|
HC INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna American Axle |
$9.94
|
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: UMR Bronson Commercial |
$6.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
HC INJ ENOXAPARIN SODIUM PER 10 MG
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
63600151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna American Axle |
$9.94
|
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: UMR Bronson Commercial |
$5.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
HC INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
OP
|
$332.99
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.25 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna American Axle |
$216.44
|
| Rate for Payer: Aetna Commercial |
$283.04
|
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.44
|
| 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 |
$55.25
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$266.39
|
| Rate for Payer: Cash Price |
$266.39
|
| Rate for Payer: Cofinity Commercial |
$233.09
|
| Rate for Payer: Cofinity Commercial |
$286.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$299.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.74
|
| 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 |
$283.04
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$283.04
|
| 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 |
$233.09
|
| 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 |
$209.78
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$64.51
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: UMR Bronson Commercial |
$123.21
|
| Rate for Payer: VA VA |
$263.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.74
|
|
|
HC INJ ENZYME PALMAR FASCIAL CORD
|
Facility
|
IP
|
$332.99
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
76100305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.52 |
| Max. Negotiated Rate |
$299.69 |
| Rate for Payer: Aetna American Axle |
$216.44
|
| Rate for Payer: Aetna Commercial |
$283.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.44
|
| Rate for Payer: Cash Price |
$266.39
|
| Rate for Payer: Cofinity Commercial |
$233.09
|
| Rate for Payer: Cofinity Commercial |
$286.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.39
|
| Rate for Payer: Healthscope Commercial |
$299.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.04
|
| Rate for Payer: PHP Commercial |
$283.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.09
|
| Rate for Payer: Priority Health SBD |
$209.78
|
| Rate for Payer: UMR Bronson Commercial |
$146.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.74
|
|
|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna American Axle |
$0.66
|
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.66
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.86
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.71
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.87
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.71
|
| Rate for Payer: Priority Health SBD |
$0.64
|
| Rate for Payer: UMR Bronson Commercial |
$0.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
HC INJ HEPARIN SODIUM PER 1000U
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
63600140
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna American Axle |
$0.66
|
| Rate for Payer: Aetna Commercial |
$0.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.66
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.71
|
| Rate for Payer: Cofinity Commercial |
$0.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$0.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.87
|
| Rate for Payer: PHP Commercial |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.71
|
| Rate for Payer: Priority Health SBD |
$0.64
|
| Rate for Payer: UMR Bronson Commercial |
$0.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.77
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
IP
|
$542.10
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$238.52 |
| Max. Negotiated Rate |
$487.89 |
| Rate for Payer: Aetna American Axle |
$352.36
|
| Rate for Payer: Aetna Commercial |
$460.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.36
|
| Rate for Payer: Cash Price |
$433.68
|
| Rate for Payer: Cofinity Commercial |
$379.47
|
| Rate for Payer: Cofinity Commercial |
$466.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.68
|
| Rate for Payer: Healthscope Commercial |
$487.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.78
|
| Rate for Payer: PHP Commercial |
$460.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.47
|
| Rate for Payer: Priority Health SBD |
$341.52
|
| Rate for Payer: UMR Bronson Commercial |
$238.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.58
|
|
|
HC INJ KNEE ARTHROGRAM CT/MRI
|
Facility
|
OP
|
$542.10
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
36100562
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.97 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$352.36
|
| Rate for Payer: Aetna Commercial |
$460.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.36
|
| Rate for Payer: BCBS Complete |
$216.84
|
| Rate for Payer: BCBS Trust/PPO |
$339.30
|
| Rate for Payer: Cash Price |
$433.68
|
| Rate for Payer: Cash Price |
$433.68
|
| Rate for Payer: Cofinity Commercial |
$466.21
|
| Rate for Payer: Cofinity Commercial |
$379.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.68
|
| Rate for Payer: Healthscope Commercial |
$487.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.78
|
| Rate for Payer: PHP Commercial |
