|
HC INJECTION VENOGRAM
|
Facility
|
OP
|
$566.97
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
36100095
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.66 |
| Max. Negotiated Rate |
$510.27 |
| Rate for Payer: Aetna Commercial |
$481.92
|
| Rate for Payer: Aetna Medicare |
$147.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.18
|
| Rate for Payer: BCBS Complete |
$226.79
|
| Rate for Payer: BCBS MAPPO |
$141.74
|
| Rate for Payer: BCBS Trust/PPO |
$466.11
|
| Rate for Payer: BCN Commercial |
$440.82
|
| Rate for Payer: BCN Medicare Advantage |
$141.74
|
| Rate for Payer: Cash Price |
$453.58
|
| Rate for Payer: Cofinity Commercial |
$487.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.74
|
| Rate for Payer: Healthscope Commercial |
$510.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$425.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.92
|
| Rate for Payer: Nomi Health Commercial |
$464.92
|
| Rate for Payer: PACE Senior Care Partners |
$134.66
|
| Rate for Payer: PACE SWMI |
$141.74
|
| Rate for Payer: PHP Commercial |
$481.92
|
| Rate for Payer: PHP Medicare Advantage |
$141.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.53
|
| Rate for Payer: Priority Health HMO/PPO |
$493.26
|
| Rate for Payer: Priority Health Medicare |
$143.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.87
|
| Rate for Payer: Railroad Medicare Medicare |
$141.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.93
|
| Rate for Payer: UHC Core |
$473.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.74
|
| Rate for Payer: UHC Exchange |
$141.74
|
| Rate for Payer: UHC Medicare Advantage |
$141.74
|
| Rate for Payer: VA VA |
$141.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$425.23
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
OP
|
$1,152.20
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$273.65 |
| Max. Negotiated Rate |
$1,036.98 |
| Rate for Payer: Aetna Commercial |
$979.37
|
| Rate for Payer: Aetna Medicare |
$299.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$360.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$360.06
|
| Rate for Payer: BCBS Complete |
$460.88
|
| Rate for Payer: BCBS MAPPO |
$288.05
|
| Rate for Payer: BCBS Trust/PPO |
$947.22
|
| Rate for Payer: BCN Commercial |
$895.84
|
| Rate for Payer: BCN Medicare Advantage |
$288.05
|
| Rate for Payer: Cash Price |
$921.76
|
| Rate for Payer: Cofinity Commercial |
$990.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.05
|
| Rate for Payer: Healthscope Commercial |
$1,036.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$864.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$979.37
|
| Rate for Payer: Nomi Health Commercial |
$944.80
|
| Rate for Payer: PACE Senior Care Partners |
$273.65
|
| Rate for Payer: PACE SWMI |
$288.05
|
| Rate for Payer: PHP Commercial |
$979.37
|
| Rate for Payer: PHP Medicare Advantage |
$288.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$748.93
|
| Rate for Payer: Priority Health HMO/PPO |
$1,002.41
|
| Rate for Payer: Priority Health Medicare |
$290.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$771.97
|
| Rate for Payer: Railroad Medicare Medicare |
$288.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,013.94
|
| Rate for Payer: UHC Core |
$962.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$288.05
|
| Rate for Payer: UHC Exchange |
$288.05
|
| Rate for Payer: UHC Medicare Advantage |
$288.05
|
| Rate for Payer: VA VA |
$288.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$864.15
|
|
|
HC INJECTION WRIST ARTHROGRAM
|
Facility
|
IP
|
$1,152.20
|
|
|
Service Code
|
CPT 25246
|
| Hospital Charge Code |
36100039
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$748.93 |
| Max. Negotiated Rate |
$1,036.98 |
| Rate for Payer: Aetna Commercial |
$979.37
|
| Rate for Payer: BCBS Trust/PPO |
$940.54
|
| Rate for Payer: BCN Commercial |
$890.42
|
| Rate for Payer: Cash Price |
$921.76
|
| Rate for Payer: Cofinity Commercial |
$990.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.76
|
| Rate for Payer: Healthscope Commercial |
$1,036.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$864.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$979.37
|
| Rate for Payer: Nomi Health Commercial |
$944.80
|
| Rate for Payer: PHP Commercial |
$979.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$748.93
|
| Rate for Payer: Priority Health HMO/PPO |
$1,002.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$771.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,013.94
|
| Rate for Payer: UHC Core |
$962.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$864.15
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
OP
