|
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 |
$224.11
|
| Rate for Payer: BCBS MAPPO |
$93.53
|
| Rate for Payer: BCBS Trust/PPO |
$307.58
|
| Rate for Payer: BCN Commercial |
$290.89
|
| Rate for Payer: BCN Medicare Advantage |
$93.53
|
| 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 |
$93.53
|
| Rate for Payer: Healthscope Commercial |
$336.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.61
|
| Rate for Payer: Mclaren Medicaid |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.21
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| 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 |
$93.53
|
| Rate for Payer: PHP Commercial |
$318.02
|
| Rate for Payer: PHP Medicare Advantage |
$93.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.42
|
| 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 |
$93.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.24
|
| Rate for Payer: UHC Core |
$312.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.53
|
| Rate for Payer: UHC Exchange |
$93.53
|
| Rate for Payer: UHC Medicare Advantage |
$93.53
|
| Rate for Payer: UHCCP Medicaid |
$213.42
|
| Rate for Payer: VA VA |
$93.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.61
|
|
|
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 |
$280.61
|
| 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 |
$280.61
|
|
|
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 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 |
$224.11
|
| 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 |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.01
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| 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 |
$213.42
|
| 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 |
$213.42
|
| Rate for Payer: VA VA |
$121.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$365.75
|
|
|
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 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 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 |
$305.69 |
| 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 |
$305.69
|
| 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 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 |
$305.69 |
| 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 |
$224.11
|
| 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 |
$305.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.74
|
| Rate for Payer: Mclaren Medicaid |
$213.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.16
|
| Rate for Payer: Meridian Medicaid |
$224.11
|
| 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 |
$213.42
|
| 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 |
$213.42
|
| Rate for Payer: VA VA |
$84.91
|
| 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
|
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 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 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
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
OP
|
$2,096.95
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$498.03 |
| Max. Negotiated Rate |
$1,887.26 |
| Rate for Payer: Aetna Commercial |
$1,782.41
|
| Rate for Payer: Aetna Medicare |
$545.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$655.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$655.30
|
| Rate for Payer: BCBS Complete |
$599.81
|
| Rate for Payer: BCBS MAPPO |
$524.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,723.90
|
| Rate for Payer: BCN Commercial |
$1,630.38
|
| Rate for Payer: BCN Medicare Advantage |
$524.24
|
| Rate for Payer: Cash Price |
$1,677.56
|
| Rate for Payer: Cash Price |
$1,677.56
|
| Rate for Payer: Cofinity Commercial |
$1,803.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.24
|
| Rate for Payer: Healthscope Commercial |
$1,887.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,572.71
|
| Rate for Payer: Mclaren Medicaid |
$571.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$550.45
|
| Rate for Payer: Meridian Medicaid |
$599.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.41
|
| Rate for Payer: Nomi Health Commercial |
$1,719.50
|
| Rate for Payer: PACE Senior Care Partners |
$498.03
|
| Rate for Payer: PACE SWMI |
$524.24
|
| Rate for Payer: PHP Commercial |
$1,782.41
|
| Rate for Payer: PHP Medicare Advantage |
$524.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,824.35
|
| Rate for Payer: Priority Health Medicare |
$529.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,404.96
|
| Rate for Payer: Railroad Medicare Medicare |
$524.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,845.32
|
| Rate for Payer: UHC Core |
$1,750.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.24
|
| Rate for Payer: UHC Exchange |
$524.24
|
| Rate for Payer: UHC Medicare Advantage |
$524.24
|
| Rate for Payer: UHCCP Medicaid |
$571.21
|
| Rate for Payer: VA VA |
$524.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,572.71
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
IP
|
$2,096.95
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,363.02 |
| Max. Negotiated Rate |
