|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT J1030
|
| Hospital Charge Code |
63600094
|
|
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, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT J1040
|
| Hospital Charge Code |
63600095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
OP
|
$1,067.34
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$253.49 |
| Max. Negotiated Rate |
$960.61 |
| Rate for Payer: Aetna Commercial |
$907.24
|
| Rate for Payer: Aetna Medicare |
$277.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$333.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$333.54
|
| Rate for Payer: BCBS Complete |
$426.94
|
| Rate for Payer: BCBS MAPPO |
$266.83
|
| Rate for Payer: BCBS Trust/PPO |
$877.46
|
| Rate for Payer: BCN Commercial |
$829.86
|
| Rate for Payer: BCN Medicare Advantage |
$266.83
|
| Rate for Payer: Cash Price |
$853.87
|
| Rate for Payer: Cofinity Commercial |
$917.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$266.83
|
| Rate for Payer: Healthscope Commercial |
$960.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$280.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$907.24
|
| Rate for Payer: Nomi Health Commercial |
$875.22
|
| Rate for Payer: PACE Senior Care Partners |
$253.49
|
| Rate for Payer: PACE SWMI |
$266.83
|
| Rate for Payer: PHP Commercial |
$907.24
|
| Rate for Payer: PHP Medicare Advantage |
$266.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.77
|
| Rate for Payer: Priority Health HMO/PPO |
$928.59
|
| Rate for Payer: Priority Health Medicare |
$269.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$715.12
|
| Rate for Payer: Railroad Medicare Medicare |
$266.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$939.26
|
| Rate for Payer: UHC Core |
$891.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$266.83
|
| Rate for Payer: UHC Exchange |
$266.83
|
| Rate for Payer: UHC Medicare Advantage |
$266.83
|
| Rate for Payer: VA VA |
$266.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.50
|
|
|
HC INJECTION MYELOGRAM
|
Facility
|
IP
|
$1,067.34
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
36100281
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$693.77 |
| Max. Negotiated Rate |
$960.61 |
| Rate for Payer: Aetna Commercial |
$907.24
|
| Rate for Payer: BCBS Trust/PPO |
$871.27
|
| Rate for Payer: BCN Commercial |
$824.84
|
| Rate for Payer: Cash Price |
$853.87
|
| Rate for Payer: Cofinity Commercial |
$917.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.87
|
| Rate for Payer: Healthscope Commercial |
$960.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$907.24
|
| Rate for Payer: Nomi Health Commercial |
$875.22
|
| Rate for Payer: PHP Commercial |
$907.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.77
|
| Rate for Payer: Priority Health HMO/PPO |
$928.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$715.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$939.26
|
| Rate for Payer: UHC Core |
$891.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.50
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
IP
|
$351.66
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.58 |
| Max. Negotiated Rate |
$316.49 |
| Rate for Payer: Aetna Commercial |
$298.91
|
| Rate for Payer: BCBS Trust/PPO |
$287.06
|
| Rate for Payer: BCN Commercial |
$271.76
|
| Rate for Payer: Cash Price |
$281.33
|
| Rate for Payer: Cofinity Commercial |
$302.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.33
|
| Rate for Payer: Healthscope Commercial |
$316.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.91
|
| Rate for Payer: Nomi Health Commercial |
$288.36
|
| Rate for Payer: PHP Commercial |
$298.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.58
|
| Rate for Payer: Priority Health HMO/PPO |
$305.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.46
|
| Rate for Payer: UHC Core |
$293.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.75
|
|
|
HC INJECTION PLANTAR DIGIT
|
Facility
|
OP
|
$351.66
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.52 |
| Max. Negotiated Rate |
$316.49 |
| Rate for Payer: Aetna Commercial |
$298.91
|
| Rate for Payer: Aetna Medicare |
$91.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.89
|
| Rate for Payer: BCBS Complete |
$224.11
|
| Rate for Payer: BCBS MAPPO |
$87.92
|
| Rate for Payer: BCBS Trust/PPO |
$289.10
|
| Rate for Payer: BCN Commercial |
$273.42
|
| Rate for Payer: BCN Medicare Advantage |
$87.92
|
| Rate for Payer: Cash Price |
$281.33
|
| Rate for Payer: Cash Price |
$281.33
|
| Rate for Payer: Cofinity Commercial |
$302.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.92
|
| Rate for Payer: Healthscope Commercial |
$316.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.75
|
| Rate for Payer: Mclaren Medicaid |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.31
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.91
|
