|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
IP
|
$534.78
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$347.61 |
| Max. Negotiated Rate |
$481.30 |
| Rate for Payer: Aetna Commercial |
$454.56
|
| Rate for Payer: BCBS Trust/PPO |
$436.54
|
| Rate for Payer: BCN Commercial |
$413.28
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Healthscope Commercial |
$481.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.56
|
| Rate for Payer: Nomi Health Commercial |
$438.52
|
| Rate for Payer: PHP Commercial |
$454.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.61
|
| Rate for Payer: Priority Health HMO/PPO |
$465.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.61
|
| Rate for Payer: UHC Core |
$446.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC IV INFUSION THERAPY INITIAL HOUR
|
Facility
|
OP
|
$534.78
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
26000003
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$127.01 |
| Max. Negotiated Rate |
$481.30 |
| Rate for Payer: Aetna Commercial |
$454.56
|
| 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 |
$156.72
|
| Rate for Payer: BCBS MAPPO |
$133.70
|
| Rate for Payer: BCBS Trust/PPO |
$439.64
|
| Rate for Payer: BCN Commercial |
$415.79
|
| Rate for Payer: BCN Medicare Advantage |
$133.70
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cash Price |
$427.82
|
| Rate for Payer: Cofinity Commercial |
$459.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.70
|
| Rate for Payer: Healthscope Commercial |
$481.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.08
|
| Rate for Payer: Mclaren Medicaid |
$149.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.38
|
| Rate for Payer: Meridian Medicaid |
$156.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.56
|
| Rate for Payer: Nomi Health Commercial |
$438.52
|
| Rate for Payer: PACE Senior Care Partners |
$127.01
|
| Rate for Payer: PACE SWMI |
$133.70
|
| Rate for Payer: PHP Commercial |
$454.56
|
| Rate for Payer: PHP Medicare Advantage |
$133.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.61
|
| Rate for Payer: Priority Health HMO/PPO |
$465.26
|
| Rate for Payer: Priority Health Medicare |
$135.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.30
|
| Rate for Payer: Railroad Medicare Medicare |
$133.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.61
|
| Rate for Payer: UHC Core |
$446.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.70
|
| Rate for Payer: UHC Exchange |
$133.70
|
| Rate for Payer: UHC Medicare Advantage |
$133.70
|
| Rate for Payer: UHCCP Medicaid |
$149.25
|
| Rate for Payer: VA VA |
$133.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.08
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
IP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: BCBS Trust/PPO |
$68.36
|
| Rate for Payer: BCN Commercial |
$64.71
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.18
|
| Rate for Payer: Nomi Health Commercial |
$68.67
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.43
|
| Rate for Payer: Priority Health HMO/PPO |
$72.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.69
|
| Rate for Payer: UHC Core |
$69.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.80
|
|
|
HC IV LACTATED RINGERS 1000
|
Facility
|
OP
|
$83.74
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: Aetna Medicare |
$21.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.17
|
| Rate for Payer: BCBS Complete |
$33.50
|
| Rate for Payer: BCBS MAPPO |
$20.94
|
| Rate for Payer: BCBS Trust/PPO |
$68.84
|
| Rate for Payer: BCN Commercial |
$65.11
|
| Rate for Payer: BCN Medicare Advantage |
$20.94
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.18
|
| Rate for Payer: Nomi Health Commercial |
$68.67
|
| Rate for Payer: PACE Senior Care Partners |
$19.89
|
| Rate for Payer: PACE SWMI |
$20.94
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: PHP Medicare Advantage |
$20.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.43
|
| Rate for Payer: Priority Health HMO/PPO |
$72.85
|
| Rate for Payer: Priority Health Medicare |
$21.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.11
|
| Rate for Payer: Railroad Medicare Medicare |
$20.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.69
|
| Rate for Payer: UHC Core |
$69.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.94
|
| Rate for Payer: UHC Exchange |
$20.94
|
| Rate for Payer: UHC Medicare Advantage |
$20.94
|
| Rate for Payer: VA VA |
$20.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.80
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
IP