$1,887.26 |
| Rate for Payer: Aetna Commercial |
$1,782.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.74
|
| Rate for Payer: BCN Commercial |
$1,620.52
|
| Rate for Payer: Cash Price |
$1,677.56
|
| Rate for Payer: Cofinity Commercial |
$1,803.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.56
|
| Rate for Payer: Healthscope Commercial |
$1,887.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,572.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.41
|
| Rate for Payer: Nomi Health Commercial |
$1,719.50
|
| Rate for Payer: PHP Commercial |
$1,782.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,824.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,404.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,845.32
|
| Rate for Payer: UHC Core |
$1,750.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,572.71
|
|
|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
IP
|
$2,204.53
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,432.94 |
| Max. Negotiated Rate |
$1,984.08 |
| Rate for Payer: Aetna Commercial |
$1,873.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.56
|
| Rate for Payer: BCN Commercial |
$1,703.66
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$1,895.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Healthscope Commercial |
$1,984.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,653.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: Nomi Health Commercial |
$1,807.71
|
| Rate for Payer: PHP Commercial |
$1,873.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,917.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,477.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,939.99
|
| Rate for Payer: UHC Core |
$1,840.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,653.40
|
|
|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
OP
|
$2,204.53
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$523.58 |
| Max. Negotiated Rate |
$1,984.08 |
| Rate for Payer: Aetna Commercial |
$1,873.85
|
| Rate for Payer: Aetna Medicare |
$573.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.92
|
| Rate for Payer: BCBS Complete |
$599.81
|
| Rate for Payer: BCBS MAPPO |
$551.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,812.34
|
| Rate for Payer: BCN Commercial |
$1,714.02
|
| Rate for Payer: BCN Medicare Advantage |
$551.13
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$1,895.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$551.13
|
| Rate for Payer: Healthscope Commercial |
$1,984.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,653.40
|
| Rate for Payer: Mclaren Medicaid |
$571.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.69
|
| Rate for Payer: Meridian Medicaid |
$599.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: Nomi Health Commercial |
$1,807.71
|
| Rate for Payer: PACE Senior Care Partners |
$523.58
|
| Rate for Payer: PACE SWMI |
$551.13
|
| Rate for Payer: PHP Commercial |
$1,873.85
|
| Rate for Payer: PHP Medicare Advantage |
$551.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,917.94
|
| Rate for Payer: Priority Health Medicare |
$556.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,477.04
|
| Rate for Payer: Railroad Medicare Medicare |
$551.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,939.99
|
| Rate for Payer: UHC Core |
$1,840.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$551.13
|
| Rate for Payer: UHC Exchange |
$551.13
|
| Rate for Payer: UHC Medicare Advantage |
$551.13
|
| Rate for Payer: UHCCP Medicaid |
$571.21
|
| Rate for Payer: VA VA |
$551.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,653.40
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
OP
|
$2,204.53
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$523.58 |
| Max. Negotiated Rate |
$1,984.08 |
| Rate for Payer: Aetna Commercial |
$1,873.85
|
| Rate for Payer: Aetna Medicare |
$573.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.92
|
| Rate for Payer: BCBS Complete |
$599.81
|
| Rate for Payer: BCBS MAPPO |
$551.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,812.34
|
| Rate for Payer: BCN Commercial |
$1,714.02
|
| Rate for Payer: BCN Medicare Advantage |
$551.13
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$1,895.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$551.13
|
| Rate for Payer: Healthscope Commercial |
$1,984.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,653.40
|
| Rate for Payer: Mclaren Medicaid |
$571.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.69
|
| Rate for Payer: Meridian Medicaid |
$599.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: Nomi Health Commercial |
$1,807.71
|
| Rate for Payer: PACE Senior Care Partners |
$523.58
|
| Rate for Payer: PACE SWMI |
$551.13
|
| Rate for Payer: PHP Commercial |
$1,873.85
|
| Rate for Payer: PHP Medicare Advantage |
$551.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,917.94
|
| Rate for Payer: Priority Health Medicare |
$556.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,477.04
|
| Rate for Payer: Railroad Medicare Medicare |
$551.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,939.99
