
| Rate for Payer: Priority Health HMO/PPO |
$314.09
|
| Rate for Payer: Priority Health Medicare |
$91.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.88
|
| Rate for Payer: Railroad Medicare Medicare |
$90.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.70
|
| Rate for Payer: UHC Core |
$301.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.26
|
| Rate for Payer: UHC Exchange |
$90.26
|
| Rate for Payer: UHC Medicare Advantage |
$90.26
|
| Rate for Payer: UHCCP Medicaid |
$172.28
|
| Rate for Payer: VA VA |
$90.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.76
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
IP
|
$361.02
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.66 |
| Max. Negotiated Rate |
$324.92 |
| Rate for Payer: Aetna Commercial |
$306.87
|
| Rate for Payer: BCBS Trust/PPO |
$294.70
|
| Rate for Payer: BCN Commercial |
$279.00
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cofinity Commercial |
$310.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.82
|
| Rate for Payer: Healthscope Commercial |
$324.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.87
|
| Rate for Payer: Nomi Health Commercial |
$296.04
|
| Rate for Payer: PHP Commercial |
$306.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.66
|
| Rate for Payer: Priority Health HMO/PPO |
$314.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.70
|
| Rate for Payer: UHC Core |
$301.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.76
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$8.98
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: PHP Commercial |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health HMO/PPO |
$9.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.68
|
| Rate for Payer: UHC Core |
$9.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.25
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.44
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: BCBS MAPPO |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$9.04
|
| Rate for Payer: BCN Commercial |
$8.55
|
| Rate for Payer: BCN Medicare Advantage |
$2.75
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.75
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.25
|
| Rate for Payer: Mclaren Medicaid |
$2.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.89
|
| Rate for Payer: Meridian Medicaid |
$2.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: PACE Senior Care Partners |
$2.61
|
| Rate for Payer: PACE SWMI |
$2.75
|
| Rate for Payer: PHP Commercial |
$9.35
|
| Rate for Payer: PHP Medicare Advantage |
$2.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health HMO/PPO |
$9.57
|
| Rate for Payer: Priority Health Medicare |
$2.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.37
|
| Rate for Payer: Railroad Medicare Medicare |
$2.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.68
|
| Rate for Payer: UHC Core |
$9.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.75
|
| Rate for Payer: UHC Exchange |
$2.75
|
| Rate for Payer: UHC Medicare Advantage |
$2.75
|
| Rate for Payer: UHCCP Medicaid |
$2.26
|
| Rate for Payer: VA VA |
$2.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.25
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$876.34
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.13 |
| Max. Negotiated Rate |
$788.71 |
| Rate for Payer: Aetna Commercial |
$744.89
|
| Rate for Payer: Aetna Medicare |
$227.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$273.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$273.86
|
| Rate for Payer: BCBS Complete |
$515.13
|
| Rate for Payer: BCBS MAPPO |
$219.08
|
| Rate for Payer: BCBS Trust/PPO |
$720.44
|
| Rate for Payer: BCN Commercial |
$681.35
|
| Rate for Payer: BCN Medicare Advantage |
$219.08
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cofinity Commercial |
$753.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.08
|
| Rate for Payer: Healthscope Commercial |
$788.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.26
|
| Rate for Payer: Mclaren Medicaid |
$490.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.04
|
| Rate for Payer: Meridian Medicaid |
$515.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.89
|
| Rate for Payer: Nomi Health Commercial |
$718.60
|
| Rate for Payer: PACE Senior Care Partners |
$208.13
|
| Rate for Payer: PACE SWMI |
$219.08
|
| Rate for Payer: PHP Commercial |
$744.89
|
| Rate for Payer: PHP Medicare Advantage |
$219.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.62
|
| Rate for Payer: Priority Health HMO/PPO |
$762.42
|
| Rate for Payer: Priority Health Medicare |
$221.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$587.15
|
| Rate for Payer: Railroad Medicare Medicare |
$219.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$771.18
|
| Rate for Payer: UHC Core |
$731.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.08
|
| Rate for Payer: UHC Exchange |
$219.08
|
| Rate for Payer: UHC Medicare Advantage |
$219.08
|
| Rate for Payer: UHCCP Medicaid |
$490.57
|
| Rate for Payer: VA VA |
$219.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.26
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$876.34
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.62 |
| Max. Negotiated Rate |
$788.71 |
| Rate for Payer: Aetna Commercial |
$744.89
|
| Rate for Payer: BCBS Trust/PPO |
$715.36
|
| Rate for Payer: BCN Commercial |
$677.24
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cofinity Commercial |
$753.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.07
