|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC W IMAGIG GUID
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
36100540
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$485.52 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna American Axle |
$717.25
|
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.25
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$772.42
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$772.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health SBD |
$695.18
|
| Rate for Payer: UMR Bronson Commercial |
$485.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.28 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna American Axle |
$717.25
|
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Cofinity Commercial |
$772.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$772.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$695.18
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,659.37
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: UMR Bronson Commercial |
$408.28
|
| Rate for Payer: VA VA |
$868.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS CERV OR THORACIC WO IMAGING
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
36100542
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$485.52 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna American Axle |
$717.25
|
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.25
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$772.42
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$772.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health SBD |
$695.18
|
| Rate for Payer: UMR Bronson Commercial |
$485.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
IP
|
$1,103.46
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$485.52 |
| Max. Negotiated Rate |
$993.11 |
| Rate for Payer: Aetna American Axle |
$717.25
|
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.25
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$772.42
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$772.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health SBD |
$695.18
|
| Rate for Payer: UMR Bronson Commercial |
$485.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ CATH PLACE CON INF OR BOLUS LUMBAR OR SACRAL W IMAGING GUID
|
Facility
|
OP
|
$1,103.46
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
36100541
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$408.28 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna American Axle |
$717.25
|
| Rate for Payer: Aetna Commercial |
$937.94
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cash Price |
$882.77
|
| Rate for Payer: Cofinity Commercial |
$948.98
|
| Rate for Payer: Cofinity Commercial |
$772.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$772.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$993.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$772.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.60
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$937.94
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$937.94
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$717.25
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$695.18
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,659.37
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: UMR Bronson Commercial |
$408.28
|
| Rate for Payer: VA VA |
$868.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.60
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$213.68 |
| Rate for Payer: Aetna American Axle |
$43.09
|
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna Medicare |
$78.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.89
|
| Rate for Payer: BCBS Complete |
$42.72
|
| Rate for Payer: BCBS MAPPO |
$75.91
|
| Rate for Payer: BCN Medicare Advantage |
$75.91
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.91
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Mclaren Medicaid |
$40.69
|
| Rate for Payer: Mclaren Medicare |
$75.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.71
|
| Rate for Payer: Meridian Medicaid |
$42.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: PACE Medicare |
$72.11
|
| Rate for Payer: PACE SWMI |
$75.91
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: PHP Medicare Advantage |
$75.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health Medicare |
$75.91
|
| Rate for Payer: Priority Health SBD |
$41.77
|
| Rate for Payer: Railroad Medicare Medicare |
$75.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.91
|
| Rate for Payer: UHC Exchange |
$145.07
|
| Rate for Payer: UHC Medicare Advantage |
$75.91
|
| Rate for Payer: UHCCP Medicaid |
$40.69
|
| Rate for Payer: UMR Bronson Commercial |
$24.53
|
| Rate for Payer: VA VA |
$75.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
HC INJ COLLAGENASE, CLOSTRIDIUM HISTOLYTICUM, 0.01MG
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
63600164
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.17 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna American Axle |
$43.09
|
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.09
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health SBD |
$41.77
|
| Rate for Payer: UMR Bronson Commercial |
$29.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
IP
|
$361.02
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.85 |
| Max. Negotiated Rate |
$324.92 |
| Rate for Payer: Aetna American Axle |
$234.66
|
| Rate for Payer: Aetna Commercial |
$306.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.66
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cofinity Commercial |
$252.71
|
| Rate for Payer: Cofinity Commercial |