|
$85.72
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.72 |
| Max. Negotiated Rate |
$77.15 |
| Rate for Payer: Aetna Commercial |
$72.86
|
| Rate for Payer: BCBS Trust/PPO |
$69.97
|
| Rate for Payer: BCN Commercial |
$66.24
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$73.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$77.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.86
|
| Rate for Payer: Nomi Health Commercial |
$70.29
|
| Rate for Payer: PHP Commercial |
$72.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.72
|
| Rate for Payer: Priority Health HMO/PPO |
$74.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.43
|
| Rate for Payer: UHC Core |
$71.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.29
|
|
|
HC IV NORMAL SALINE 500 ML
|
Facility
|
OP
|
$85.72
|
|
|
Service Code
|
HCPCS J7040
|
| Hospital Charge Code |
63600038
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$77.15 |
| Rate for Payer: Aetna Commercial |
$72.86
|
| Rate for Payer: Aetna Medicare |
$22.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.79
|
| Rate for Payer: BCBS Complete |
$34.29
|
| Rate for Payer: BCBS MAPPO |
$21.43
|
| Rate for Payer: BCBS Trust/PPO |
$70.47
|
| Rate for Payer: BCN Commercial |
$66.65
|
| Rate for Payer: BCN Medicare Advantage |
$21.43
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$73.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.43
|
| Rate for Payer: Healthscope Commercial |
$77.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.86
|
| Rate for Payer: Nomi Health Commercial |
$70.29
|
| Rate for Payer: PACE Senior Care Partners |
$20.36
|
| Rate for Payer: PACE SWMI |
$21.43
|
| Rate for Payer: PHP Commercial |
$72.86
|
| Rate for Payer: PHP Medicare Advantage |
$21.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.72
|
| Rate for Payer: Priority Health HMO/PPO |
$74.58
|
| Rate for Payer: Priority Health Medicare |
$21.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.43
|
| Rate for Payer: Railroad Medicare Medicare |
$21.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.43
|
| Rate for Payer: UHC Core |
$71.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.43
|
| Rate for Payer: UHC Exchange |
$21.43
|
| Rate for Payer: UHC Medicare Advantage |
$21.43
|
| Rate for Payer: VA VA |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.29
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
OP
|
$167.72
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.69 |
| Max. Negotiated Rate |
$150.95 |
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: Aetna Medicare |
$43.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.41
|
| Rate for Payer: BCBS Complete |
$34.32
|
| Rate for Payer: BCBS MAPPO |
$41.93
|
| Rate for Payer: BCBS Trust/PPO |
$137.88
|
| Rate for Payer: BCN Commercial |
$130.40
|
| Rate for Payer: BCN Medicare Advantage |
$41.93
|
| Rate for Payer: Cash Price |
$134.18
|
| Rate for Payer: Cash Price |
$134.18
|
| Rate for Payer: Cofinity Commercial |
$144.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.93
|
| Rate for Payer: Healthscope Commercial |
$150.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.79
|
| Rate for Payer: Mclaren Medicaid |
$32.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.03
|
| Rate for Payer: Meridian Medicaid |
$34.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.56
|
| Rate for Payer: Nomi Health Commercial |
$137.53
|
| Rate for Payer: PACE Senior Care Partners |
$39.83
|
| Rate for Payer: PACE SWMI |
$41.93
|
| Rate for Payer: PHP Commercial |
$142.56
|
| Rate for Payer: PHP Medicare Advantage |
$41.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.02
|
| Rate for Payer: Priority Health HMO/PPO |
$145.92
|
| Rate for Payer: Priority Health Medicare |
$42.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.37
|
| Rate for Payer: Railroad Medicare Medicare |
$41.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.59
|
| Rate for Payer: UHC Core |
$140.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.93
|
| Rate for Payer: UHC Exchange |
$41.93
|
| Rate for Payer: UHC Medicare Advantage |
$41.93
|
| Rate for Payer: UHCCP Medicaid |
$32.69
|
| Rate for Payer: VA VA |
$41.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.79
|
|
|
HC IV PUSH ADDL DIFF DRUG
|
Facility
|
IP
|
$167.72
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.02 |
| Max. Negotiated Rate |
$150.95 |
| Rate for Payer: Aetna Commercial |
$142.56
|
| Rate for Payer: BCBS Trust/PPO |
$136.91
|
| Rate for Payer: BCN Commercial |
$129.61
|
| Rate for Payer: Cash Price |
$134.18
|