$460.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.47
|
| Rate for Payer: Priority Health SBD |
$341.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.87
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$38.97
|
| Rate for Payer: UMR Bronson Commercial |
$200.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.58
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
IP
|
$2,055.83
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$904.57 |
| Max. Negotiated Rate |
$1,850.25 |
| Rate for Payer: Aetna American Axle |
$1,336.29
|
| Rate for Payer: Aetna Commercial |
$1,747.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,336.29
|
| Rate for Payer: Cash Price |
$1,644.66
|
| Rate for Payer: Cofinity Commercial |
$1,439.08
|
| Rate for Payer: Cofinity Commercial |
$1,768.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,644.66
|
| Rate for Payer: Healthscope Commercial |
$1,850.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,439.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,541.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,747.46
|
| Rate for Payer: PHP Commercial |
$1,747.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.08
|
| Rate for Payer: Priority Health SBD |
$1,295.17
|
| Rate for Payer: UMR Bronson Commercial |
$904.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,541.87
|
|
|
HC INJ LUMB W MYELO 2+REG SAME MD
|
Facility
|
OP
|
$2,055.83
|
|
|
Service Code
|
CPT 62305
|
| Hospital Charge Code |
36100463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$2,240.48 |
| Rate for Payer: Aetna American Axle |
$1,336.29
|
| Rate for Payer: Aetna Commercial |
$1,747.46
|
| Rate for Payer: Aetna Medicare |
$740.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,336.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.95
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,644.66
|
| Rate for Payer: Cash Price |
$1,644.66
|
| Rate for Payer: Cofinity Commercial |
$1,439.08
|
| Rate for Payer: Cofinity Commercial |
$1,768.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,644.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$1,850.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,439.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,541.87
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,747.46
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$1,747.46
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,439.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,240.48
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.38
|
| Rate for Payer: Priority Health SBD |
$1,295.17
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.67
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$711.71
|
| Rate for Payer: UHC Exchange |
$117.88
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: UMR Bronson Commercial |
$760.66
|
| Rate for Payer: VA VA |
$711.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,541.87
|
|
|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
IP
|
$2,161.30
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$950.97 |
| Max. Negotiated Rate |
$1,945.17 |
| Rate for Payer: Aetna American Axle |
$1,404.84
|
| Rate for Payer: Aetna Commercial |
$1,837.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.84
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$1,512.91
|
| Rate for Payer: Cofinity Commercial |
$1,858.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Healthscope Commercial |
$1,945.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,512.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,620.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PHP Commercial |
$1,837.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health SBD |
$1,361.62
|
| Rate for Payer: UMR Bronson Commercial |
$950.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,620.98
|
|
|
HC INJ LUMB W MYELO CERV SAME MD
|
Facility
|
OP
|
$2,161.30
|
|
|
Service Code
|
CPT 62302
|
| Hospital Charge Code |
36100460
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.93 |
| Max. Negotiated Rate |
$2,240.48 |
| Rate for Payer: Aetna American Axle |
$1,404.84
|
| Rate for Payer: Aetna Commercial |
$1,837.10
|
| Rate for Payer: Aetna Medicare |
$740.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$841.86
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$1,858.72
|
| Rate for Payer: Cofinity Commercial |
$1,512.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$1,945.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,512.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$1,837.10
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,240.48
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.38
|
| Rate for Payer: Priority Health SBD |
$1,361.62
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.42
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$711.71
|
| Rate for Payer: UHC Exchange |
$114.93
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: UMR Bronson Commercial |
$799.68
|
| Rate for Payer: VA VA |
$711.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,620.98
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
OP
|
$2,161.30
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.62 |
| Max. Negotiated Rate |
$2,240.48 |
| Rate for Payer: Aetna American Axle |
$1,404.84
|
| Rate for Payer: Aetna Commercial |
$1,837.10
|
| Rate for Payer: Aetna Medicare |
$740.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$861.41
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$1,858.72
|
| Rate for Payer: Cofinity Commercial |