| Rate for Payer: Nomi Health Commercial |
$288.36
|
| Rate for Payer: PACE Senior Care Partners |
$83.52
|
| Rate for Payer: PACE SWMI |
$87.92
|
| Rate for Payer: PHP Commercial |
$298.91
|
| Rate for Payer: PHP Medicare Advantage |
$87.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.58
|
| Rate for Payer: Priority Health HMO/PPO |
$305.94
|
| Rate for Payer: Priority Health Medicare |
$88.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.61
|
| Rate for Payer: Railroad Medicare Medicare |
$87.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.46
|
| Rate for Payer: UHC Core |
$293.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.92
|
| Rate for Payer: UHC Exchange |
$87.92
|
| Rate for Payer: UHC Medicare Advantage |
$87.92
|
| Rate for Payer: UHCCP Medicaid |
$213.42
|
| Rate for Payer: VA VA |
$87.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.75
|
|
|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
OP
|
$527.48
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.28 |
| Max. Negotiated Rate |
$474.73 |
| Rate for Payer: Aetna Commercial |
$448.36
|
| Rate for Payer: Aetna Medicare |
$137.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$164.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$164.84
|
| Rate for Payer: BCBS Complete |
$224.11
|
| Rate for Payer: BCBS MAPPO |
$131.87
|
| Rate for Payer: BCBS Trust/PPO |
$433.64
|
| Rate for Payer: BCN Commercial |
$410.12
|
| Rate for Payer: BCN Medicare Advantage |
$131.87
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$453.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.87
|
| Rate for Payer: Healthscope Commercial |
$474.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.61
|
| Rate for Payer: Mclaren Medicaid |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.46
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: Nomi Health Commercial |
$432.53
|
| Rate for Payer: PACE Senior Care Partners |
$125.28
|
| Rate for Payer: PACE SWMI |
$131.87
|
| Rate for Payer: PHP Commercial |
$448.36
|
| Rate for Payer: PHP Medicare Advantage |
$131.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: Priority Health HMO/PPO |
$458.91
|
| Rate for Payer: Priority Health Medicare |
$133.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.41
|
| Rate for Payer: Railroad Medicare Medicare |
$131.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.18
|
| Rate for Payer: UHC Core |
$440.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.87
|
| Rate for Payer: UHC Exchange |
$131.87
|
| Rate for Payer: UHC Medicare Advantage |
$131.87
|
| Rate for Payer: UHCCP Medicaid |
$213.42
|
| Rate for Payer: VA VA |
$131.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.61
|
|
|
HC INJECTION PLANTAR DIGIT BILATERAL
|
Facility
|
IP
|
$527.48
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
76100510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.86 |
| Max. Negotiated Rate |
$474.73 |
| Rate for Payer: Aetna Commercial |
$448.36
|
| Rate for Payer: BCBS Trust/PPO |
$430.58
|
| Rate for Payer: BCN Commercial |
$407.64
|
| Rate for Payer: Cash Price |
$421.98
|
| Rate for Payer: Cofinity Commercial |
$453.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.98
|
| Rate for Payer: Healthscope Commercial |
$474.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.36
|
| Rate for Payer: Nomi Health Commercial |
$432.53
|
| Rate for Payer: PHP Commercial |
$448.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.86
|
| Rate for Payer: Priority Health HMO/PPO |
$458.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.18
|
| Rate for Payer: UHC Core |
$440.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.61
|
|
|
HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
OP
|
$805.80
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.38 |
| Max. Negotiated Rate |
$725.22 |
| Rate for Payer: Aetna Commercial |
$684.93
|
| Rate for Payer: Aetna Medicare |
$209.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.81
|
| Rate for Payer: BCBS Complete |
$302.95
|
| Rate for Payer: BCBS MAPPO |
$201.45
|
| Rate for Payer: BCBS Trust/PPO |
$662.45
|
| Rate for Payer: BCN Commercial |
$626.51
|
| Rate for Payer: BCN Medicare Advantage |
$201.45
|
| Rate for Payer: Cash Price |
$644.64
|
| Rate for Payer: Cash Price |
$644.64
|
| Rate for Payer: Cofinity Commercial |
$692.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.45
|
| Rate for Payer: Healthscope Commercial |
$725.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$604.35
|
| Rate for Payer: Mclaren Medicaid |
$288.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.52
|
| Rate for Payer: Meridian Medicaid |
$302.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.93
|
| Rate for Payer: Nomi Health Commercial |
$660.76
|
| Rate for Payer: PACE Senior Care Partners |
$191.38
|
| Rate for Payer: PACE SWMI |
$201.45
|
| Rate for Payer: PHP Commercial |
$684.93
|
