|
HC INJECTION PROCEDURE ILEAL CONDUIT
|
Facility
|
OP
|
$643.53
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
36100249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.84 |
| Max. Negotiated Rate |
$579.18 |
| Rate for Payer: Aetna Commercial |
$547.00
|
| Rate for Payer: Aetna Medicare |
$167.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$201.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$201.10
|
| Rate for Payer: BCBS Complete |
$257.41
|
| Rate for Payer: BCBS MAPPO |
$160.88
|
| Rate for Payer: BCBS Trust/PPO |
$529.05
|
| Rate for Payer: BCN Commercial |
$500.34
|
| Rate for Payer: BCN Medicare Advantage |
$160.88
|
| Rate for Payer: Cash Price |
$514.82
|
| Rate for Payer: Cofinity Commercial |
$553.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.88
|
| Rate for Payer: Healthscope Commercial |
$579.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.00
|
| Rate for Payer: Nomi Health Commercial |
$527.69
|
| Rate for Payer: PACE Senior Care Partners |
$152.84
|
| Rate for Payer: PACE SWMI |
$160.88
|
| Rate for Payer: PHP Commercial |
$547.00
|
| Rate for Payer: PHP Medicare Advantage |
$160.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.29
|
| Rate for Payer: Priority Health HMO/PPO |
$559.87
|
| Rate for Payer: Priority Health Medicare |
$162.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$431.17
|
| Rate for Payer: Railroad Medicare Medicare |
$160.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.31
|
| Rate for Payer: UHC Core |
$537.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.88
|
| Rate for Payer: UHC Exchange |
$160.88
|
| Rate for Payer: UHC Medicare Advantage |
$160.88
|
| Rate for Payer: VA VA |
$160.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.65
|
|
|
HC INJECTION PROC RETROGRAD CYSTOGRAPHY
|
Facility
|
IP
|
$832.48
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
36100252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$541.11 |
| Max. Negotiated Rate |
$749.23 |
| Rate for Payer: Aetna Commercial |
$707.61
|
| Rate for Payer: BCBS Trust/PPO |
$679.55
|
| Rate for Payer: BCN Commercial |
$643.34
|
| Rate for Payer: Cash Price |
$665.98
|
| Rate for Payer: Cofinity Commercial |
$715.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$665.98
|
| Rate for Payer: Healthscope Commercial |
$749.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$624.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$707.61
|
| Rate for Payer: Nomi Health Commercial |
$682.63
|
| Rate for Payer: PHP Commercial |
$707.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.11
|
| Rate for Payer: Priority Health HMO/PPO |
$724.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$557.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$732.58
|
| Rate for Payer: UHC Core |
$695.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$624.36
|
|
|
HC INJECTION PROC RETROGRAD CYSTOGRAPHY
|
Facility
|
OP
|
$832.48
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
36100252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$197.71 |
| Max. Negotiated Rate |
$749.23 |
| Rate for Payer: Aetna Commercial |
$707.61
|
| Rate for Payer: Aetna Medicare |
$216.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$260.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$260.15
|
| Rate for Payer: BCBS Complete |
$332.99
|
| Rate for Payer: BCBS MAPPO |
$208.12
|
| Rate for Payer: BCBS Trust/PPO |
$684.38
|
| Rate for Payer: BCN Commercial |
$647.25
|
| Rate for Payer: BCN Medicare Advantage |
$208.12
|
| Rate for Payer: Cash Price |
$665.98
|
| Rate for Payer: Cofinity Commercial |
$715.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$665.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.12
|
| Rate for Payer: Healthscope Commercial |
$749.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$624.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$218.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$707.61
|
| Rate for Payer: Nomi Health Commercial |
$682.63
|
| Rate for Payer: PACE Senior Care Partners |
$197.71
|
| Rate for Payer: PACE SWMI |
$208.12
|
| Rate for Payer: PHP Commercial |
$707.61
|
| Rate for Payer: PHP Medicare Advantage |
$208.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.11
|
| Rate for Payer: Priority Health HMO/PPO |
$724.26
|
| Rate for Payer: Priority Health Medicare |
$210.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$557.76
|
| Rate for Payer: Railroad Medicare Medicare |
$208.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$732.58
|
