|
HC ISOVUE 370 PER ML
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna Medicare |
$0.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.59
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.56
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Medicare Advantage |
$0.48
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.48
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.62
|
| Rate for Payer: Nomi Health Commercial |
$1.56
|
| Rate for Payer: PACE Senior Care Partners |
$0.45
|
| Rate for Payer: PACE SWMI |
$0.48
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: PHP Medicare Advantage |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO |
$1.65
|
| Rate for Payer: Priority Health Medicare |
$0.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.27
|
| Rate for Payer: Railroad Medicare Medicare |
$0.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.67
|
| Rate for Payer: UHC Core |
$1.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.48
|
| Rate for Payer: UHC Exchange |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.48
|
| Rate for Payer: VA VA |
$0.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$321.69
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$289.52 |
| Rate for Payer: Aetna Commercial |
$273.44
|
| Rate for Payer: Aetna Medicare |
$83.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.53
|
| Rate for Payer: BCBS Complete |
$226.27
|
| Rate for Payer: BCBS MAPPO |
$80.42
|
| Rate for Payer: BCBS Trust/PPO |
$264.46
|
| Rate for Payer: BCN Commercial |
$250.11
|
| Rate for Payer: BCN Medicare Advantage |
$80.42
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cofinity Commercial |
$276.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.42
|
| Rate for Payer: Healthscope Commercial |
$289.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.27
|
| Rate for Payer: Mclaren Medicaid |
$215.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.44
|
| Rate for Payer: Meridian Medicaid |
$226.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.44
|
| Rate for Payer: Nomi Health Commercial |
$263.79
|
| Rate for Payer: PACE Senior Care Partners |
$76.40
|
| Rate for Payer: PACE SWMI |
$80.42
|
| Rate for Payer: PHP Commercial |
$273.44
|
| Rate for Payer: PHP Medicare Advantage |
$80.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$215.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.10
|
| Rate for Payer: Priority Health HMO/PPO |
$279.87
|
| Rate for Payer: Priority Health Medicare |
$81.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.53
|
| Rate for Payer: Railroad Medicare Medicare |
$80.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.09
|
| Rate for Payer: UHC Core |
$268.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.42
|
| Rate for Payer: UHC Exchange |
$80.42
|
| Rate for Payer: UHC Medicare Advantage |
$80.42
|
| Rate for Payer: UHCCP Medicaid |
$215.48
|
| Rate for Payer: VA VA |
$80.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.27
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$321.69
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.10 |
| Max. Negotiated Rate |
$289.52 |
| Rate for Payer: Aetna Commercial |
$273.44
|
| Rate for Payer: BCBS Trust/PPO |
$262.60
|
| Rate for Payer: BCN Commercial |
$248.60
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cofinity Commercial |
$276.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.35
|
| Rate for Payer: Healthscope Commercial |
$289.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.44
|
| Rate for Payer: Nomi Health Commercial |
$263.79
|
| Rate for Payer: PHP Commercial |
$273.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.10
|
| Rate for Payer: Priority Health HMO/PPO |
$279.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.09
|
| Rate for Payer: UHC Core |
$268.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.27
|
|
|
HC IUPC ASSIST
|
Facility
|
OP
|
$119.72
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.43 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Medicare |
$31.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.41
|
| Rate for Payer: BCBS Complete |
$47.89
|
| Rate for Payer: BCBS MAPPO |
$29.93
|
| Rate for Payer: BCBS Trust/PPO |
$98.42
|
| Rate for Payer: BCN Commercial |
$93.08
|
| Rate for Payer: BCN Medicare Advantage |
$29.93
|
| Rate for Payer: Cash Price |
$95.78
|
| Rate for Payer: Cofinity Commercial |
$102.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.93
