|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
IP
|
$353.94
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.73 |
| Max. Negotiated Rate |
$318.55 |
| Rate for Payer: Aetna American Axle |
$230.06
|
| Rate for Payer: Aetna Commercial |
$300.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.06
|
| Rate for Payer: Cash Price |
$283.15
|
| Rate for Payer: Cofinity Commercial |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$304.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.15
|
| Rate for Payer: Healthscope Commercial |
$318.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.85
|
| Rate for Payer: PHP Commercial |
$300.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.76
|
| Rate for Payer: Priority Health SBD |
$222.98
|
| Rate for Payer: UMR Bronson Commercial |
$155.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.46
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
OP
|
$353.94
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$691.57 |
| Rate for Payer: Aetna American Axle |
$230.06
|
| Rate for Payer: Aetna Commercial |
$300.85
|
| Rate for Payer: Aetna Medicare |
$228.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.60
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$154.84
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Cash Price |
$283.15
|
| Rate for Payer: Cash Price |
$283.15
|
| Rate for Payer: Cofinity Commercial |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$304.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Healthscope Commercial |
$318.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$247.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.46
|
| Rate for Payer: Mclaren Medicaid |
$120.16
|
| Rate for Payer: Mclaren Medicare |
$219.68
|
| Rate for Payer: Meridian Medicaid |
$126.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$300.85
|
| Rate for Payer: PACE Medicare |
$208.70
|
| Rate for Payer: PACE SWMI |
$219.68
|
| Rate for Payer: PHP Commercial |
$300.85
|
| Rate for Payer: PHP Medicare Advantage |
$219.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.57
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$553.26
|
| Rate for Payer: Priority Health SBD |
$222.98
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.68
|
| Rate for Payer: UHC Exchange |
$72.36
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: UMR Bronson Commercial |
$130.96
|
| Rate for Payer: VA VA |
$219.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.46
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$859.16
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.78 |
| Max. Negotiated Rate |
$1,935.09 |
| Rate for Payer: Aetna American Axle |
$558.45
|
| Rate for Payer: Aetna Commercial |
$730.29
|
| Rate for Payer: Aetna Medicare |
$639.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$681.66
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$687.33
|
| Rate for Payer: Cash Price |
$687.33
|
| Rate for Payer: Cofinity Commercial |
$738.88
|
| Rate for Payer: Cofinity Commercial |
$601.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$773.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$601.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.37
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.29
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$730.29
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.09
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.07
|
| Rate for Payer: Priority Health SBD |
$541.27
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.26
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.70
|
| Rate for Payer: UHC Exchange |
$104.78
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: UMR Bronson Commercial |
$317.89
|
| Rate for Payer: VA VA |
$614.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.37
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$859.16
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$378.03 |
| Max. Negotiated Rate |
$773.24 |
| Rate for Payer: Aetna American Axle |
$558.45
|
| Rate for Payer: Aetna Commercial |
$730.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.45
|
| Rate for Payer: Cash Price |
$687.33
|
| Rate for Payer: Cofinity Commercial |
$601.41
|
| Rate for Payer: Cofinity Commercial |
$738.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.33
|
| Rate for Payer: Healthscope Commercial |
$773.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$601.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.29
|
| Rate for Payer: PHP Commercial |
$730.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.41
|
| Rate for Payer: Priority Health SBD |
$541.27
|
| Rate for Payer: UMR Bronson Commercial |
$378.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.37
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$902.12
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.93 |
| Max. Negotiated Rate |
$811.91 |
| Rate for Payer: Aetna American Axle |
$586.38
|
| Rate for Payer: Aetna Commercial |
$766.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.38
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: Cofinity Commercial |
$631.48
|
| Rate for Payer: Cofinity Commercial |
$775.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.70
|
| Rate for Payer: Healthscope Commercial |
$811.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$631.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$676.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$766.80
|
| Rate for Payer: PHP Commercial |
$766.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.48
|
| Rate for Payer: Priority Health SBD |