| Rate for Payer: UHC Core |
$695.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$208.12
|
| Rate for Payer: UHC Exchange |
$208.12
|
| Rate for Payer: UHC Medicare Advantage |
$208.12
|
| Rate for Payer: VA VA |
$208.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$624.36
|
|
|
HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$12.74
|
| Rate for Payer: BCN Commercial |
$12.06
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
|
HC INJECTION, PROMETHAZINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT J2550
|
| Hospital Charge Code |
63600100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.88
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: BCBS MAPPO |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$12.83
|
| Rate for Payer: BCN Commercial |
$12.14
|
| Rate for Payer: BCN Medicare Advantage |
$3.90
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PACE Senior Care Partners |
$3.71
|
| Rate for Payer: PACE SWMI |
$3.90
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: PHP Medicare Advantage |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Medicare |
$3.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.90
|
| Rate for Payer: UHC Exchange |
$3.90
|
| Rate for Payer: UHC Medicare Advantage |
$3.90
|
| Rate for Payer: VA VA |
$3.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
|
HC INJECTION PUDENDAL NERVE
|
Facility
|
IP
|
$1,193.61
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$775.85 |
| Max. Negotiated Rate |
$1,074.25 |
| Rate for Payer: Aetna Commercial |
$1,014.57
|
| Rate for Payer: BCBS Trust/PPO |
$974.34
|
| Rate for Payer: BCN Commercial |
$922.42
|
| Rate for Payer: Cash Price |
$954.89
|
| Rate for Payer: Cofinity Commercial |
$1,026.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.89
|
| Rate for Payer: Healthscope Commercial |
$1,074.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$895.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.57
|
| Rate for Payer: Nomi Health Commercial |
$978.76
|
| Rate for Payer: PHP Commercial |
$1,014.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1,038.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$799.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,050.38
|
| Rate for Payer: UHC Core |
$996.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$895.21
|
|
|
HC INJECTION PUDENDAL NERVE
|
Facility
|
OP
|
$1,193.61
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
36100570
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.48 |
| Max. Negotiated Rate |
$1,074.25 |
| Rate for Payer: Aetna Commercial |
$1,014.57
|
| Rate for Payer: Aetna Medicare |
$310.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$373.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$373.00
|
| Rate for Payer: BCBS Complete |
$662.24
|
| Rate for Payer: BCBS MAPPO |
$298.40
|
| Rate for Payer: BCBS Trust/PPO |
$981.27
|
| Rate for Payer: BCN Commercial |
$928.03
|
| Rate for Payer: BCN Medicare Advantage |
$298.40
|
| Rate for Payer: Cash Price |
$954.89
|
| Rate for Payer: Cash Price |
$954.89
|
| Rate for Payer: Cofinity Commercial |
$1,026.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$954.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.40
|
| Rate for Payer: Healthscope Commercial |
$1,074.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$895.21
|
| Rate for Payer: Mclaren Medicaid |
$630.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.32
|
| Rate for Payer: Meridian Medicaid |
$662.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,014.57
|
| Rate for Payer: Nomi Health Commercial |
$978.76
|
| Rate for Payer: PACE Senior Care Partners |
$283.48
|
| Rate for Payer: PACE SWMI |
$298.40
|
| Rate for Payer: PHP Commercial |
$1,014.57
|
| Rate for Payer: PHP Medicare Advantage |
$298.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$775.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1,038.44
|
| Rate for Payer: Priority Health Medicare |
$301.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$799.72
|
| Rate for Payer: Railroad Medicare Medicare |
$298.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,050.38
|
| Rate for Payer: UHC Core |
$996.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.40
|
| Rate for Payer: UHC Exchange |
$298.40
|
| Rate for Payer: UHC Medicare Advantage |
$298.40
|
| Rate for Payer: UHCCP Medicaid |
$630.67
|
| Rate for Payer: VA VA |
$298.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$895.21
|
|
|
HC INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
OP
|