| Rate for Payer: PHP Medicare Advantage |
$201.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.77
|
| Rate for Payer: Priority Health HMO/PPO |
$701.05
|
| Rate for Payer: Priority Health Medicare |
$203.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$539.89
|
| Rate for Payer: Railroad Medicare Medicare |
$201.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$709.10
|
| Rate for Payer: UHC Core |
$672.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$201.45
|
| Rate for Payer: UHC Exchange |
$201.45
|
| Rate for Payer: UHC Medicare Advantage |
$201.45
|
| Rate for Payer: UHCCP Medicaid |
$288.51
|
| Rate for Payer: VA VA |
$201.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$604.35
|
|
|
HC INJECTION PLATELET PLASMA W/IMG HARVEST/PREP
|
Facility
|
IP
|
$805.80
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$523.77 |
| Max. Negotiated Rate |
$725.22 |
| Rate for Payer: Aetna Commercial |
$684.93
|
| Rate for Payer: BCBS Trust/PPO |
$657.77
|
| Rate for Payer: BCN Commercial |
$622.72
|
| Rate for Payer: Cash Price |
$644.64
|
| Rate for Payer: Cofinity Commercial |
$692.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.64
|
| Rate for Payer: Healthscope Commercial |
$725.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$604.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.93
|
| Rate for Payer: Nomi Health Commercial |
$660.76
|
| Rate for Payer: PHP Commercial |
$684.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.77
|
| Rate for Payer: Priority Health HMO/PPO |
$701.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$539.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$709.10
|
| Rate for Payer: UHC Core |
$672.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$604.35
|
|
|
HC INJECTION PROC CYSTOGRAPHY VOIDING
|
Facility
|
OP
|
$1,310.34
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$311.21 |
| Max. Negotiated Rate |
$1,179.31 |
| Rate for Payer: Aetna Commercial |
$1,113.79
|
| Rate for Payer: Aetna Medicare |
$340.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$409.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$409.48
|
| Rate for Payer: BCBS Complete |
$524.14
|
| Rate for Payer: BCBS MAPPO |
$327.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,077.23
|
| Rate for Payer: BCN Commercial |
$1,018.79
|
| Rate for Payer: BCN Medicare Advantage |
$327.58
|
| Rate for Payer: Cash Price |
$1,048.27
|
| Rate for Payer: Cofinity Commercial |
$1,126.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.58
|
| Rate for Payer: Healthscope Commercial |
$1,179.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$982.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,113.79
|
| Rate for Payer: Nomi Health Commercial |
$1,074.48
|
| Rate for Payer: PACE Senior Care Partners |
$311.21
|
| Rate for Payer: PACE SWMI |
$327.58
|
| Rate for Payer: PHP Commercial |
$1,113.79
|
| Rate for Payer: PHP Medicare Advantage |
$327.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,140.00
|
| Rate for Payer: Priority Health Medicare |
$330.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$877.93
|
| Rate for Payer: Railroad Medicare Medicare |
$327.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,153.10
|
| Rate for Payer: UHC Core |
$1,094.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.58
|
| Rate for Payer: UHC Exchange |
$327.58
|
| Rate for Payer: UHC Medicare Advantage |
$327.58
|
| Rate for Payer: VA VA |
$327.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$982.75
|
|
|
HC INJECTION PROC CYSTOGRAPHY VOIDING
|
Facility
|
IP
|
$1,310.34
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
36100251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$851.72 |
| Max. Negotiated Rate |
$1,179.31 |
| Rate for Payer: Aetna Commercial |
$1,113.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,069.63
|
| Rate for Payer: BCN Commercial |
$1,012.63
|
| Rate for Payer: Cash Price |
$1,048.27
|
| Rate for Payer: Cofinity Commercial |
$1,126.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,048.27
|
| Rate for Payer: Healthscope Commercial |
$1,179.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$982.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,113.79
|
| Rate for Payer: Nomi Health Commercial |
$1,074.48
|
| Rate for Payer: PHP Commercial |
$1,113.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$851.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,140.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$877.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,153.10
|
| Rate for Payer: UHC Core |
$1,094.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$982.75
|
|
|
HC INJECTION PROCEDURE
|
Facility
|
IP
|
$603.48
|
|
| Hospital Charge Code |
36000085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$392.26 |
| Max. Negotiated Rate |
$543.13 |
| Rate for Payer: Aetna Commercial |
$512.96
|
| Rate for Payer: BCBS Trust/PPO |
$492.62
|