|
| Rate for Payer: Healthscope Commercial |
$107.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.76
|
| Rate for Payer: Nomi Health Commercial |
$98.17
|
| Rate for Payer: PACE Senior Care Partners |
$28.43
|
| Rate for Payer: PACE SWMI |
$29.93
|
| Rate for Payer: PHP Commercial |
$101.76
|
| Rate for Payer: PHP Medicare Advantage |
$29.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.82
|
| Rate for Payer: Priority Health HMO/PPO |
$104.16
|
| Rate for Payer: Priority Health Medicare |
$30.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.21
|
| Rate for Payer: Railroad Medicare Medicare |
$29.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.35
|
| Rate for Payer: UHC Core |
$99.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.93
|
| Rate for Payer: UHC Exchange |
$29.93
|
| Rate for Payer: UHC Medicare Advantage |
$29.93
|
| Rate for Payer: VA VA |
$29.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.79
|
|
|
HC IUPC ASSIST
|
Facility
|
IP
|
$119.72
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.82 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: BCBS Trust/PPO |
$97.73
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: Cash Price |
$95.78
|
| Rate for Payer: Cofinity Commercial |
$102.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.78
|
| Rate for Payer: Healthscope Commercial |
$107.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.76
|
| Rate for Payer: Nomi Health Commercial |
$98.17
|
| Rate for Payer: PHP Commercial |
$101.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.82
|
| Rate for Payer: Priority Health HMO/PPO |
$104.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.35
|
| Rate for Payer: UHC Core |
$99.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.79
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
IP
|
$85.41
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.52 |
| Max. Negotiated Rate |
$76.87 |
| Rate for Payer: Aetna Commercial |
$72.60
|
| Rate for Payer: BCBS Trust/PPO |
$69.72
|
| Rate for Payer: BCN Commercial |
$66.00
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cofinity Commercial |
$73.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$76.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.60
|
| Rate for Payer: Nomi Health Commercial |
$70.04
|
| Rate for Payer: PHP Commercial |
$72.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.52
|
| Rate for Payer: Priority Health HMO/PPO |
$74.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.16
|
| Rate for Payer: UHC Core |
$71.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.06
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
OP
|
$85.41
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$76.87 |
| Rate for Payer: Aetna Commercial |
$72.60
|
| Rate for Payer: Aetna Medicare |
$22.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.69
|
| Rate for Payer: BCBS Complete |
$34.16
|
| Rate for Payer: BCBS MAPPO |
$21.35
|
| Rate for Payer: BCBS Trust/PPO |
$70.22
|
| Rate for Payer: BCN Commercial |
$66.41
|
| Rate for Payer: BCN Medicare Advantage |
$21.35
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cofinity Commercial |
$73.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.35
|
| Rate for Payer: Healthscope Commercial |
$76.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.60
|
| Rate for Payer: Nomi Health Commercial |
$70.04
|
| Rate for Payer: PACE Senior Care Partners |
$20.28
|
| Rate for Payer: PACE SWMI |
$21.35
|
| Rate for Payer: PHP Commercial |
$72.60
|
| Rate for Payer: PHP Medicare Advantage |
$21.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.52
|
| Rate for Payer: Priority Health HMO/PPO |
$74.31
|
| Rate for Payer: Priority Health Medicare |
$21.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.22
|
| Rate for Payer: Railroad Medicare Medicare |
$21.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.16
|
| Rate for Payer: UHC Core |
$71.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.35
|
| Rate for Payer: UHC Exchange |
$21.35
|
| Rate for Payer: UHC Medicare Advantage |
$21.35
|
| Rate for Payer: VA VA |
$21.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.06
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
OP
|
$203.57
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$32.69 |
| Max. Negotiated Rate |
$183.21 |
| Rate for Payer: Aetna Commercial |
$173.03
|
| Rate for Payer: Aetna Medicare |