$568.34
|
| Rate for Payer: UMR Bronson Commercial |
$396.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$676.59
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$902.12
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$1,935.09 |
| Rate for Payer: Aetna American Axle |
$586.38
|
| Rate for Payer: Aetna Commercial |
$766.80
|
| Rate for Payer: Aetna Medicare |
$639.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$631.79
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: Cash Price |
$721.70
|
| Rate for Payer: Cofinity Commercial |
$631.48
|
| Rate for Payer: Cofinity Commercial |
$775.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$811.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$631.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$676.59
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$766.80
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$766.80
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.09
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.07
|
| Rate for Payer: Priority Health SBD |
$568.34
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.61
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.70
|
| Rate for Payer: UHC Exchange |
$96.92
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: UMR Bronson Commercial |
$333.78
|
| Rate for Payer: VA VA |
$614.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$676.59
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$378.64
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna American Axle |
$246.12
|
| Rate for Payer: Aetna Commercial |
$321.84
|
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$290.76
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$325.63
|
| Rate for Payer: Cofinity Commercial |
$265.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.98
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$321.84
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Priority Health SBD |
$238.54
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$55.67
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: UMR Bronson Commercial |
$140.10
|
| Rate for Payer: VA VA |
$263.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.98
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$378.64
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$340.78 |
| Rate for Payer: Aetna American Axle |
$246.12
|
| Rate for Payer: Aetna Commercial |
$321.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.12
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$325.63
|
| Rate for Payer: Cofinity Commercial |
$265.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.91
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PHP Commercial |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health SBD |
$238.54
|
| Rate for Payer: UMR Bronson Commercial |
$166.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.98
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna American Axle |
$494.00
|
| Rate for Payer: Aetna Commercial |
$646.00
|
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$124.62
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cofinity Commercial |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$653.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$684.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$532.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.00
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.00
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$646.00
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Priority Health SBD |
$478.80
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$43.88
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: UMR Bronson Commercial |
$281.20
|
| Rate for Payer: VA VA |
$263.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.00
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.40 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna American Axle |
$494.00
|
| Rate for Payer: Aetna Commercial |
$646.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.00
|
| Rate for Payer: Cash Price |
$608.00
|
| Rate for Payer: Cofinity Commercial |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$653.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.00
|
| Rate for Payer: Healthscope Commercial |
$684.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$532.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$646.00
|
| Rate for Payer: PHP Commercial |
$646.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.00
|
| Rate for Payer: Priority Health SBD |
$478.80
|
| Rate for Payer: UMR Bronson Commercial |
$334.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.00
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,346.40 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna American Axle |
$1,989.00
|
| Rate for Payer: Aetna Commercial |
$2,601.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,989.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cofinity Commercial |
$2,142.00
|
| Rate for Payer: Cofinity Commercial |
$2,631.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,448.00
|
| Rate for Payer: Healthscope Commercial |
$2,754.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,142.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,295.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,601.00
|
| Rate for Payer: PHP Commercial |
$2,601.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,142.00
|
| Rate for Payer: Priority Health SBD |
$1,927.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,346.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,295.00