| Rate for Payer: Cofinity Commercial |
$144.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.18
|
| Rate for Payer: Healthscope Commercial |
$150.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.56
|
| Rate for Payer: Nomi Health Commercial |
$137.53
|
| Rate for Payer: PHP Commercial |
$142.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.02
|
| Rate for Payer: Priority Health HMO/PPO |
$145.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.59
|
| Rate for Payer: UHC Core |
$140.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.79
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
OP
|
$154.83
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.77 |
| Max. Negotiated Rate |
$139.35 |
| Rate for Payer: Aetna Commercial |
$131.61
|
| Rate for Payer: Aetna Medicare |
$40.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.38
|
| Rate for Payer: BCBS Complete |
$61.93
|
| Rate for Payer: BCBS MAPPO |
$38.71
|
| Rate for Payer: BCBS Trust/PPO |
$127.29
|
| Rate for Payer: BCN Commercial |
$120.38
|
| Rate for Payer: BCN Medicare Advantage |
$38.71
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$133.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.71
|
| Rate for Payer: Healthscope Commercial |
$139.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: Nomi Health Commercial |
$126.96
|
| Rate for Payer: PACE Senior Care Partners |
$36.77
|
| Rate for Payer: PACE SWMI |
$38.71
|
| Rate for Payer: PHP Commercial |
$131.61
|
| Rate for Payer: PHP Medicare Advantage |
$38.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health HMO/PPO |
$134.70
|
| Rate for Payer: Priority Health Medicare |
$39.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.74
|
| Rate for Payer: Railroad Medicare Medicare |
$38.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.25
|
| Rate for Payer: UHC Core |
$129.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.71
|
| Rate for Payer: UHC Exchange |
$38.71
|
| Rate for Payer: UHC Medicare Advantage |
$38.71
|
| Rate for Payer: VA VA |
$38.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.12
|
|
|
HC IV PUSH ADDL SAME DRUG
|
Facility
|
IP
|
$154.83
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$139.35 |
| Rate for Payer: Aetna Commercial |
$131.61
|
| Rate for Payer: BCBS Trust/PPO |
$126.39
|
| Rate for Payer: BCN Commercial |
$119.65
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$133.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$139.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: Nomi Health Commercial |
$126.96
|
| Rate for Payer: PHP Commercial |
$131.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health HMO/PPO |
$134.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.25
|
| Rate for Payer: UHC Core |
$129.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.12
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
IP
|
$401.79
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$261.16 |
| Max. Negotiated Rate |
$361.61 |
| Rate for Payer: Aetna Commercial |
$341.52
|
| Rate for Payer: BCBS Trust/PPO |
$327.98
|
| Rate for Payer: BCN Commercial |
$310.50
|
| Rate for Payer: Cash Price |
$321.43
|
| Rate for Payer: Cofinity Commercial |
$345.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.43
|
| Rate for Payer: Healthscope Commercial |
$361.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.52
|
| Rate for Payer: Nomi Health Commercial |
$329.47
|
| Rate for Payer: PHP Commercial |
$341.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.16
|
| Rate for Payer: Priority Health HMO/PPO |
$349.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.58
|
| Rate for Payer: UHC Core |
$335.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.34
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
OP
|
$401.79
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$50.41 |
| Max. Negotiated Rate |
$361.61 |
| Rate for Payer: Aetna Commercial |
$341.52
|
| Rate for Payer: Aetna Medicare |
$104.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.56
|
| Rate for Payer: BCBS Complete |
$52.94
|
| Rate for Payer: BCBS MAPPO |
$100.45
|
| Rate for Payer: BCBS Trust/PPO |
$330.31
|
| Rate for Payer: BCN Commercial |
$312.39
|
| Rate for Payer: BCN Medicare Advantage |
$100.45
|
| Rate for Payer: Cash Price |
$321.43
|
| Rate for Payer: Cash Price |
$321.43
|
| Rate for Payer: Cofinity Commercial |
$345.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.45
|
| Rate for Payer: Healthscope Commercial |
$361.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.34
|
| Rate for Payer: Mclaren Medicaid |