|
| Rate for Payer: UHC Core |
$1,840.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$551.13
|
| Rate for Payer: UHC Exchange |
$551.13
|
| Rate for Payer: UHC Medicare Advantage |
$551.13
|
| Rate for Payer: UHCCP Medicaid |
$571.21
|
| Rate for Payer: VA VA |
$551.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,653.40
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
IP
|
$2,204.53
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,432.94 |
| Max. Negotiated Rate |
$1,984.08 |
| Rate for Payer: Aetna Commercial |
$1,873.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.56
|
| Rate for Payer: BCN Commercial |
$1,703.66
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$1,895.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Healthscope Commercial |
$1,984.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,653.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: Nomi Health Commercial |
$1,807.71
|
| Rate for Payer: PHP Commercial |
$1,873.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,917.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,477.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,939.99
|
| Rate for Payer: UHC Core |
$1,840.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,653.40
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
OP
|
$2,204.53
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$523.58 |
| Max. Negotiated Rate |
$1,984.08 |
| Rate for Payer: Aetna Commercial |
$1,873.85
|
| Rate for Payer: Aetna Medicare |
$573.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.92
|
| Rate for Payer: BCBS Complete |
$599.81
|
| Rate for Payer: BCBS MAPPO |
$551.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,812.34
|
| Rate for Payer: BCN Commercial |
$1,714.02
|
| Rate for Payer: BCN Medicare Advantage |
$551.13
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$1,895.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$551.13
|
| Rate for Payer: Healthscope Commercial |
$1,984.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,653.40
|
| Rate for Payer: Mclaren Medicaid |
$571.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.69
|
| Rate for Payer: Meridian Medicaid |
$599.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: Nomi Health Commercial |
$1,807.71
|
| Rate for Payer: PACE Senior Care Partners |
$523.58
|
| Rate for Payer: PACE SWMI |
$551.13
|
| Rate for Payer: PHP Commercial |
$1,873.85
|
| Rate for Payer: PHP Medicare Advantage |
$551.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,917.94
|
| Rate for Payer: Priority Health Medicare |
$556.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,477.04
|
| Rate for Payer: Railroad Medicare Medicare |
$551.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,939.99
|
| Rate for Payer: UHC Core |
$1,840.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$551.13
|
| Rate for Payer: UHC Exchange |
$551.13
|
| Rate for Payer: UHC Medicare Advantage |
$551.13
|
| Rate for Payer: UHCCP Medicaid |
$571.21
|
| Rate for Payer: VA VA |
$551.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,653.40
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
IP
|
$2,204.53
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,432.94 |
| Max. Negotiated Rate |
$1,984.08 |
| Rate for Payer: Aetna Commercial |
$1,873.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.56
|
| Rate for Payer: BCN Commercial |
$1,703.66
|
| Rate for Payer: Cash Price |
$1,763.62
|
| Rate for Payer: Cofinity Commercial |
$1,895.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.62
|
| Rate for Payer: Healthscope Commercial |
$1,984.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,653.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.85
|
| Rate for Payer: Nomi Health Commercial |
$1,807.71
|
| Rate for Payer: PHP Commercial |
$1,873.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,917.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,477.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,939.99
|
| Rate for Payer: UHC Core |
$1,840.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,653.40
|
|
|
HC INJ LYMPHANGIOGRAPHY
|
Facility
|
IP
|
$1,305.17
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$848.36 |
| Max. Negotiated Rate |
$1,174.65 |
| Rate for Payer: Aetna Commercial |
$1,109.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,065.41
|
| Rate for Payer: BCN Commercial |
$1,008.64
|
| Rate for Payer: Cash Price |
$1,044.14
|
| Rate for Payer: Cofinity Commercial |
$1,122.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.14
|
| Rate for Payer: Healthscope Commercial |
$1,174.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$978.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.39
|
| Rate for Payer: Nomi Health Commercial |
$1,070.24
|
| Rate for Payer: PHP Commercial |
$1,109.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1,135.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$874.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,148.55
|
| Rate for Payer: UHC Core |
$1,089.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$978.88
|
|