$329.29
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.21 |
| Max. Negotiated Rate |
$297.19 |
| Rate for Payer: Aetna Commercial |
$279.90
|
| Rate for Payer: Aetna Medicare |
$85.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.90
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$82.32
|
| Rate for Payer: BCBS Trust/PPO |
$270.71
|
| Rate for Payer: BCN Commercial |
$256.02
|
| Rate for Payer: BCN Medicare Advantage |
$82.32
|
| Rate for Payer: Cash Price |
$263.43
|
| Rate for Payer: Cash Price |
$263.43
|
| Rate for Payer: Cofinity Commercial |
$283.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.32
|
| Rate for Payer: Healthscope Commercial |
$296.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.97
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.44
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.90
|
| Rate for Payer: Nomi Health Commercial |
$270.02
|
| Rate for Payer: PACE Senior Care Partners |
$78.21
|
| Rate for Payer: PACE SWMI |
$82.32
|
| Rate for Payer: PHP Commercial |
$279.90
|
| Rate for Payer: PHP Medicare Advantage |
$82.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.04
|
| Rate for Payer: Priority Health HMO/PPO |
$286.48
|
| Rate for Payer: Priority Health Medicare |
$83.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.62
|
| Rate for Payer: Railroad Medicare Medicare |
$82.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.78
|
| Rate for Payer: UHC Core |
$274.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.32
|
| Rate for Payer: UHC Exchange |
$82.32
|
| Rate for Payer: UHC Medicare Advantage |
$82.32
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$82.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.97
|
|
|
HC INJECTION SCLEROSING SOL MULTIPLE
|
Facility
|
IP
|
$329.29
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
36100117
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.04 |
| Max. Negotiated Rate |
$296.36 |
| Rate for Payer: Aetna Commercial |
$279.90
|
| Rate for Payer: BCBS Trust/PPO |
$268.80
|
| Rate for Payer: BCN Commercial |
$254.48
|
| Rate for Payer: Cash Price |
$263.43
|
| Rate for Payer: Cofinity Commercial |
$283.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.43
|
| Rate for Payer: Healthscope Commercial |
$296.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.90
|
| Rate for Payer: Nomi Health Commercial |
$270.02
|
| Rate for Payer: PHP Commercial |
$279.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.04
|
| Rate for Payer: Priority Health HMO/PPO |
$286.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.78
|
| Rate for Payer: UHC Core |
$274.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.97
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
OP
|
$252.82
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.04 |
| Max. Negotiated Rate |
$297.19 |
| Rate for Payer: Aetna Commercial |
$214.90
|
| Rate for Payer: Aetna Medicare |
$65.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.01
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$63.20
|
| Rate for Payer: BCBS Trust/PPO |
$207.84
|
| Rate for Payer: BCN Commercial |
$196.57
|
| Rate for Payer: BCN Medicare Advantage |
$63.20
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cofinity Commercial |
$217.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.20
|
| Rate for Payer: Healthscope Commercial |
$227.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.62
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.37
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.90
|
| Rate for Payer: Nomi Health Commercial |
$207.31
|
| Rate for Payer: PACE Senior Care Partners |
$60.04
|
| Rate for Payer: PACE SWMI |
$63.20
|
| Rate for Payer: PHP Commercial |
$214.90
|
| Rate for Payer: PHP Medicare Advantage |
$63.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.33
|
| Rate for Payer: Priority Health HMO/PPO |
$219.95
|
| Rate for Payer: Priority Health Medicare |
$63.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.39
|
| Rate for Payer: Railroad Medicare Medicare |
$63.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.48
|
| Rate for Payer: UHC Core |
$211.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.20
|
| Rate for Payer: UHC Exchange |
$63.20
|
| Rate for Payer: UHC Medicare Advantage |
$63.20
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$63.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.62
|
|
|
HC INJECTION SCLEROSING SOL SINGLE
|
Facility
|
IP
|
$252.82
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