|
$373.37
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.68 |
| Max. Negotiated Rate |
$336.03 |
| Rate for Payer: Aetna Commercial |
$317.36
|
| Rate for Payer: Aetna Medicare |
$97.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.68
|
| Rate for Payer: BCBS Complete |
$149.35
|
| Rate for Payer: BCBS MAPPO |
$93.34
|
| Rate for Payer: BCBS Trust/PPO |
$306.95
|
| Rate for Payer: BCN Commercial |
$290.30
|
| Rate for Payer: BCN Medicare Advantage |
$93.34
|
| Rate for Payer: Cash Price |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$321.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.34
|
| Rate for Payer: Healthscope Commercial |
$336.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.36
|
| Rate for Payer: Nomi Health Commercial |
$306.16
|
| Rate for Payer: PACE Senior Care Partners |
$88.68
|
| Rate for Payer: PACE SWMI |
$93.34
|
| Rate for Payer: PHP Commercial |
$317.36
|
| Rate for Payer: PHP Medicare Advantage |
$93.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.69
|
| Rate for Payer: Priority Health HMO/PPO |
$324.83
|
| Rate for Payer: Priority Health Medicare |
$94.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.16
|
| Rate for Payer: Railroad Medicare Medicare |
$93.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.57
|
| Rate for Payer: UHC Core |
$311.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.34
|
| Rate for Payer: UHC Exchange |
$93.34
|
| Rate for Payer: UHC Medicare Advantage |
$93.34
|
| Rate for Payer: VA VA |
$93.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.03
|
|
|
HC INJECT/IRRIGATE CORPORA CAVERNOSA
|
Facility
|
IP
|
$373.37
|
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.69 |
| Max. Negotiated Rate |
$336.03 |
| Rate for Payer: Aetna Commercial |
$317.36
|
| Rate for Payer: BCBS Trust/PPO |
$304.78
|
| Rate for Payer: BCN Commercial |
$288.54
|
| Rate for Payer: Cash Price |
$298.70
|
| Rate for Payer: Cofinity Commercial |
$321.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.70
|
| Rate for Payer: Healthscope Commercial |
$336.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.36
|
| Rate for Payer: Nomi Health Commercial |
$306.16
|
| Rate for Payer: PHP Commercial |
$317.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.69
|
| Rate for Payer: Priority Health HMO/PPO |
$324.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.57
|
| Rate for Payer: UHC Core |
$311.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.03
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
IP
|
$2,780.89
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,807.58 |
| Max. Negotiated Rate |
$2,502.80 |
| Rate for Payer: Aetna Commercial |
$2,363.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,270.04
|
| Rate for Payer: BCN Commercial |
$2,149.07
|
| Rate for Payer: Cash Price |
$2,224.71
|
| Rate for Payer: Cofinity Commercial |
$2,391.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.71
|
| Rate for Payer: Healthscope Commercial |
$2,502.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,085.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.76
|
| Rate for Payer: Nomi Health Commercial |
$2,280.33
|
| Rate for Payer: PHP Commercial |
$2,363.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.58
|
| Rate for Payer: Priority Health HMO/PPO |
$2,419.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,863.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,447.18
|
| Rate for Payer: UHC Core |
$2,322.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,085.67
|
|
|
HC INJECT PORTAL VEIN
|
Facility
|
OP
|
$2,780.89
|
|
|
Service Code
|
CPT 36481
|
| Hospital Charge Code |
36100543
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.46 |
| Max. Negotiated Rate |
$2,502.80 |
| Rate for Payer: Aetna Commercial |
$2,363.76
|
| Rate for Payer: Aetna Medicare |
$723.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$869.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$869.03
|
| Rate for Payer: BCBS Complete |
$1,112.36
|
| Rate for Payer: BCBS MAPPO |
$695.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,286.17
|
| Rate for Payer: BCN Commercial |
$2,162.14
|
| Rate for Payer: BCN Medicare Advantage |
$695.22
|
| Rate for Payer: Cash Price |
$2,224.71
|
| Rate for Payer: Cofinity Commercial |
$2,391.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,224.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.22
|
| Rate for Payer: Healthscope Commercial |
$2,502.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,085.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.76
|
| Rate for Payer: Nomi Health Commercial |
$2,280.33
|
| Rate for Payer: PACE Senior Care Partners |
$660.46
|