$52.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.62
|
| Rate for Payer: BCBS Complete |
$34.32
|
| Rate for Payer: BCBS MAPPO |
$50.89
|
| Rate for Payer: BCBS Trust/PPO |
$167.35
|
| Rate for Payer: BCN Commercial |
$158.28
|
| Rate for Payer: BCN Medicare Advantage |
$50.89
|
| Rate for Payer: Cash Price |
$162.86
|
| Rate for Payer: Cash Price |
$162.86
|
| Rate for Payer: Cofinity Commercial |
$175.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.89
|
| Rate for Payer: Healthscope Commercial |
$183.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.68
|
| Rate for Payer: Mclaren Medicaid |
$32.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.44
|
| Rate for Payer: Meridian Medicaid |
$34.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.03
|
| Rate for Payer: Nomi Health Commercial |
$166.93
|
| Rate for Payer: PACE Senior Care Partners |
$48.35
|
| Rate for Payer: PACE SWMI |
$50.89
|
| Rate for Payer: PHP Commercial |
$173.03
|
| Rate for Payer: PHP Medicare Advantage |
$50.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.32
|
| Rate for Payer: Priority Health HMO/PPO |
$177.11
|
| Rate for Payer: Priority Health Medicare |
$51.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.39
|
| Rate for Payer: Railroad Medicare Medicare |
$50.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.14
|
| Rate for Payer: UHC Core |
$169.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.89
|
| Rate for Payer: UHC Exchange |
$50.89
|
| Rate for Payer: UHC Medicare Advantage |
$50.89
|
| Rate for Payer: UHCCP Medicaid |
$32.69
|
| Rate for Payer: VA VA |
$50.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.68
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
IP
|
$203.57
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$132.32 |
| Max. Negotiated Rate |
$183.21 |
| Rate for Payer: Aetna Commercial |
$173.03
|
| Rate for Payer: BCBS Trust/PPO |
$166.17
|
| Rate for Payer: BCN Commercial |
$157.32
|
| Rate for Payer: Cash Price |
$162.86
|
| Rate for Payer: Cofinity Commercial |
$175.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.86
|
| Rate for Payer: Healthscope Commercial |
$183.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.03
|
| Rate for Payer: Nomi Health Commercial |
$166.93
|
| Rate for Payer: PHP Commercial |
$173.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.32
|
| Rate for Payer: Priority Health HMO/PPO |
$177.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.14
|
| Rate for Payer: UHC Core |
$169.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.68
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
IP
|
$510.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$331.66 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: BCN Commercial |
$394.31
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: Nomi Health Commercial |
$418.40
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health HMO/PPO |
$443.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.01
|
| Rate for Payer: UHC Core |
$426.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
OP
|
$510.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$121.18 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna Medicare |
$132.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.45
|
| Rate for Payer: BCBS Complete |
$156.72
|
| Rate for Payer: BCBS MAPPO |
$127.56
|
| Rate for Payer: BCBS Trust/PPO |
$419.47
|
| Rate for Payer: BCN Commercial |
$396.71
|
| Rate for Payer: BCN Medicare Advantage |
$127.56
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.56
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Mclaren Medicaid |
$149.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.94
|
| Rate for Payer: Meridian Medicaid |
$156.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: Nomi Health Commercial |
$418.40
|
| Rate for Payer: PACE Senior Care Partners |
$121.18
|
| Rate for Payer: PACE SWMI |
$127.56
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: PHP Medicare Advantage |
$127.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health HMO/PPO |
$443.91
|
| Rate for Payer: Priority Health Medicare |
$128.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.86
|
| Rate for Payer: Railroad Medicare Medicare |
$127.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.01
|
| Rate for Payer: UHC Core |
$426.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.56
|
| Rate for Payer: UHC Exchange |
$127.56
|
| Rate for Payer: UHC Medicare Advantage |