36100116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.33 |
| Max. Negotiated Rate |
$227.54 |
| Rate for Payer: Aetna Commercial |
$214.90
|
| Rate for Payer: BCBS Trust/PPO |
$206.38
|
| Rate for Payer: BCN Commercial |
$195.38
|
| Rate for Payer: Cash Price |
$202.26
|
| Rate for Payer: Cofinity Commercial |
$217.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.26
|
| Rate for Payer: Healthscope Commercial |
$227.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.90
|
| Rate for Payer: Nomi Health Commercial |
$207.31
|
| Rate for Payer: PHP Commercial |
$214.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.33
|
| Rate for Payer: Priority Health HMO/PPO |
$219.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.48
|
| Rate for Payer: UHC Core |
$211.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.62
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
OP
|
$863.45
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.07 |
| Max. Negotiated Rate |
$777.10 |
| Rate for Payer: Aetna Commercial |
$733.93
|
| Rate for Payer: Aetna Medicare |
$224.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$269.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$269.83
|
| Rate for Payer: BCBS Complete |
$345.38
|
| Rate for Payer: BCBS MAPPO |
$215.86
|
| Rate for Payer: BCBS Trust/PPO |
$709.84
|
| Rate for Payer: BCN Commercial |
$671.33
|
| Rate for Payer: BCN Medicare Advantage |
$215.86
|
| Rate for Payer: Cash Price |
$690.76
|
| Rate for Payer: Cofinity Commercial |
$742.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.86
|
| Rate for Payer: Healthscope Commercial |
$777.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.93
|
| Rate for Payer: Nomi Health Commercial |
$708.03
|
| Rate for Payer: PACE Senior Care Partners |
$205.07
|
| Rate for Payer: PACE SWMI |
$215.86
|
| Rate for Payer: PHP Commercial |
$733.93
|
| Rate for Payer: PHP Medicare Advantage |
$215.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.24
|
| Rate for Payer: Priority Health HMO/PPO |
$751.20
|
| Rate for Payer: Priority Health Medicare |
$218.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.51
|
| Rate for Payer: Railroad Medicare Medicare |
$215.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$759.84
|
| Rate for Payer: UHC Core |
$720.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.86
|
| Rate for Payer: UHC Exchange |
$215.86
|
| Rate for Payer: UHC Medicare Advantage |
$215.86
|
| Rate for Payer: VA VA |
$215.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$647.59
|
|
|
HC INJECTION SHOULDER ARTHROGRAM
|
Facility
|
IP
|
$863.45
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
36100037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$561.24 |
| Max. Negotiated Rate |
$777.10 |
| Rate for Payer: Aetna Commercial |
$733.93
|
| Rate for Payer: BCBS Trust/PPO |
$704.83
|
| Rate for Payer: BCN Commercial |
$667.27
|
| Rate for Payer: Cash Price |
$690.76
|
| Rate for Payer: Cofinity Commercial |
$742.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.76
|
| Rate for Payer: Healthscope Commercial |
$777.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.93
|
| Rate for Payer: Nomi Health Commercial |
$708.03
|
| Rate for Payer: PHP Commercial |
$733.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.24
|
| Rate for Payer: Priority Health HMO/PPO |
$751.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$759.84
|
| Rate for Payer: UHC Core |
$720.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$647.59
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$92.32 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna Medicare |
$101.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.47
|
| Rate for Payer: BCBS Complete |
$155.48
|
| Rate for Payer: BCBS MAPPO |
$97.18
|
| Rate for Payer: BCBS Trust/PPO |
$319.56
|
| Rate for Payer: BCN Commercial |
$302.22
|
| Rate for Payer: BCN Medicare Advantage |
$97.18
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.18
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: PACE Senior Care Partners |
$92.32
|
| Rate for Payer: PACE SWMI |
$97.18
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: PHP Medicare Advantage |
$97.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO |
$338.18
|
| Rate for Payer: Priority Health Medicare |
$98.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.44
|
| Rate for Payer: Railroad Medicare Medicare |
$97.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.06
|
| Rate for Payer: UHC Core |
$324.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.18