| Rate for Payer: PACE SWMI |
$695.22
|
| Rate for Payer: PHP Commercial |
$2,363.76
|
| Rate for Payer: PHP Medicare Advantage |
$695.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,807.58
|
| Rate for Payer: Priority Health HMO/PPO |
$2,419.37
|
| Rate for Payer: Priority Health Medicare |
$702.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,863.20
|
| Rate for Payer: Railroad Medicare Medicare |
$695.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,447.18
|
| Rate for Payer: UHC Core |
$2,322.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.22
|
| Rate for Payer: UHC Exchange |
$695.22
|
| Rate for Payer: UHC Medicare Advantage |
$695.22
|
| Rate for Payer: VA VA |
$695.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,085.67
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
IP
|
$361.15
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.75 |
| Max. Negotiated Rate |
$325.04 |
| Rate for Payer: Aetna Commercial |
$306.98
|
| Rate for Payer: BCBS Trust/PPO |
$294.81
|
| Rate for Payer: BCN Commercial |
$279.10
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Healthscope Commercial |
$325.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: Nomi Health Commercial |
$296.14
|
| Rate for Payer: PHP Commercial |
$306.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: Priority Health HMO/PPO |
$314.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.81
|
| Rate for Payer: UHC Core |
$301.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.86
|
|
|
HC INJECT PROC PENILE PLAQUE
|
Facility
|
OP
|
$361.15
|
|
|
Service Code
|
CPT 54200
|
| Hospital Charge Code |
76100199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.77 |
| Max. Negotiated Rate |
$325.04 |
| Rate for Payer: Aetna Commercial |
$306.98
|
| Rate for Payer: Aetna Medicare |
$93.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.86
|
| Rate for Payer: BCBS Complete |
$180.91
|
| Rate for Payer: BCBS MAPPO |
$90.29
|
| Rate for Payer: BCBS Trust/PPO |
$296.90
|
| Rate for Payer: BCN Commercial |
$280.79
|
| Rate for Payer: BCN Medicare Advantage |
$90.29
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cash Price |
$288.92
|
| Rate for Payer: Cofinity Commercial |
$310.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.29
|
| Rate for Payer: Healthscope Commercial |
$325.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.86
|
| Rate for Payer: Mclaren Medicaid |
$172.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.80
|
| Rate for Payer: Meridian Medicaid |
$180.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.98
|
| Rate for Payer: Nomi Health Commercial |
$296.14
|
| Rate for Payer: PACE Senior Care Partners |
$85.77
|
| Rate for Payer: PACE SWMI |
$90.29
|
| Rate for Payer: PHP Commercial |
$306.98
|
| Rate for Payer: PHP Medicare Advantage |
$90.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.75
|
| Rate for Payer: Priority Health HMO/PPO |
$314.20
|
| Rate for Payer: Priority Health Medicare |
$91.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.97
|
| Rate for Payer: Railroad Medicare Medicare |
$90.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.81
|
| Rate for Payer: UHC Core |
$301.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.29
|
| Rate for Payer: UHC Exchange |
$90.29
|
| Rate for Payer: UHC Medicare Advantage |
$90.29
|
| Rate for Payer: UHCCP Medicaid |
$172.28
|
| Rate for Payer: VA VA |
$90.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.86
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
OP
|
$374.14
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.86 |
| Max. Negotiated Rate |
$336.73 |
| Rate for Payer: Aetna Commercial |
$318.02
|
| Rate for Payer: Aetna Medicare |
$97.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.92
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$93.54
|
| Rate for Payer: BCBS Trust/PPO |
$307.58
|
| Rate for Payer: BCN Commercial |
$290.89
|
| Rate for Payer: BCN Medicare Advantage |
$93.54
|
| Rate for Payer: Cash Price |
$299.31
|
| Rate for Payer: Cash Price |
$299.31
|
| Rate for Payer: Cofinity Commercial |
$321.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.54
|
| Rate for Payer: Healthscope Commercial |
$336.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.60
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.21
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.02
|
| Rate for Payer: Nomi Health Commercial |
$306.79
|
| Rate for Payer: PACE Senior Care Partners |
$88.86
|
| Rate for Payer: PACE SWMI |
$93.54
|
| Rate for Payer: PHP Commercial |
$318.02
|
| Rate for Payer: PHP Medicare Advantage |
$93.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.19
|