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.61 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna American Axle |
$1,989.00
|
| Rate for Payer: Aetna Commercial |
$2,601.00
|
| Rate for Payer: Aetna Medicare |
$44.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,989.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.95
|
| Rate for Payer: BCBS Complete |
$24.79
|
| Rate for Payer: BCBS MAPPO |
$43.16
|
| Rate for Payer: BCBS Trust/PPO |
$165.44
|
| Rate for Payer: BCN Medicare Advantage |
$43.16
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cofinity Commercial |
$2,142.00
|
| Rate for Payer: Cofinity Commercial |
$2,631.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,448.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.16
|
| Rate for Payer: Healthscope Commercial |
$2,754.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,142.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,295.00
|
| Rate for Payer: Mclaren Medicaid |
$23.61
|
| Rate for Payer: Mclaren Medicare |
$43.16
|
| Rate for Payer: Meridian Medicaid |
$24.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,601.00
|
| Rate for Payer: PACE Medicare |
$41.00
|
| Rate for Payer: PACE SWMI |
$43.16
|
| Rate for Payer: PHP Commercial |
$2,601.00
|
| Rate for Payer: PHP Medicare Advantage |
$43.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,142.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.42
|
| Rate for Payer: Priority Health Medicare |
$43.16
|
| Rate for Payer: Priority Health Narrow Network |
$100.34
|
| Rate for Payer: Priority Health SBD |
$1,927.80
|
| Rate for Payer: Railroad Medicare Medicare |
$43.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.16
|
| Rate for Payer: UHC Medicare Advantage |
$44.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,132.20
|
| Rate for Payer: VA VA |
$43.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,295.00
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UMR Bronson Commercial |
$26.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna American Axle |
$39.78
|
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: UMR Bronson Commercial |
$22.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna American Axle |
$6.50
|
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.50
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$7.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health SBD |
$6.30
|
| Rate for Payer: UMR Bronson Commercial |
$4.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$15.54 |
| Rate for Payer: Aetna American Axle |
$6.50
|
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna Medicare |
$5.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.02
|
| Rate for Payer: BCBS Complete |
$2.77
|
| Rate for Payer: BCBS MAPPO |
$4.82
|
| Rate for Payer: BCBS Trust/PPO |
$15.54
|
| Rate for Payer: BCN Medicare Advantage |
$4.82
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$7.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Mclaren Medicaid |
$2.63
|
| Rate for Payer: Mclaren Medicare |
$4.82
|
| Rate for Payer: Meridian Medicaid |
$2.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: PACE Medicare |
$4.58
|
| Rate for Payer: PACE SWMI |
$4.82
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: PHP Medicare Advantage |
$4.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.40
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Narrow Network |
$11.52
|
| Rate for Payer: Priority Health SBD |
$6.30
|
| Rate for Payer: Railroad Medicare Medicare |
$4.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.82
|
| Rate for Payer: UHC Medicare Advantage |
$4.96
|
| Rate for Payer: UMR Bronson Commercial |
$3.70
|
| Rate for Payer: VA VA |
$4.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
OP
|
$991.13
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.18 |
| Max. Negotiated Rate |
$1,133.59 |
| Rate for Payer: Aetna American Axle |
$644.23
|
| Rate for Payer: Aetna Commercial |
$842.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.23
|
| Rate for Payer: BCBS Complete |
$396.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,133.59
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cofinity Commercial |
$693.79
|
| Rate for Payer: Cofinity Commercial |
$852.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.90
|
| Rate for Payer: Healthscope Commercial |
$892.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$693.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$842.46
|
| Rate for Payer: PHP Commercial |
$842.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.79
|
| Rate for Payer: Priority Health SBD |
$624.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.00
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$138.18
|
| Rate for Payer: UMR Bronson Commercial |
$366.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.35
|
|
|
HC INJECTION CERVICAL OR THORACIC
|
Facility
|
IP
|
$991.13
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
36100283
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.10 |
| Max. Negotiated Rate |
$892.02 |
| Rate for Payer: Aetna American Axle |
$644.23
|
| Rate for Payer: Aetna Commercial |
$842.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.23
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cofinity Commercial |
$693.79
|
| Rate for Payer: Cofinity Commercial |
$852.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.90
|
| Rate for Payer: Healthscope Commercial |
$892.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$693.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$842.46