|
| Rate for Payer: UHC Exchange |
$97.18
|
| Rate for Payer: UHC Medicare Advantage |
$97.18
|
| Rate for Payer: VA VA |
$97.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.53
|
|
|
HC INJECTION SHUNTOGRAM
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
36100224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: BCBS Trust/PPO |
$317.30
|
| Rate for Payer: BCN Commercial |
$300.40
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO |
$338.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.06
|
| Rate for Payer: UHC Core |
$324.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.53
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
OP
|
$291.84
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$262.66 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: Aetna Medicare |
$75.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.20
|
| Rate for Payer: BCBS Complete |
$116.74
|
| Rate for Payer: BCBS MAPPO |
$72.96
|
| Rate for Payer: BCBS Trust/PPO |
$239.92
|
| Rate for Payer: BCN Commercial |
$226.91
|
| Rate for Payer: BCN Medicare Advantage |
$72.96
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.96
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| Rate for Payer: PACE Senior Care Partners |
$69.31
|
| Rate for Payer: PACE SWMI |
$72.96
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: PHP Medicare Advantage |
$72.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health HMO/PPO |
$253.90
|
| Rate for Payer: Priority Health Medicare |
$73.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.53
|
| Rate for Payer: Railroad Medicare Medicare |
$72.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.82
|
| Rate for Payer: UHC Core |
$243.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.96
|
| Rate for Payer: UHC Exchange |
$72.96
|
| Rate for Payer: UHC Medicare Advantage |
$72.96
|
| Rate for Payer: VA VA |
$72.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.88
|
|
|
HC INJECTION SIALOGRAM
|
Facility
|
IP
|
$291.84
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
36100190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$189.70 |
| Max. Negotiated Rate |
$262.66 |
| Rate for Payer: Aetna Commercial |
$248.06
|
| Rate for Payer: BCBS Trust/PPO |
$238.23
|
| Rate for Payer: BCN Commercial |
$225.53
|
| Rate for Payer: Cash Price |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$250.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$262.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.06
|
| Rate for Payer: Nomi Health Commercial |
$239.31
|
| Rate for Payer: PHP Commercial |
$248.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.70
|
| Rate for Payer: Priority Health HMO/PPO |
$253.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.82
|
| Rate for Payer: UHC Core |
$243.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.88
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,011.25
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$240.17 |
| Max. Negotiated Rate |
$910.12 |
| Rate for Payer: Aetna Commercial |
$859.56
|
| Rate for Payer: Aetna Medicare |
$262.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$316.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$316.02
|
| Rate for Payer: BCBS Complete |
$404.50
|
| Rate for Payer: BCBS MAPPO |
$252.81
|
| Rate for Payer: BCBS Trust/PPO |
$831.35
|
| Rate for Payer: BCN Commercial |
$786.25
|
| Rate for Payer: BCN Medicare Advantage |
$252.81
|
| Rate for Payer: Cash Price |
$809.00
|
| Rate for Payer: Cofinity Commercial |
$869.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.81
|
| Rate for Payer: Healthscope Commercial |
$910.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$265.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$290.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.56
|
| Rate for Payer: Nomi Health Commercial |
$829.22
|
| Rate for Payer: PACE Senior Care Partners |
$240.17
|
| Rate for Payer: PACE SWMI |
$252.81
|
| Rate for Payer: PHP Commercial |
$859.56
|
| Rate for Payer: PHP Medicare Advantage |
$252.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.31
|
| Rate for Payer: Priority Health HMO/PPO |
$879.79
|
| Rate for Payer: Priority Health Medicare |
$255.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$677.54
|
| Rate for Payer: Railroad Medicare Medicare |
$252.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$889.90
|
| Rate for Payer: UHC Core |
$844.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$252.81
|