| Rate for Payer: Priority Health HMO/PPO |
$325.50
|
| Rate for Payer: Priority Health Medicare |
$94.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.67
|
| Rate for Payer: Railroad Medicare Medicare |
$93.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.24
|
| Rate for Payer: UHC Core |
$312.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.54
|
| Rate for Payer: UHC Exchange |
$93.54
|
| Rate for Payer: UHC Medicare Advantage |
$93.54
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$93.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.60
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 1 OR 2 MUSCLES
|
Facility
|
IP
|
$374.14
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
36100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.19 |
| Max. Negotiated Rate |
$336.73 |
| Rate for Payer: Aetna Commercial |
$318.02
|
| Rate for Payer: BCBS Trust/PPO |
$305.41
|
| Rate for Payer: BCN Commercial |
$289.14
|
| Rate for Payer: Cash Price |
$299.31
|
| Rate for Payer: Cofinity Commercial |
$321.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.31
|
| Rate for Payer: Healthscope Commercial |
$336.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.02
|
| Rate for Payer: Nomi Health Commercial |
$306.79
|
| Rate for Payer: PHP Commercial |
$318.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.19
|
| Rate for Payer: Priority Health HMO/PPO |
$325.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$250.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.24
|
| Rate for Payer: UHC Core |
$312.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.60
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
OP
|
$487.67
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.82 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Aetna Commercial |
$414.52
|
| Rate for Payer: Aetna Medicare |
$126.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.40
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$121.92
|
| Rate for Payer: BCBS Trust/PPO |
$400.91
|
| Rate for Payer: BCN Commercial |
$379.16
|
| Rate for Payer: BCN Medicare Advantage |
$121.92
|
| Rate for Payer: Cash Price |
$390.14
|
| Rate for Payer: Cash Price |
$390.14
|
| Rate for Payer: Cofinity Commercial |
$419.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.92
|
| Rate for Payer: Healthscope Commercial |
$438.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$365.75
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.01
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.52
|
| Rate for Payer: Nomi Health Commercial |
$399.89
|
| Rate for Payer: PACE Senior Care Partners |
$115.82
|
| Rate for Payer: PACE SWMI |
$121.92
|
| Rate for Payer: PHP Commercial |
$414.52
|
| Rate for Payer: PHP Medicare Advantage |
$121.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.99
|
| Rate for Payer: Priority Health HMO/PPO |
$424.27
|
| Rate for Payer: Priority Health Medicare |
$123.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.74
|
| Rate for Payer: Railroad Medicare Medicare |
$121.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.15
|
| Rate for Payer: UHC Core |
$407.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.92
|
| Rate for Payer: UHC Exchange |
$121.92
|
| Rate for Payer: UHC Medicare Advantage |
$121.92
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$121.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$365.75
|
|
|
HC INJECT SING OR MULTI TRIGGER PTS 3 OR MORE MUSCLES
|
Facility
|
IP
|
$487.67
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
36100400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.99 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Aetna Commercial |
$414.52
|
| Rate for Payer: BCBS Trust/PPO |
$398.09
|
| Rate for Payer: BCN Commercial |
$376.87
|
| Rate for Payer: Cash Price |
$390.14
|
| Rate for Payer: Cofinity Commercial |
$419.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.14
|
| Rate for Payer: Healthscope Commercial |
$438.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$365.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.52
|
| Rate for Payer: Nomi Health Commercial |
$399.89
|
| Rate for Payer: PHP Commercial |
$414.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.99
|
| Rate for Payer: Priority Health HMO/PPO |
$424.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.15
|
| Rate for Payer: UHC Core |
$407.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$365.75
|
|
|
HC INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
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 INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
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 INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