|
| Rate for Payer: PHP Commercial |
$842.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.79
|
| Rate for Payer: Priority Health SBD |
$624.41
|
| Rate for Payer: UMR Bronson Commercial |
$436.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.35
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
IP
|
$998.88
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.51 |
| Max. Negotiated Rate |
$898.99 |
| Rate for Payer: Aetna American Axle |
$649.27
|
| Rate for Payer: Aetna Commercial |
$849.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.27
|
| Rate for Payer: Cash Price |
$799.10
|
| Rate for Payer: Cofinity Commercial |
$859.04
|
| Rate for Payer: Cofinity Commercial |
$699.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.10
|
| Rate for Payer: Healthscope Commercial |
$898.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$699.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$749.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$849.05
|
| Rate for Payer: PHP Commercial |
$849.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$699.22
|
| Rate for Payer: Priority Health SBD |
$629.29
|
| Rate for Payer: UMR Bronson Commercial |
$439.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$749.16
|
|
|
HC INJECTION CONTRAST FOR TUBE ASSESSMENT
|
Facility
|
OP
|
$998.88
|
|
|
Service Code
|
CPT 49424
|
| Hospital Charge Code |
36100223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$898.99 |
| Rate for Payer: Aetna American Axle |
$649.27
|
| Rate for Payer: Aetna Commercial |
$849.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.27
|
| Rate for Payer: BCBS Complete |
$399.55
|
| Rate for Payer: BCBS Trust/PPO |
$301.86
|
| Rate for Payer: Cash Price |
$799.10
|
| Rate for Payer: Cash Price |
$799.10
|
| Rate for Payer: Cofinity Commercial |
$859.04
|
| Rate for Payer: Cofinity Commercial |
$699.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$799.10
|
| Rate for Payer: Healthscope Commercial |
$898.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$699.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$749.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$849.05
|
| Rate for Payer: PHP Commercial |
$849.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$699.22
|
| Rate for Payer: Priority Health SBD |
$629.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.26
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$35.69
|
| Rate for Payer: UMR Bronson Commercial |
$369.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$749.16
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$81.42 |
| Rate for Payer: Aetna American Axle |
$16.25
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Medicare |
$26.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.50
|
| Rate for Payer: BCBS Complete |
$14.47
|
| Rate for Payer: BCBS MAPPO |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$81.42
|
| Rate for Payer: BCN Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Mclaren Medicaid |
$13.78
|
| Rate for Payer: Mclaren Medicare |
$25.20
|
| Rate for Payer: Meridian Medicaid |
$14.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PACE Medicare |
$23.94
|
| Rate for Payer: PACE SWMI |
$25.20
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Medicare Advantage |
$25.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.11
|
| Rate for Payer: Priority Health Medicare |
$25.20
|
| Rate for Payer: Priority Health Narrow Network |
$56.89
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: Railroad Medicare Medicare |
$25.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.20
|
| Rate for Payer: UHC Medicare Advantage |
$25.95
|
| Rate for Payer: UMR Bronson Commercial |
$9.25
|
| Rate for Payer: VA VA |
$25.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
|
HC INJECTION, DENOSUMAB, 1MG
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT J0897
|
| Hospital Charge Code |
63600091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna American Axle |
$16.25
|
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: UMR Bronson Commercial |
$11.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna American Axle |
$9.28
|
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.28
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health SBD |
$9.00
|
| Rate for Payer: UMR Bronson Commercial |
$6.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
CPT J1000
|
| Hospital Charge Code |
63600092
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$115.51 |
| Rate for Payer: Aetna American Axle |
$9.28
|
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.28
|
| Rate for Payer: BCBS Complete |
$5.71
|
| Rate for Payer: BCBS Trust/PPO |
$115.51
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health SBD |
$9.00
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
|
Facility
|
OP
|
$2.04
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
63600167
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna American Axle |
$1.33
|
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.33
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$2.57
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Cofinity Commercial |
$1.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.63
|
| Rate for Payer: Healthscope Commercial |
$1.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.73
|
| Rate for Payer: PHP Commercial |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.43
|
| Rate for Payer: Priority Health SBD |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$0.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.53
|
|