$127.56
|
| Rate for Payer: UHCCP Medicaid |
$149.25
|
| Rate for Payer: VA VA |
$127.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
OP
|
$129.02
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$116.12 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Medicare |
$33.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.32
|
| Rate for Payer: BCBS Complete |
$34.32
|
| Rate for Payer: BCBS MAPPO |
$32.26
|
| Rate for Payer: BCBS Trust/PPO |
$106.07
|
| Rate for Payer: BCN Commercial |
$100.31
|
| Rate for Payer: BCN Medicare Advantage |
$32.26
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$110.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$116.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.76
|
| Rate for Payer: Mclaren Medicaid |
$32.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.87
|
| Rate for Payer: Meridian Medicaid |
$34.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: Nomi Health Commercial |
$105.80
|
| Rate for Payer: PACE Senior Care Partners |
$30.64
|
| Rate for Payer: PACE SWMI |
$32.26
|
| Rate for Payer: PHP Commercial |
$109.67
|
| Rate for Payer: PHP Medicare Advantage |
$32.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health HMO/PPO |
$112.25
|
| Rate for Payer: Priority Health Medicare |
$32.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.44
|
| Rate for Payer: Railroad Medicare Medicare |
$32.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.54
|
| Rate for Payer: UHC Core |
$107.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.26
|
| Rate for Payer: UHC Exchange |
$32.26
|
| Rate for Payer: UHC Medicare Advantage |
$32.26
|
| Rate for Payer: UHCCP Medicaid |
$32.69
|
| Rate for Payer: VA VA |
$32.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.76
|
|
|
HC IV HYDRATION W/OBS, EACH ADDL HR
|
Facility
|
IP
|
$129.02
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000011
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.86 |
| Max. Negotiated Rate |
$116.12 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: BCBS Trust/PPO |
$105.32
|
| Rate for Payer: BCN Commercial |
$99.71
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$110.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$116.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.67
|
| Rate for Payer: Nomi Health Commercial |
$105.80
|
| Rate for Payer: PHP Commercial |
$109.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health HMO/PPO |
$112.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.54
|
| Rate for Payer: UHC Core |
$107.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.76
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
IP
|
$270.93
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$176.10 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna Commercial |
$230.29
|
| Rate for Payer: BCBS Trust/PPO |
$221.16
|
| Rate for Payer: BCN Commercial |
$209.37
|
| Rate for Payer: Cash Price |
$216.74
|
| Rate for Payer: Cofinity Commercial |
$233.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.74
|
| Rate for Payer: Healthscope Commercial |
$243.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.29
|
| Rate for Payer: Nomi Health Commercial |
$222.16
|
| Rate for Payer: PHP Commercial |
$230.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.10
|
| Rate for Payer: Priority Health HMO/PPO |
$235.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.42
|
| Rate for Payer: UHC Core |
$226.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.20
|
|
|
HC IV HYDRATION W/OBS, INITIAL HR
|
Facility
|
OP
|
$270.93
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000010
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna Commercial |
$230.29
|
| Rate for Payer: Aetna Medicare |
$70.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.67
|
| Rate for Payer: BCBS Complete |
$156.72
|
| Rate for Payer: BCBS MAPPO |
$67.73
|
| Rate for Payer: BCBS Trust/PPO |
$222.73
|
| Rate for Payer: BCN Commercial |
$210.65
|
| Rate for Payer: BCN Medicare Advantage |
$67.73
|
| Rate for Payer: Cash Price |
$216.74
|
| Rate for Payer: Cash Price |
$216.74
|
| Rate for Payer: Cofinity Commercial |
$233.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.73
|
| Rate for Payer: Healthscope Commercial |
$243.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.20
|
| Rate for Payer: Mclaren Medicaid |
$149.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.12
|
| Rate for Payer: Meridian Medicaid |