OP
|
$339.65
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.67 |
| Max. Negotiated Rate |
$305.68 |
| Rate for Payer: Aetna Commercial |
$288.70
|
| Rate for Payer: Aetna Medicare |
$88.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.14
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$84.91
|
| Rate for Payer: BCBS Trust/PPO |
$279.23
|
| Rate for Payer: BCN Commercial |
$264.08
|
| Rate for Payer: BCN Medicare Advantage |
$84.91
|
| Rate for Payer: Cash Price |
$271.72
|
| Rate for Payer: Cash Price |
$271.72
|
| Rate for Payer: Cofinity Commercial |
$292.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.91
|
| Rate for Payer: Healthscope Commercial |
$305.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.74
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.16
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.70
|
| Rate for Payer: Nomi Health Commercial |
$278.51
|
| Rate for Payer: PACE Senior Care Partners |
$80.67
|
| Rate for Payer: PACE SWMI |
$84.91
|
| Rate for Payer: PHP Commercial |
$288.70
|
| Rate for Payer: PHP Medicare Advantage |
$84.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.77
|
| Rate for Payer: Priority Health HMO/PPO |
$295.50
|
| Rate for Payer: Priority Health Medicare |
$85.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.57
|
| Rate for Payer: Railroad Medicare Medicare |
$84.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.89
|
| Rate for Payer: UHC Core |
$283.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.91
|
| Rate for Payer: UHC Exchange |
$84.91
|
| Rate for Payer: UHC Medicare Advantage |
$84.91
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$84.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.74
|
|
|
HC INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
IP
|
$339.65
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.77 |
| Max. Negotiated Rate |
$305.68 |
| Rate for Payer: Aetna Commercial |
$288.70
|
| Rate for Payer: BCBS Trust/PPO |
$277.26
|
| Rate for Payer: BCN Commercial |
$262.48
|
| Rate for Payer: Cash Price |
$271.72
|
| Rate for Payer: Cofinity Commercial |
$292.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.72
|
| Rate for Payer: Healthscope Commercial |
$305.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.70
|
| Rate for Payer: Nomi Health Commercial |
$278.51
|
| Rate for Payer: PHP Commercial |
$288.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.77
|
| Rate for Payer: Priority Health HMO/PPO |
$295.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.89
|
| Rate for Payer: UHC Core |
$283.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.74
|
|
|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.33
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.81
|
| Rate for Payer: BCN Medicare Advantage |
$0.26
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$0.85
|
| Rate for Payer: PACE Senior Care Partners |
$0.25
|
| Rate for Payer: PACE SWMI |
$0.26
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: PHP Medicare Advantage |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: Priority Health HMO/PPO |
$0.90
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.70
|
| Rate for Payer: Railroad Medicare Medicare |
$0.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.92
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.26
|
| Rate for Payer: UHC Exchange |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.26
|
| Rate for Payer: VA VA |
$0.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.78
|
|
|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: BCBS Trust/PPO |
$0.85
|
| Rate for Payer: BCN Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$0.85
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.68
|
| Rate for Payer: Priority Health HMO/PPO |
$0.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.92
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.78
|
|
|
HC INJ HYDROCORTISONE NA SUCCINATE, UP TO 100MG
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
63600241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.39
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS MAPPO |
$10.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.22
|
| Rate for Payer: BCN Commercial |
$33.31
|
| Rate for Payer: BCN Medicare Advantage |
$10.71
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: PACE Senior Care Partners |
$10.17
|
| Rate for Payer: PACE SWMI |
$10.71
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Medicare |
$10.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.70
|
| Rate for Payer: Railroad Medicare Medicare |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.71
|