$310.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.82
|
| Rate for Payer: Healthscope Commercial |
$324.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.87
|
| Rate for Payer: PHP Commercial |
$306.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.66
|
| Rate for Payer: Priority Health SBD |
$227.44
|
| Rate for Payer: UMR Bronson Commercial |
$158.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.76
|
|
|
HC INJ CORPORA CAVERN, PHARM AGENT
|
Facility
|
OP
|
$361.02
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
76100218
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$667.69 |
| Rate for Payer: Aetna American Axle |
$234.66
|
| Rate for Payer: Aetna Commercial |
$306.87
|
| Rate for Payer: Aetna Medicare |
$246.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.50
|
| Rate for Payer: BCBS Complete |
$133.50
|
| Rate for Payer: BCBS MAPPO |
$237.20
|
| Rate for Payer: BCN Medicare Advantage |
$237.20
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cash Price |
$288.82
|
| Rate for Payer: Cofinity Commercial |
$310.48
|
| Rate for Payer: Cofinity Commercial |
$252.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.20
|
| Rate for Payer: Healthscope Commercial |
$324.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.76
|
| Rate for Payer: Mclaren Medicaid |
$127.14
|
| Rate for Payer: Mclaren Medicare |
$237.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.06
|
| Rate for Payer: Meridian Medicaid |
$133.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.87
|
| Rate for Payer: PACE Medicare |
$225.34
|
| Rate for Payer: PACE SWMI |
$237.20
|
| Rate for Payer: PHP Commercial |
$306.87
|
| Rate for Payer: PHP Medicare Advantage |
$237.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.66
|
| Rate for Payer: Priority Health Medicare |
$237.20
|
| Rate for Payer: Priority Health SBD |
$227.44
|
| Rate for Payer: Railroad Medicare Medicare |
$237.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.20
|
| Rate for Payer: UHC Exchange |
$453.31
|
| Rate for Payer: UHC Medicare Advantage |
$237.20
|
| Rate for Payer: UHCCP Medicaid |
$127.14
|
| Rate for Payer: UMR Bronson Commercial |
$133.58
|
| Rate for Payer: VA VA |
$237.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.76
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna American Axle |
$7.15
|
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.15
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$7.70
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: PHP Commercial |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health SBD |
$6.93
|
| Rate for Payer: UMR Bronson Commercial |
$4.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.25
|
|
|
HC INJ DAXIBOTULINUMTOXINA-LANM, 1 UNIT
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J0589
|
| Hospital Charge Code |
63600257
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna American Axle |
$7.15
|
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Aetna Medicare |
$3.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.94
|
| Rate for Payer: BCBS Complete |
$1.77
|
| Rate for Payer: BCBS MAPPO |
$3.15
|
| Rate for Payer: BCN Medicare Advantage |
$3.15
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Cofinity Commercial |
$7.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.15
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.25
|
| Rate for Payer: Mclaren Medicaid |
$1.69
|
| Rate for Payer: Mclaren Medicare |
$3.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.31
|
| Rate for Payer: Meridian Medicaid |
$1.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: PACE Medicare |
$2.99
|
| Rate for Payer: PACE SWMI |
$3.15
|
| Rate for Payer: PHP Commercial |
$9.35
|
| Rate for Payer: PHP Medicare Advantage |
$3.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health Medicare |
$3.15
|
| Rate for Payer: Priority Health SBD |
$6.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.15
|
| Rate for Payer: UHC Exchange |
$6.02
|
| Rate for Payer: UHC Medicare Advantage |
$3.15
|
| Rate for Payer: UHCCP Medicaid |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$4.07
|
| Rate for Payer: VA VA |
$3.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.25
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$876.34
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$385.59 |
| Max. Negotiated Rate |
$788.71 |
| Rate for Payer: Aetna American Axle |
$569.62
|
| Rate for Payer: Aetna Commercial |
$744.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.62
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cofinity Commercial |
$613.44
|
| Rate for Payer: Cofinity Commercial |
$753.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$613.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.07
|
| Rate for Payer: Healthscope Commercial |
$788.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$613.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.89
|
| Rate for Payer: PHP Commercial |
$744.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.62
|
| Rate for Payer: Priority Health SBD |
$552.09
|
| Rate for Payer: UMR Bronson Commercial |
$385.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.25
|
|
|
HC INJ DIAG OR THER CERV OR THORACIC WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$876.34
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
36100538
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$324.25 |
| Max. Negotiated Rate |
$1,901.18 |
| Rate for Payer: Aetna American Axle |
$569.62
|
| Rate for Payer: Aetna Commercial |
$744.89
|
| Rate for Payer: Aetna Medicare |
$702.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cash Price |
$701.07
|
| Rate for Payer: Cofinity Commercial |
$753.65
|