$50.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.47
|
| Rate for Payer: Meridian Medicaid |
$52.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.52
|
| Rate for Payer: Nomi Health Commercial |
$329.47
|
| Rate for Payer: PACE Senior Care Partners |
$95.43
|
| Rate for Payer: PACE SWMI |
$100.45
|
| Rate for Payer: PHP Commercial |
$341.52
|
| Rate for Payer: PHP Medicare Advantage |
$100.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.16
|
| Rate for Payer: Priority Health HMO/PPO |
$349.56
|
| Rate for Payer: Priority Health Medicare |
$101.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.20
|
| Rate for Payer: Railroad Medicare Medicare |
$100.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.58
|
| Rate for Payer: UHC Core |
$335.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.45
|
| Rate for Payer: UHC Exchange |
$100.45
|
| Rate for Payer: UHC Medicare Advantage |
$100.45
|
| Rate for Payer: UHCCP Medicaid |
$50.41
|
| Rate for Payer: VA VA |
$100.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.34
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
OP
|
$696.51
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$165.42 |
| Max. Negotiated Rate |
$626.86 |
| Rate for Payer: Aetna Commercial |
$592.03
|
| Rate for Payer: Aetna Medicare |
$181.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.66
|
| Rate for Payer: BCBS Complete |
$246.72
|
| Rate for Payer: BCBS MAPPO |
$174.13
|
| Rate for Payer: BCBS Trust/PPO |
$572.60
|
| Rate for Payer: BCN Commercial |
$541.54
|
| Rate for Payer: BCN Medicare Advantage |
$174.13
|
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$599.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.13
|
| Rate for Payer: Healthscope Commercial |
$626.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.38
|
| Rate for Payer: Mclaren Medicaid |
$234.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.83
|
| Rate for Payer: Meridian Medicaid |
$246.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.03
|
| Rate for Payer: Nomi Health Commercial |
$571.14
|
| Rate for Payer: PACE Senior Care Partners |
$165.42
|
| Rate for Payer: PACE SWMI |
$174.13
|
| Rate for Payer: PHP Commercial |
$592.03
|
| Rate for Payer: PHP Medicare Advantage |
$174.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.73
|
| Rate for Payer: Priority Health HMO/PPO |
$605.96
|
| Rate for Payer: Priority Health Medicare |
$175.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$466.66
|
| Rate for Payer: Railroad Medicare Medicare |
$174.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$612.93
|
| Rate for Payer: UHC Core |
$581.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.13
|
| Rate for Payer: UHC Exchange |
$174.13
|
| Rate for Payer: UHC Medicare Advantage |
$174.13
|
| Rate for Payer: UHCCP Medicaid |
$234.96
|
| Rate for Payer: VA VA |
$174.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.38
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
IP
|
$696.51
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$452.73 |
| Max. Negotiated Rate |
$626.86 |
| Rate for Payer: Aetna Commercial |
$592.03
|
| Rate for Payer: BCBS Trust/PPO |
$568.56
|
| Rate for Payer: BCN Commercial |
$538.26
|
| Rate for Payer: Cash Price |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$599.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.21
|
| Rate for Payer: Healthscope Commercial |
$626.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$522.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$592.03
|
| Rate for Payer: Nomi Health Commercial |
$571.14
|
| Rate for Payer: PHP Commercial |
$592.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.73
|
| Rate for Payer: Priority Health HMO/PPO |
$605.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$466.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$612.93
|
| Rate for Payer: UHC Core |
$581.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$522.38
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
OP
|
$282.63
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.12 |
| Max. Negotiated Rate |
$254.37 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Aetna Medicare |
$73.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.32
|
| Rate for Payer: BCBS Complete |
$156.72
|
| Rate for Payer: BCBS MAPPO |
$70.66
|
| Rate for Payer: BCBS Trust/PPO |
$232.35
|
| Rate for Payer: BCN Commercial |
$219.74
|
| Rate for Payer: BCN Medicare Advantage |
$70.66
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$243.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.66
|