$1,512.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$1,945.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,512.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$1,837.10
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,240.48
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.38
|
| Rate for Payer: Priority Health SBD |
$1,361.62
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.98
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$711.71
|
| Rate for Payer: UHC Exchange |
$113.62
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: UMR Bronson Commercial |
$799.68
|
| Rate for Payer: VA VA |
$711.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,620.98
|
|
|
HC INJ LUMB W MYELO LS SAME MD
|
Facility
|
IP
|
$2,161.30
|
|
|
Service Code
|
CPT 62304
|
| Hospital Charge Code |
36100462
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$950.97 |
| Max. Negotiated Rate |
$1,945.17 |
| Rate for Payer: Aetna American Axle |
$1,404.84
|
| Rate for Payer: Aetna Commercial |
$1,837.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.84
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$1,512.91
|
| Rate for Payer: Cofinity Commercial |
$1,858.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Healthscope Commercial |
$1,945.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,512.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,620.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PHP Commercial |
$1,837.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health SBD |
$1,361.62
|
| Rate for Payer: UMR Bronson Commercial |
$950.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,620.98
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
OP
|
$2,161.30
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.93 |
| Max. Negotiated Rate |
$2,240.48 |
| Rate for Payer: Aetna American Axle |
$1,404.84
|
| Rate for Payer: Aetna Commercial |
$1,837.10
|
| Rate for Payer: Aetna Medicare |
$740.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.64
|
| Rate for Payer: BCBS Complete |
$408.81
|
| Rate for Payer: BCBS MAPPO |
$711.71
|
| Rate for Payer: BCBS Trust/PPO |
$449.01
|
| Rate for Payer: BCN Medicare Advantage |
$711.71
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$1,512.91
|
| Rate for Payer: Cofinity Commercial |
$1,858.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.71
|
| Rate for Payer: Healthscope Commercial |
$1,945.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,512.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$389.31
|
| Rate for Payer: Mclaren Medicare |
$711.71
|
| Rate for Payer: Meridian Medicaid |
$408.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PACE Medicare |
$676.12
|
| Rate for Payer: PACE SWMI |
$711.71
|
| Rate for Payer: PHP Commercial |
$1,837.10
|
| Rate for Payer: PHP Medicare Advantage |
$711.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,240.48
|
| Rate for Payer: Priority Health Medicare |
$711.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.38
|
| Rate for Payer: Priority Health SBD |
$1,361.62
|
| Rate for Payer: Railroad Medicare Medicare |
$711.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.42
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$711.71
|
| Rate for Payer: UHC Exchange |
$114.93
|
| Rate for Payer: UHC Medicare Advantage |
$733.06
|
| Rate for Payer: UMR Bronson Commercial |
$799.68
|
| Rate for Payer: VA VA |
$711.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,620.98
|
|
|
HC INJ LUMB W MYELO THOR SAME MD
|
Facility
|
IP
|
$2,161.30
|
|
|
Service Code
|
CPT 62303
|
| Hospital Charge Code |
36100461
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$950.97 |
| Max. Negotiated Rate |
$1,945.17 |
| Rate for Payer: Aetna American Axle |
$1,404.84
|
| Rate for Payer: Aetna Commercial |
$1,837.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.84
|
| Rate for Payer: Cash Price |
$1,729.04
|
| Rate for Payer: Cofinity Commercial |
$1,512.91
|
| Rate for Payer: Cofinity Commercial |
$1,858.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,729.04
|
| Rate for Payer: Healthscope Commercial |
$1,945.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,512.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,620.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,837.10
|
| Rate for Payer: PHP Commercial |
$1,837.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.91
|
| Rate for Payer: Priority Health SBD |
$1,361.62
|
| Rate for Payer: UMR Bronson Commercial |
$950.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,620.98
|
|
|
HC INJ LYMPHANGIOGRAPHY
|
Facility
|
IP
|
$1,279.58
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$563.02 |
| Max. Negotiated Rate |
$1,151.62 |
| Rate for Payer: Aetna American Axle |
$831.73
|
| Rate for Payer: Aetna Commercial |
$1,087.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$831.73
|
| Rate for Payer: Cash Price |
$1,023.66
|
| Rate for Payer: Cofinity Commercial |
$1,100.44
|
| Rate for Payer: Cofinity Commercial |
$895.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.66
|
| Rate for Payer: Healthscope Commercial |
$1,151.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$895.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$959.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,087.64
|
| Rate for Payer: PHP Commercial |
$1,087.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.71
|
| Rate for Payer: Priority Health SBD |
$806.14
|
| Rate for Payer: UMR Bronson Commercial |
$563.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$959.68
|
|
|
HC INJ LYMPHANGIOGRAPHY
|
Facility
|
OP
|
$1,279.58
|