| Rate for Payer: UHC Exchange |
$10.71
|
| Rate for Payer: UHC Medicare Advantage |
$10.71
|
| Rate for Payer: VA VA |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC INJ HYDROCORTISONE NA SUCCINATE, UP TO 100MG
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
63600241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: BCBS Trust/PPO |
$34.97
|
| Rate for Payer: BCN Commercial |
$33.11
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
IP
|
$617.14
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.14 |
| Max. Negotiated Rate |
$555.43 |
| Rate for Payer: Aetna Commercial |
$524.57
|
| Rate for Payer: BCBS Trust/PPO |
$503.77
|
| Rate for Payer: BCN Commercial |
$476.93
|
| Rate for Payer: Cash Price |
$493.71
|
| Rate for Payer: Cofinity Commercial |
$530.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.71
|
| Rate for Payer: Healthscope Commercial |
$555.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.57
|
| Rate for Payer: Nomi Health Commercial |
$506.05
|
| Rate for Payer: PHP Commercial |
$524.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.14
|
| Rate for Payer: Priority Health HMO/PPO |
$536.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.08
|
| Rate for Payer: UHC Core |
$515.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.86
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
OP
|
$617.14
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.57 |
| Max. Negotiated Rate |
$555.43 |
| Rate for Payer: Aetna Commercial |
$524.57
|
| Rate for Payer: Aetna Medicare |
$160.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.86
|
| Rate for Payer: BCBS Complete |
$246.86
|
| Rate for Payer: BCBS MAPPO |
$154.28
|
| Rate for Payer: BCBS Trust/PPO |
$507.35
|
| Rate for Payer: BCN Commercial |
$479.83
|
| Rate for Payer: BCN Medicare Advantage |
$154.28
|
| Rate for Payer: Cash Price |
$493.71
|
| Rate for Payer: Cofinity Commercial |
$530.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$555.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$462.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.57
|
| Rate for Payer: Nomi Health Commercial |
$506.05
|
| Rate for Payer: PACE Senior Care Partners |
$146.57
|
| Rate for Payer: PACE SWMI |
$154.28
|
| Rate for Payer: PHP Commercial |
$524.57
|
| Rate for Payer: PHP Medicare Advantage |
$154.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.14
|
| Rate for Payer: Priority Health HMO/PPO |
$536.91
|
| Rate for Payer: Priority Health Medicare |
$155.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.48
|
| Rate for Payer: Railroad Medicare Medicare |
$154.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.08
|
| Rate for Payer: UHC Core |
$515.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.28
|
| Rate for Payer: UHC Exchange |
$154.28
|
| Rate for Payer: UHC Medicare Advantage |
$154.28
|
| Rate for Payer: VA VA |
$154.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$462.86
|
|
|
HC INJ LIDOCAINE HYDROCHLORIDE 1 MG
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
63600262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.82
|
| Rate for Payer: BCN Commercial |
$0.77
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.85
|
| Rate for Payer: Nomi Health Commercial |
$0.82
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health HMO/PPO |
$0.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.88
|
| Rate for Payer: UHC Core |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.75
|
|
|
HC INJ LIDOCAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
63600262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: Aetna Medicare |
$0.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.31
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.82
|
| Rate for Payer: BCN Commercial |
$0.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.25
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.25
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.85
|
| Rate for Payer: Nomi Health Commercial |
$0.82
|
| Rate for Payer: PACE Senior Care Partners |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.25
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: PHP Medicare Advantage |
$0.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health HMO/PPO |
$0.87
|
| Rate for Payer: Priority Health Medicare |
$0.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.67
|
| Rate for Payer: Railroad Medicare Medicare |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.88
|
| Rate for Payer: UHC Core |
$0.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
| Rate for Payer: UHC Medicare Advantage |
$0.25
|
| Rate for Payer: VA VA |
$0.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.75
|
|