| Rate for Payer: Healthscope Commercial |
$254.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.97
|
| Rate for Payer: Mclaren Medicaid |
$149.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.19
|
| Rate for Payer: Meridian Medicaid |
$156.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.24
|
| Rate for Payer: Nomi Health Commercial |
$231.76
|
| Rate for Payer: PACE Senior Care Partners |
$67.12
|
| Rate for Payer: PACE SWMI |
$70.66
|
| Rate for Payer: PHP Commercial |
$240.24
|
| Rate for Payer: PHP Medicare Advantage |
$70.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.71
|
| Rate for Payer: Priority Health HMO/PPO |
$245.89
|
| Rate for Payer: Priority Health Medicare |
$71.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.36
|
| Rate for Payer: Railroad Medicare Medicare |
$70.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.71
|
| Rate for Payer: UHC Core |
$236.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.66
|
| Rate for Payer: UHC Exchange |
$70.66
|
| Rate for Payer: UHC Medicare Advantage |
$70.66
|
| Rate for Payer: UHCCP Medicaid |
$149.25
|
| Rate for Payer: VA VA |
$70.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.97
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
IP
|
$282.63
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.71 |
| Max. Negotiated Rate |
$254.37 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: BCBS Trust/PPO |
$230.71
|
| Rate for Payer: BCN Commercial |
$218.42
|
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$243.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.10
|
| Rate for Payer: Healthscope Commercial |
$254.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.24
|
| Rate for Payer: Nomi Health Commercial |
$231.76
|
| Rate for Payer: PHP Commercial |
$240.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.71
|
| Rate for Payer: Priority Health HMO/PPO |
$245.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.71
|
| Rate for Payer: UHC Core |
$236.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.97
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
IP
|
$222.24
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$144.46 |
| Max. Negotiated Rate |
$200.02 |
| Rate for Payer: Aetna Commercial |
$188.90
|
| Rate for Payer: BCBS Trust/PPO |
$181.41
|
| Rate for Payer: BCN Commercial |
$171.75
|
| Rate for Payer: Cash Price |
$177.79
|
| Rate for Payer: Cofinity Commercial |
$191.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.79
|
| Rate for Payer: Healthscope Commercial |
$200.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.90
|
| Rate for Payer: Nomi Health Commercial |
$182.24
|
| Rate for Payer: PHP Commercial |
$188.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.46
|
| Rate for Payer: Priority Health HMO/PPO |
$193.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.57
|
| Rate for Payer: UHC Core |
$185.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.68
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
OP
|
$222.24
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.41 |
| Max. Negotiated Rate |
$200.02 |
| Rate for Payer: Aetna Commercial |
$188.90
|
| Rate for Payer: Aetna Medicare |
$57.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.45
|
| Rate for Payer: BCBS Complete |
$52.94
|
| Rate for Payer: BCBS MAPPO |
$55.56
|
| Rate for Payer: BCBS Trust/PPO |
$182.70
|
| Rate for Payer: BCN Commercial |
$172.79
|
| Rate for Payer: BCN Medicare Advantage |
$55.56
|
| Rate for Payer: Cash Price |
$177.79
|
| Rate for Payer: Cash Price |
$177.79
|
| Rate for Payer: Cofinity Commercial |
$191.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.56
|
| Rate for Payer: Healthscope Commercial |
$200.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.68
|
| Rate for Payer: Mclaren Medicaid |
$50.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.34
|
| Rate for Payer: Meridian Medicaid |
$52.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.90
|
| Rate for Payer: Nomi Health Commercial |
$182.24
|
| Rate for Payer: PACE Senior Care Partners |
$52.78
|
| Rate for Payer: PACE SWMI |
$55.56
|
| Rate for Payer: PHP Commercial |
$188.90
|
| Rate for Payer: PHP Medicare Advantage |
$55.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.46
|
| Rate for Payer: Priority Health HMO/PPO |
$193.35
|
| Rate for Payer: Priority Health Medicare |
$56.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.90
|
| Rate for Payer: Railroad Medicare Medicare |
$55.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.57
|
| Rate for Payer: UHC Core |