|
| Rate for Payer: Healthscope Commercial |
$788.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.89
|
| Rate for Payer: Nomi Health Commercial |
$718.60
|
| Rate for Payer: PHP Commercial |
$744.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.62
|
| Rate for Payer: Priority Health HMO/PPO |
$762.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$587.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$771.18
|
| Rate for Payer: UHC Core |
$731.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.26
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$920.16
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.54 |
| Max. Negotiated Rate |
$828.14 |
| Rate for Payer: Aetna Commercial |
$782.14
|
| Rate for Payer: Aetna Medicare |
$239.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$287.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$287.55
|
| Rate for Payer: BCBS Complete |
$515.13
|
| Rate for Payer: BCBS MAPPO |
$230.04
|
| Rate for Payer: BCBS Trust/PPO |
$756.46
|
| Rate for Payer: BCN Commercial |
$715.42
|
| Rate for Payer: BCN Medicare Advantage |
$230.04
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cofinity Commercial |
$791.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.04
|
| Rate for Payer: Healthscope Commercial |
$828.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.12
|
| Rate for Payer: Mclaren Medicaid |
$490.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.54
|
| Rate for Payer: Meridian Medicaid |
$515.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$264.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.14
|
| Rate for Payer: Nomi Health Commercial |
$754.53
|
| Rate for Payer: PACE Senior Care Partners |
$218.54
|
| Rate for Payer: PACE SWMI |
$230.04
|
| Rate for Payer: PHP Commercial |
$782.14
|
| Rate for Payer: PHP Medicare Advantage |
$230.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.10
|
| Rate for Payer: Priority Health HMO/PPO |
$800.54
|
| Rate for Payer: Priority Health Medicare |
$232.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$616.51
|
| Rate for Payer: Railroad Medicare Medicare |
$230.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$809.74
|
| Rate for Payer: UHC Core |
$768.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.04
|
| Rate for Payer: UHC Exchange |
$230.04
|
| Rate for Payer: UHC Medicare Advantage |
$230.04
|
| Rate for Payer: UHCCP Medicaid |
$490.57
|
| Rate for Payer: VA VA |
$230.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.12
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$920.16
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$598.10 |
| Max. Negotiated Rate |
$828.14 |
| Rate for Payer: Aetna Commercial |
$782.14
|
| Rate for Payer: BCBS Trust/PPO |
$751.13
|
| Rate for Payer: BCN Commercial |
$711.10
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cofinity Commercial |
$791.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.13
|
| Rate for Payer: Healthscope Commercial |
$828.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.14
|
| Rate for Payer: Nomi Health Commercial |
$754.53
|
| Rate for Payer: PHP Commercial |
$782.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.10
|
| Rate for Payer: Priority Health HMO/PPO |
$800.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$616.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$809.74
|
| Rate for Payer: UHC Core |
$768.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.12
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$386.21
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$347.59 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare |
$100.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.69
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$96.55
|
| Rate for Payer: BCBS Trust/PPO |
$317.50
|
| Rate for Payer: BCN Commercial |
$300.28
|
| Rate for Payer: BCN Medicare Advantage |
$96.55
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.55
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.66
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.38
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$316.69
|
| Rate for Payer: PACE Senior Care Partners |
$91.72
|
| Rate for Payer: PACE SWMI |
$96.55
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: PHP Medicare Advantage |
$96.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health HMO/PPO |
$336.00
|
| Rate for Payer: Priority Health Medicare |
$97.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.76
|
| Rate for Payer: Railroad Medicare Medicare |
$96.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.86
|
| Rate for Payer: UHC Core |
$322.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.55
|
| Rate for Payer: UHC Exchange |
$96.55
|
| Rate for Payer: UHC Medicare Advantage |
$96.55
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$96.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.66
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$386.21
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.04 |
| Max. Negotiated Rate |
$347.59 |
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: BCBS Trust/PPO |
$315.26
|
| Rate for Payer: BCN Commercial |
$298.46
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: Nomi Health Commercial |
$316.69
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health HMO/PPO |
$336.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.86
|
| Rate for Payer: UHC Core |
$322.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.66