| Rate for Payer: UHC Exchange |
$252.81
|
| Rate for Payer: UHC Medicare Advantage |
$252.81
|
| Rate for Payer: VA VA |
$252.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.44
|
|
|
HC INJECTION SI JOINT ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,011.25
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$657.31 |
| Max. Negotiated Rate |
$910.12 |
| Rate for Payer: Aetna Commercial |
$859.56
|
| Rate for Payer: BCBS Trust/PPO |
$825.48
|
| Rate for Payer: BCN Commercial |
$781.49
|
| Rate for Payer: Cash Price |
$809.00
|
| Rate for Payer: Cofinity Commercial |
$869.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.00
|
| Rate for Payer: Healthscope Commercial |
$910.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.56
|
| Rate for Payer: Nomi Health Commercial |
$829.22
|
| Rate for Payer: PHP Commercial |
$859.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.31
|
| Rate for Payer: Priority Health HMO/PPO |
$879.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$677.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$889.90
|
| Rate for Payer: UHC Core |
$844.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.44
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
IP
|
$1,047.85
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$681.10 |
| Max. Negotiated Rate |
$943.06 |
| Rate for Payer: Aetna Commercial |
$890.67
|
| Rate for Payer: BCBS Trust/PPO |
$855.36
|
| Rate for Payer: BCN Commercial |
$809.78
|
| Rate for Payer: Cash Price |
$838.28
|
| Rate for Payer: Cofinity Commercial |
$901.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.28
|
| Rate for Payer: Healthscope Commercial |
$943.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$785.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.67
|
| Rate for Payer: Nomi Health Commercial |
$859.24
|
| Rate for Payer: PHP Commercial |
$890.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.10
|
| Rate for Payer: Priority Health HMO/PPO |
$911.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$702.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$922.11
|
| Rate for Payer: UHC Core |
$874.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$785.89
|
|
|
HC INJECTION SI JOINT BIL ANESTHESIA/STEROID
|
Facility
|
OP
|
$1,047.85
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
36100043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$248.86 |
| Max. Negotiated Rate |
$943.06 |
| Rate for Payer: Aetna Commercial |
$890.67
|
| Rate for Payer: Aetna Medicare |
$272.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$327.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$327.45
|
| Rate for Payer: BCBS Complete |
$419.14
|
| Rate for Payer: BCBS MAPPO |
$261.96
|
| Rate for Payer: BCBS Trust/PPO |
$861.44
|
| Rate for Payer: BCN Commercial |
$814.70
|
| Rate for Payer: BCN Medicare Advantage |
$261.96
|
| Rate for Payer: Cash Price |
$838.28
|
| Rate for Payer: Cofinity Commercial |
$901.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$261.96
|
| Rate for Payer: Healthscope Commercial |
$943.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$785.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$301.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.67
|
| Rate for Payer: Nomi Health Commercial |
$859.24
|
| Rate for Payer: PACE Senior Care Partners |
$248.86
|
| Rate for Payer: PACE SWMI |
$261.96
|
| Rate for Payer: PHP Commercial |
$890.67
|
| Rate for Payer: PHP Medicare Advantage |
$261.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$681.10
|
| Rate for Payer: Priority Health HMO/PPO |
$911.63
|
| Rate for Payer: Priority Health Medicare |
$264.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$702.06
|
| Rate for Payer: Railroad Medicare Medicare |
$261.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$922.11
|
| Rate for Payer: UHC Core |
$874.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$261.96
|
| Rate for Payer: UHC Exchange |
$261.96
|
| Rate for Payer: UHC Medicare Advantage |
$261.96
|
| Rate for Payer: VA VA |
$261.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$785.89
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$279.36
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.58 |
| Max. Negotiated Rate |
$251.42 |
| Rate for Payer: Aetna Commercial |
$237.46
|
| Rate for Payer: BCBS Trust/PPO |
$228.04
|
| Rate for Payer: BCN Commercial |
$215.89
|
| Rate for Payer: Cash Price |
$223.49
|
| Rate for Payer: Cofinity Commercial |
$240.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.49
|