$185.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.56
|
| Rate for Payer: UHC Exchange |
$55.56
|
| Rate for Payer: UHC Medicare Advantage |
$55.56
|
| Rate for Payer: UHCCP Medicaid |
$50.41
|
| Rate for Payer: VA VA |
$55.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.68
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
OP
|
$534.77
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
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/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
IP
|
$534.77
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
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 IVUS CATHETER
|
Facility
|
IP
|
$2,739.36
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,780.58 |
| Max. Negotiated Rate |
$2,465.42 |
| Rate for Payer: Aetna Commercial |
$2,328.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,236.14
|
| Rate for Payer: BCN Commercial |
$2,116.98
|
| Rate for Payer: Cash Price |
$2,191.49
|
| Rate for Payer: Cofinity Commercial |
$2,355.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,191.49
|
| Rate for Payer: Healthscope Commercial |
$2,465.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,054.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,328.46
|
| Rate for Payer: Nomi Health Commercial |
$2,246.28
|
| Rate for Payer: PHP Commercial |
$2,328.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.58
|
| Rate for Payer: Priority Health HMO/PPO |
$2,383.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,835.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,410.64
|
| Rate for Payer: UHC Core |
$2,287.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,054.52
|
|
|
HC IVUS CATHETER
|
Facility
|
OP
|
$2,739.36
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.60 |
| Max. Negotiated Rate |
$2,465.42 |
| Rate for Payer: Aetna Commercial |
$2,328.46
|
| Rate for Payer: Aetna Medicare |
$712.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$856.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$856.05
|
| Rate for Payer: BCBS Complete |
$1,095.74
|
| Rate for Payer: BCBS MAPPO |
$684.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,252.03
|
| Rate for Payer: BCN Commercial |
$2,129.85
|
| Rate for Payer: BCN Medicare Advantage |
$684.84
|
| Rate for Payer: Cash Price |
$2,191.49
|
| Rate for Payer: Cofinity Commercial |
$2,355.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,191.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.84
|
| Rate for Payer: Healthscope Commercial |
$2,465.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,054.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$787.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,328.46
|
| Rate for Payer: Nomi Health Commercial |
$2,246.28
|
| Rate for Payer: PACE Senior Care Partners |
$650.60
|
| Rate for Payer: PACE SWMI |
$684.84
|
| Rate for Payer: PHP Commercial |
$2,328.46
|
| Rate for Payer: PHP Medicare Advantage |
$684.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.58
|
| Rate for Payer: Priority Health HMO/PPO |
$2,383.24
|
| Rate for Payer: Priority Health Medicare |
$691.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,835.37
|
| Rate for Payer: Railroad Medicare Medicare |
$684.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,410.64
|
| Rate for Payer: UHC Core |
$2,287.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.84
|
| Rate for Payer: UHC Exchange |
$684.84
|
| Rate for Payer: UHC Medicare Advantage |
$684.84
|
| Rate for Payer: VA VA |
$684.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,054.52
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
IP
|
$1,324.84
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$861.15 |
| Max. Negotiated Rate |
$1,192.36 |
| Rate for Payer: Aetna Commercial |
$1,126.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,081.47
|
| Rate for Payer: BCN Commercial |
$1,023.84
|
| Rate for Payer: Cash Price |
$1,059.87
|
| Rate for Payer: Cofinity Commercial |
$1,139.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,059.87
|
| Rate for Payer: Healthscope Commercial |
$1,192.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$993.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,126.11
|
| Rate for Payer: Nomi Health Commercial |
$1,086.37
|
| Rate for Payer: PHP Commercial |
$1,126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,152.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$887.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,165.86
|
| Rate for Payer: UHC Core |
$1,106.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$993.63
|
|