| Rate for Payer: BCN Commercial |
$466.37
|
| Rate for Payer: Cash Price |
$482.78
|
| Rate for Payer: Cofinity Commercial |
$518.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.78
|
| Rate for Payer: Healthscope Commercial |
$543.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$452.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.96
|
| Rate for Payer: Nomi Health Commercial |
$494.85
|
| Rate for Payer: PHP Commercial |
$512.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.26
|
| Rate for Payer: Priority Health HMO/PPO |
$525.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$404.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$531.06
|
| Rate for Payer: UHC Core |
$503.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$452.61
|
|
|
HC INJECTION PROCEDURE
|
Facility
|
OP
|
$603.48
|
|
| Hospital Charge Code |
36000085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$143.33 |
| Max. Negotiated Rate |
$543.13 |
| Rate for Payer: Aetna Commercial |
$512.96
|
| Rate for Payer: Aetna Medicare |
$156.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$188.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$188.59
|
| Rate for Payer: BCBS Complete |
$241.39
|
| Rate for Payer: BCBS MAPPO |
$150.87
|
| Rate for Payer: BCBS Trust/PPO |
$496.12
|
| Rate for Payer: BCN Commercial |
$469.21
|
| Rate for Payer: BCN Medicare Advantage |
$150.87
|
| Rate for Payer: Cash Price |
$482.78
|
| Rate for Payer: Cofinity Commercial |
$518.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$482.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.87
|
| Rate for Payer: Healthscope Commercial |
$543.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$452.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.96
|
| Rate for Payer: Nomi Health Commercial |
$494.85
|
| Rate for Payer: PACE Senior Care Partners |
$143.33
|
| Rate for Payer: PACE SWMI |
$150.87
|
| Rate for Payer: PHP Commercial |
$512.96
|
| Rate for Payer: PHP Medicare Advantage |
$150.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.26
|
| Rate for Payer: Priority Health HMO/PPO |
$525.03
|
| Rate for Payer: Priority Health Medicare |
$152.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$404.33
|
| Rate for Payer: Railroad Medicare Medicare |
$150.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$531.06
|
| Rate for Payer: UHC Core |
$503.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.87
|
| Rate for Payer: UHC Exchange |
$150.87
|
| Rate for Payer: UHC Medicare Advantage |
$150.87
|
| Rate for Payer: VA VA |
$150.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$452.61
|
|
|
HC INJECTION PROCEDURE ILEAL CONDUIT
|
Facility
|
IP
|
$643.53
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
36100249
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$418.29 |
| Max. Negotiated Rate |
$579.18 |
| Rate for Payer: Aetna Commercial |
$547.00
|
| Rate for Payer: BCBS Trust/PPO |
$525.31
|
| Rate for Payer: BCN Commercial |
$497.32
|
| 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: Healthscope Commercial |
$579.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.00
|
| Rate for Payer: Nomi Health Commercial |
$527.69
|
| Rate for Payer: PHP Commercial |
$547.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.29
|
| Rate for Payer: Priority Health HMO/PPO |
$559.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$431.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.31
|
| Rate for Payer: UHC Core |
$537.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.65
|
|
|
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
|
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 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, 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, 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 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 |
$675.91
|
| 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 |
$643.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.32
|
| Rate for Payer: Meridian Medicaid |
$675.91
|
| 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 |
$643.68
|
| 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 |
$643.68
|
| Rate for Payer: VA VA |
$298.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$895.21
|
|
|
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 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 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 |
$303.32 |
| 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 |
$303.32
|
| 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 |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.44
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| 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 |
$288.86
|
| 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 |
$288.86
|
| Rate for Payer: VA VA |
$82.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.97
|
|