|
|
Service Code
|
CPT 38790
|
| Hospital Charge Code |
36100445
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$1,151.62 |
| Rate for Payer: Aetna American Axle |
$831.73
|
| Rate for Payer: Aetna Commercial |
$1,087.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$831.73
|
| Rate for Payer: BCBS Complete |
$511.83
|
| Rate for Payer: BCBS Trust/PPO |
$289.11
|
| Rate for Payer: Cash Price |
$1,023.66
|
| Rate for Payer: Cash Price |
$1,023.66
|
| Rate for Payer: Cofinity Commercial |
$1,100.44
|
| Rate for Payer: Cofinity Commercial |
$895.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.66
|
| Rate for Payer: Healthscope Commercial |
$1,151.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$895.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$959.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,087.64
|
| Rate for Payer: PHP Commercial |
$1,087.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.71
|
| Rate for Payer: Priority Health SBD |
$806.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.89
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$79.90
|
| Rate for Payer: UMR Bronson Commercial |
$473.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$959.68
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
63600102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 125MG
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT J2930
|
| Hospital Charge Code |
63600102
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$19.00
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
63600101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna American Axle |
$13.26
|
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$13.51
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: UMR Bronson Commercial |
$7.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC INJ, METHYLPREDNISOLONE NA SUCCINATE, UP TO 40MG
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT J2920
|
| Hospital Charge Code |
63600101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna American Axle |
$13.26
|
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: UMR Bronson Commercial |
$8.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC INJ NERV BLOCK GREAT OCCIPTL
|
Facility
|
OP
|
$259.20
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
36100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna American Axle |
$168.48
|
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.48
|
| 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 |
$207.36
|
| Rate for Payer: Cash Price |
$207.36
|
| Rate for Payer: Cofinity Commercial |
$181.44
|
| Rate for Payer: Cofinity Commercial |
$222.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$233.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.40
|
| 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 |
$220.32
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$220.32
|
| 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 |
$181.44
|
| 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 |
$163.30
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$51.74
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: UMR Bronson Commercial |
$95.90
|
| Rate for Payer: VA VA |
$263.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.40
|
|
|
HC INJ NERV BLOCK GREAT OCCIPTL
|
Facility
|
IP
|
$259.20
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
36100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.05 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna American Axle |
$168.48
|
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.48
|
| Rate for Payer: Cash Price |
$207.36
|
| Rate for Payer: Cofinity Commercial |
$181.44
|
| Rate for Payer: Cofinity Commercial |
$222.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.36
|
| Rate for Payer: Healthscope Commercial |
$233.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$220.32
|
| Rate for Payer: PHP Commercial |
$220.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.44
|
| Rate for Payer: Priority Health SBD |
$163.30
|
| Rate for Payer: UMR Bronson Commercial |
$114.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.40
|
|
|
HC INJ ONABOTULINUMTOXINA PER 1 UNIT
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
63600114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$20.43 |
| Rate for Payer: Aetna American Axle |
$5.20
|
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.91
|
| Rate for Payer: BCBS Complete |
$3.63
|
| Rate for Payer: BCBS MAPPO |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$20.43
|
| Rate for Payer: BCN Medicare Advantage |
$6.33
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.33
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.00
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Mclaren Medicare |
$6.33
|
| Rate for Payer: Meridian Medicaid |
$3.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.80
|
| Rate for Payer: PACE Medicare |
$6.01
|
| Rate for Payer: PACE SWMI |
$6.33
|
| Rate for Payer: PHP Commercial |
$6.80
|
| Rate for Payer: PHP Medicare Advantage |
$6.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.58
|
| Rate for Payer: Priority Health Medicare |
$6.33
|
| Rate for Payer: Priority Health Narrow Network |
$14.86
|
| Rate for Payer: Priority Health SBD |
$5.04
|
| Rate for Payer: Railroad Medicare Medicare |
$6.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.33
|
| Rate for Payer: UHC Medicare Advantage |
$6.52
|
| Rate for Payer: UMR Bronson Commercial |
$2.96
|
| Rate for Payer: VA VA |
$6.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.00
|
|