| Rate for Payer: Healthscope Commercial |
$251.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.46
|
| Rate for Payer: Nomi Health Commercial |
$229.08
|
| Rate for Payer: PHP Commercial |
$237.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.58
|
| Rate for Payer: Priority Health HMO/PPO |
$243.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.84
|
| Rate for Payer: UHC Core |
$233.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.52
|
|
|
HC INJECTION SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$279.36
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
36100519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.35 |
| Max. Negotiated Rate |
$251.42 |
| Rate for Payer: Aetna Commercial |
$237.46
|
| Rate for Payer: Aetna Medicare |
$72.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.30
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$69.84
|
| Rate for Payer: BCBS Trust/PPO |
$229.66
|
| Rate for Payer: BCN Commercial |
$217.20
|
| Rate for Payer: BCN Medicare Advantage |
$69.84
|
| Rate for Payer: Cash Price |
$223.49
|
| Rate for Payer: Cash Price |
$223.49
|
| Rate for Payer: Cofinity Commercial |
$240.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.84
|
| Rate for Payer: Healthscope Commercial |
$251.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.52
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.33
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.46
|
| Rate for Payer: Nomi Health Commercial |
$229.08
|
| Rate for Payer: PACE Senior Care Partners |
$66.35
|
| Rate for Payer: PACE SWMI |
$69.84
|
| Rate for Payer: PHP Commercial |
$237.46
|
| Rate for Payer: PHP Medicare Advantage |
$69.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.58
|
| Rate for Payer: Priority Health HMO/PPO |
$243.04
|
| Rate for Payer: Priority Health Medicare |
$70.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.17
|
| Rate for Payer: Railroad Medicare Medicare |
$69.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.84
|
| Rate for Payer: UHC Core |
$233.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.84
|
| Rate for Payer: UHC Exchange |
$69.84
|
| Rate for Payer: UHC Medicare Advantage |
$69.84
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$69.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.52
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
IP
|
$437.63
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$284.46 |
| Max. Negotiated Rate |
$393.87 |
| Rate for Payer: Aetna Commercial |
$371.99
|
| Rate for Payer: BCBS Trust/PPO |
$357.24
|
| Rate for Payer: BCN Commercial |
$338.20
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$376.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$393.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: PHP Commercial |
$371.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO |
$380.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.11
|
| Rate for Payer: UHC Core |
$365.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.22
|
|
|
HC INJECTION SPLENOPOTOGRAM SPLENOPORTOG
|
Facility
|
OP
|
$437.63
|
|
|
Service Code
|
CPT 38200
|
| Hospital Charge Code |
36100183
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$393.87 |
| Rate for Payer: Aetna Commercial |
$371.99
|
| Rate for Payer: Aetna Medicare |
$113.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.76
|
| Rate for Payer: BCBS Complete |
$175.05
|
| Rate for Payer: BCBS MAPPO |
$109.41
|
| Rate for Payer: BCBS Trust/PPO |
$359.78
|
| Rate for Payer: BCN Commercial |
$340.26
|
| Rate for Payer: BCN Medicare Advantage |
$109.41
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$376.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.41
|
| Rate for Payer: Healthscope Commercial |
$393.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: PACE Senior Care Partners |
$103.94
|
| Rate for Payer: PACE SWMI |
$109.41
|
| Rate for Payer: PHP Commercial |
$371.99
|
| Rate for Payer: PHP Medicare Advantage |
$109.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO |
$380.74
|
| Rate for Payer: Priority Health Medicare |
$110.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.21
|
| Rate for Payer: Railroad Medicare Medicare |
$109.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.11
|
| Rate for Payer: UHC Core |
$365.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.41
|
| Rate for Payer: UHC Exchange |
$109.41
|
| Rate for Payer: UHC Medicare Advantage |
$109.41
|
| Rate for Payer: VA VA |
$109.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.22
|
|