$156.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.29
|
| Rate for Payer: Nomi Health Commercial |
$222.16
|
| Rate for Payer: PACE Senior Care Partners |
$64.35
|
| Rate for Payer: PACE SWMI |
$67.73
|
| Rate for Payer: PHP Commercial |
$230.29
|
| Rate for Payer: PHP Medicare Advantage |
$67.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.10
|
| Rate for Payer: Priority Health HMO/PPO |
$235.71
|
| Rate for Payer: Priority Health Medicare |
$68.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.52
|
| Rate for Payer: Railroad Medicare Medicare |
$67.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.42
|
| Rate for Payer: UHC Core |
$226.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.73
|
| Rate for Payer: UHC Exchange |
$67.73
|
| Rate for Payer: UHC Medicare Advantage |
$67.73
|
| Rate for Payer: UHCCP Medicaid |
$149.25
|
| Rate for Payer: VA VA |
$67.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.20
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
IP
|
$688.17
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$447.31 |
| Max. Negotiated Rate |
$619.35 |
| Rate for Payer: Aetna Commercial |
$584.94
|
| Rate for Payer: BCBS Trust/PPO |
$561.75
|
| Rate for Payer: BCN Commercial |
$531.82
|
| Rate for Payer: Cash Price |
$550.54
|
| Rate for Payer: Cofinity Commercial |
$591.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.54
|
| Rate for Payer: Healthscope Commercial |
$619.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.94
|
| Rate for Payer: Nomi Health Commercial |
$564.30
|
| Rate for Payer: PHP Commercial |
$584.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.31
|
| Rate for Payer: Priority Health HMO/PPO |
$598.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.59
|
| Rate for Payer: UHC Core |
$574.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.13
|
|
|
HC IVIG INFUSION FIRST HOUR
|
Facility
|
OP
|
$688.17
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000004
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$149.25 |
| Max. Negotiated Rate |
$619.35 |
| Rate for Payer: Aetna Commercial |
$584.94
|
| Rate for Payer: Aetna Medicare |
$178.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.05
|
| Rate for Payer: BCBS Complete |
$156.72
|
| Rate for Payer: BCBS MAPPO |
$172.04
|
| Rate for Payer: BCBS Trust/PPO |
$565.74
|
| Rate for Payer: BCN Commercial |
$535.05
|
| Rate for Payer: BCN Medicare Advantage |
$172.04
|
| Rate for Payer: Cash Price |
$550.54
|
| Rate for Payer: Cash Price |
$550.54
|
| Rate for Payer: Cofinity Commercial |
$591.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.04
|
| Rate for Payer: Healthscope Commercial |
$619.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.13
|
| Rate for Payer: Mclaren Medicaid |
$149.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.64
|
| Rate for Payer: Meridian Medicaid |
$156.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.94
|
| Rate for Payer: Nomi Health Commercial |
$564.30
|
| Rate for Payer: PACE Senior Care Partners |
$163.44
|
| Rate for Payer: PACE SWMI |
$172.04
|
| Rate for Payer: PHP Commercial |
$584.94
|
| Rate for Payer: PHP Medicare Advantage |
$172.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.31
|
| Rate for Payer: Priority Health HMO/PPO |
$598.71
|
| Rate for Payer: Priority Health Medicare |
$173.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.07
|
| Rate for Payer: Railroad Medicare Medicare |
$172.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.59
|
| Rate for Payer: UHC Core |
$574.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.04
|
| Rate for Payer: UHC Exchange |
$172.04
|
| Rate for Payer: UHC Medicare Advantage |
$172.04
|
| Rate for Payer: UHCCP Medicaid |
$149.25
|
| Rate for Payer: VA VA |
$172.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.13
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$127.01 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$139.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.12
|
| Rate for Payer: BCBS Complete |
$335.10
|
| Rate for Payer: BCBS MAPPO |
$133.69
|
| Rate for Payer: BCBS Trust/PPO |
$439.63
|
| Rate for Payer: BCN Commercial |
$415.78
|
| Rate for Payer: BCN Medicare Advantage |
$133.69
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.69
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Mclaren Medicaid |
$319.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.38
|