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
OP
|
$775.20
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.11 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: Aetna Medicare |
$201.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.25
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$193.80
|
| Rate for Payer: BCBS Trust/PPO |
$637.29
|
| Rate for Payer: BCN Commercial |
$602.72
|
| Rate for Payer: BCN Medicare Advantage |
$193.80
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$666.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.80
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.40
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.49
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: Nomi Health Commercial |
$635.66
|
| Rate for Payer: PACE Senior Care Partners |
$184.11
|
| Rate for Payer: PACE SWMI |
$193.80
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: PHP Medicare Advantage |
$193.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.88
|
| Rate for Payer: Priority Health HMO/PPO |
$674.42
|
| Rate for Payer: Priority Health Medicare |
$195.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$519.38
|
| Rate for Payer: Railroad Medicare Medicare |
$193.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.18
|
| Rate for Payer: UHC Core |
$647.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.80
|
| Rate for Payer: UHC Exchange |
$193.80
|
| Rate for Payer: UHC Medicare Advantage |
$193.80
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$193.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.40
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
IP
|
$775.20
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$503.88 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: BCBS Trust/PPO |
$632.80
|
| Rate for Payer: BCN Commercial |
$599.07
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$666.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: Nomi Health Commercial |
$635.66
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.88
|
| Rate for Payer: Priority Health HMO/PPO |
$674.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$519.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.18
|
| Rate for Payer: UHC Core |
$647.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.40
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
OP
|
$3,121.20
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.67 |
| Max. Negotiated Rate |
$2,809.08 |
| Rate for Payer: Aetna Commercial |
$2,653.02
|
| Rate for Payer: Aetna Medicare |
$811.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$975.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$975.38
|
| Rate for Payer: BCBS Complete |
$33.25
|
| Rate for Payer: BCBS MAPPO |
$780.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,565.94
|
| Rate for Payer: BCN Commercial |
$2,426.73
|
| Rate for Payer: BCN Medicare Advantage |
$780.30
|
| Rate for Payer: Cash Price |
$2,496.96
|
| Rate for Payer: Cash Price |
$2,496.96
|
| Rate for Payer: Cofinity Commercial |
$2,684.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,496.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$780.30
|
| Rate for Payer: Healthscope Commercial |
$2,809.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,340.90
|
| Rate for Payer: Mclaren Medicaid |
$31.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$819.32
|
| Rate for Payer: Meridian Medicaid |
$33.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$897.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,653.02
|
| Rate for Payer: Nomi Health Commercial |
$2,559.38
|
| Rate for Payer: PACE Senior Care Partners |
$741.28
|
| Rate for Payer: PACE SWMI |
$780.30
|
| Rate for Payer: PHP Commercial |
$2,653.02
|
| Rate for Payer: PHP Medicare Advantage |
$780.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,028.78
|
| Rate for Payer: Priority Health HMO/PPO |
$2,715.44
|
| Rate for Payer: Priority Health Medicare |
$788.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,091.20
|
| Rate for Payer: Railroad Medicare Medicare |
$780.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,746.66
|
| Rate for Payer: UHC Core |
$2,606.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$780.30
|
| Rate for Payer: UHC Exchange |
$780.30
|
| Rate for Payer: UHC Medicare Advantage |
$780.30
|
| Rate for Payer: UHCCP Medicaid |
$31.67
|
| Rate for Payer: VA VA |
$780.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,340.90
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
IP
|
$3,121.20
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,028.78 |
| Max. Negotiated Rate |
$2,809.08 |
| Rate for Payer: Aetna Commercial |
$2,653.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,547.84
|
| Rate for Payer: BCN Commercial |
$2,412.06
|
| Rate for Payer: Cash Price |
$2,496.96
|
| Rate for Payer: Cofinity Commercial |
$2,684.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,496.96
|
| Rate for Payer: Healthscope Commercial |
$2,809.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,340.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,653.02
|
| Rate for Payer: Nomi Health Commercial |
$2,559.38
|
| Rate for Payer: PHP Commercial |
$2,653.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,028.78
|
| Rate for Payer: Priority Health HMO/PPO |
$2,715.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,091.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,746.66
|
| Rate for Payer: UHC Core |
$2,606.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,340.90
|
|