| Rate for Payer: Meridian Medicaid |
$335.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$438.51
|
| Rate for Payer: PACE Senior Care Partners |
$127.01
|
| Rate for Payer: PACE SWMI |
$133.69
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: PHP Medicare Advantage |
$133.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO |
$465.25
|
| Rate for Payer: Priority Health Medicare |
$135.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.30
|
| Rate for Payer: Railroad Medicare Medicare |
$133.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.60
|
| Rate for Payer: UHC Core |
$446.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.69
|
| Rate for Payer: UHC Exchange |
$133.69
|
| Rate for Payer: UHC Medicare Advantage |
$133.69
|
| Rate for Payer: UHCCP Medicaid |
$319.12
|
| Rate for Payer: VA VA |
$133.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC IV INF BAMLANIVIMAB/ETESEVIMAB
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
CPT M0245
|
| Hospital Charge Code |
77100031
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$347.60 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: BCBS Trust/PPO |
$436.53
|
| Rate for Payer: BCN Commercial |
$413.27
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$438.51
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO |
$465.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.60
|
| Rate for Payer: UHC Core |
$446.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$127.01 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: Aetna Medicare |
$139.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.12
|
| Rate for Payer: BCBS Complete |
$335.10
|
| Rate for Payer: BCBS MAPPO |
$133.69
|
| Rate for Payer: BCBS Trust/PPO |
$439.63
|
| Rate for Payer: BCN Commercial |
$415.78
|
| Rate for Payer: BCN Medicare Advantage |
$133.69
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.69
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Mclaren Medicaid |
$319.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.38
|
| Rate for Payer: Meridian Medicaid |
$335.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$438.51
|
| Rate for Payer: PACE Senior Care Partners |
$127.01
|
| Rate for Payer: PACE SWMI |
$133.69
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: PHP Medicare Advantage |
$133.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO |
$465.25
|
| Rate for Payer: Priority Health Medicare |
$135.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.30
|
| Rate for Payer: Railroad Medicare Medicare |
$133.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.60
|
| Rate for Payer: UHC Core |
$446.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.69
|
| Rate for Payer: UHC Exchange |
$133.69
|
| Rate for Payer: UHC Medicare Advantage |
$133.69
|
| Rate for Payer: UHCCP Medicaid |
$319.12
|
| Rate for Payer: VA VA |
$133.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC IV INF SOTROVIMAB
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
77100032
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$347.60 |
| Max. Negotiated Rate |
$481.29 |
| Rate for Payer: Aetna Commercial |
$454.55
|
| Rate for Payer: BCBS Trust/PPO |
$436.53
|
| Rate for Payer: BCN Commercial |
$413.27
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.55
|
| Rate for Payer: Nomi Health Commercial |
$438.51
|
| Rate for Payer: PHP Commercial |
$454.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.60
|
| Rate for Payer: Priority Health HMO/PPO |
$465.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.60
|
| Rate for Payer: UHC Core |
$446.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
IP
|
$173.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$112.89 |
| Max. Negotiated Rate |
$156.30 |
| Rate for Payer: Aetna Commercial |
$147.62
|
| Rate for Payer: BCBS Trust/PPO |
$141.77
|
| Rate for Payer: BCN Commercial |
$134.21
|
| Rate for Payer: Cash Price |
$138.94
|
| Rate for Payer: Cofinity Commercial |
$149.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.94
|
| Rate for Payer: Healthscope Commercial |
$156.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.62
|
| Rate for Payer: Nomi Health Commercial |
$142.41
|
| Rate for Payer: PHP Commercial |
$147.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.89
|
| Rate for Payer: Priority Health HMO/PPO |
$151.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.83
|
| Rate for Payer: UHC Core |
$145.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.25
|
|
|
HC IV INFUSION CONCURRENT
|
Facility
|
OP
|
$173.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
26000007
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$156.30 |
| Rate for Payer: Aetna Commercial |
$147.62
|
| Rate for Payer: Aetna Medicare |
$45.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.27
|
| Rate for Payer: BCBS Complete |
$69.47
|
| Rate for Payer: BCBS MAPPO |
$43.42
|
| Rate for Payer: BCBS Trust/PPO |
$142.77
|
| Rate for Payer: BCN Commercial |
$135.03
|
| Rate for Payer: BCN Medicare Advantage |
$43.42
|
| Rate for Payer: Cash Price |
$138.94
|
| Rate for Payer: Cofinity Commercial |
$149.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.42
|
| Rate for Payer: Healthscope Commercial |
$156.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.62
|
| Rate for Payer: Nomi Health Commercial |
$142.41
|
| Rate for Payer: PACE Senior Care Partners |
$41.25
|
| Rate for Payer: PACE SWMI |
$43.42
|
| Rate for Payer: PHP Commercial |
$147.62
|
| Rate for Payer: PHP Medicare Advantage |
$43.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.89
|
| Rate for Payer: Priority Health HMO/PPO |
$151.09
|
| Rate for Payer: Priority Health Medicare |
$43.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.36
|
| Rate for Payer: Railroad Medicare Medicare |
$43.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.83
|
| Rate for Payer: UHC Core |
$145.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.42
|
| Rate for Payer: UHC Exchange |
$43.42
|
| Rate for Payer: UHC Medicare Advantage |
$43.42
|
| Rate for Payer: VA VA |
$43.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.25
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
IP
|
$194.54
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$175.09 |
| Rate for Payer: Aetna Commercial |
$165.36
|
| Rate for Payer: BCBS Trust/PPO |
$158.80
|
| Rate for Payer: BCN Commercial |
$150.34
|
| Rate for Payer: Cash Price |
$155.63
|
| Rate for Payer: Cofinity Commercial |
$167.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.63
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.36
|
| Rate for Payer: Nomi Health Commercial |
$159.52
|
| Rate for Payer: PHP Commercial |
$165.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.45
|
| Rate for Payer: Priority Health HMO/PPO |
$169.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.20
|
| Rate for Payer: UHC Core |
$162.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.90
|
|
|
HC IV INFUSION THERAPY EACH ADD HR
|
Facility
|
OP
|
$194.54
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
26000005
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$32.69 |
| Max. Negotiated Rate |
$175.09 |
| Rate for Payer: Aetna Commercial |
$165.36
|
| Rate for Payer: Aetna Medicare |
$50.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.79
|
| Rate for Payer: BCBS Complete |
$34.32
|
| Rate for Payer: BCBS MAPPO |
$48.64
|
| Rate for Payer: BCBS Trust/PPO |
$159.93
|
| Rate for Payer: BCN Commercial |
$151.25
|
| Rate for Payer: BCN Medicare Advantage |
$48.64
|
| Rate for Payer: Cash Price |
$155.63
|
| Rate for Payer: Cash Price |
$155.63
|
| Rate for Payer: Cofinity Commercial |
$167.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.64
|
| Rate for Payer: Healthscope Commercial |
$175.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.90
|
| Rate for Payer: Mclaren Medicaid |
$32.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.07
|
| Rate for Payer: Meridian Medicaid |
$34.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.36
|
| Rate for Payer: Nomi Health Commercial |
$159.52
|
| Rate for Payer: PACE Senior Care Partners |
$46.20
|
| Rate for Payer: PACE SWMI |
$48.64
|
| Rate for Payer: PHP Commercial |
$165.36
|
| Rate for Payer: PHP Medicare Advantage |
$48.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.45
|
| Rate for Payer: Priority Health HMO/PPO |
$169.25
|
| Rate for Payer: Priority Health Medicare |
$49.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.34
|
| Rate for Payer: Railroad Medicare Medicare |
$48.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.20
|
| Rate for Payer: UHC Core |
$162.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.64
|
| Rate for Payer: UHC Exchange |
$48.64
|
| Rate for Payer: UHC Medicare Advantage |
$48.64
|
| Rate for Payer: UHCCP Medicaid |
$32.69
|
| Rate for Payer: VA VA |
$48.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.90
|
|