| Rate for Payer: Cofinity Commercial |
$613.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$613.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$788.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$613.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.25
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.89
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$744.89
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.62
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health SBD |
$552.09
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,290.76
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: UMR Bronson Commercial |
$324.25
|
| Rate for Payer: VA VA |
$675.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.25
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$920.16
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.46 |
| Max. Negotiated Rate |
$1,901.18 |
| Rate for Payer: Aetna American Axle |
$598.10
|
| Rate for Payer: Aetna Commercial |
$782.14
|
| Rate for Payer: Aetna Medicare |
$702.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cofinity Commercial |
$791.34
|
| Rate for Payer: Cofinity Commercial |
$644.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$644.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$828.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$644.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.12
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.14
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$782.14
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.10
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health SBD |
$579.70
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,290.76
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: UMR Bronson Commercial |
$340.46
|
| Rate for Payer: VA VA |
$675.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.12
|
|
|
HC INJ DIAG OR THER LUMBAR OR SACRAL WITH IMAGING GUIDANCE
|
Facility
|
IP
|
$920.16
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
36100539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$404.87 |
| Max. Negotiated Rate |
$828.14 |
| Rate for Payer: Aetna American Axle |
$598.10
|
| Rate for Payer: Aetna Commercial |
$782.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.10
|
| Rate for Payer: Cash Price |
$736.13
|
| Rate for Payer: Cofinity Commercial |
$644.11
|
| Rate for Payer: Cofinity Commercial |
$791.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$644.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.13
|
| Rate for Payer: Healthscope Commercial |
$828.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$644.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.14
|
| Rate for Payer: PHP Commercial |
$782.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.10
|
| Rate for Payer: Priority Health SBD |
$579.70
|
| Rate for Payer: UMR Bronson Commercial |
$404.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.12
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$386.21
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.90 |
| Max. Negotiated Rate |
$810.38 |
| Rate for Payer: Aetna American Axle |
$251.04
|
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna Medicare |
$299.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Cofinity Commercial |
$270.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.66
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health SBD |
$243.31
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$550.19
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: UMR Bronson Commercial |
$142.90
|
| Rate for Payer: VA VA |
$287.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.66
|
|
|
HC INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$386.21
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100182
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.93 |
| Max. Negotiated Rate |
$347.59 |
| Rate for Payer: Aetna American Axle |
$251.04
|
| Rate for Payer: Aetna Commercial |
$328.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.04
|
| Rate for Payer: Cash Price |
$308.97
|
| Rate for Payer: Cofinity Commercial |
$270.35
|
| Rate for Payer: Cofinity Commercial |
$332.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.97
|
| Rate for Payer: Healthscope Commercial |
$347.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.28
|
| Rate for Payer: PHP Commercial |
$328.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.04
|
| Rate for Payer: Priority Health SBD |
$243.31
|
| Rate for Payer: UMR Bronson Commercial |
$169.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.66
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
OP
|
$775.20
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$810.38 |
| Rate for Payer: Aetna American Axle |
$503.88
|
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: Aetna Medicare |
$299.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$666.67
|
| Rate for Payer: Cofinity Commercial |
$542.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.40
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.88
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Priority Health SBD |
$488.38
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$550.19
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: UMR Bronson Commercial |
$286.82
|
| Rate for Payer: VA VA |
$287.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.40
|
|
|
HC INJECTION AA&/STRD VAGUS NERVE
|
Facility
|
IP
|
$775.20
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.09 |
| Max. Negotiated Rate |
$697.68 |
| Rate for Payer: Aetna American Axle |
$503.88
|
| Rate for Payer: Aetna Commercial |
$658.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.88
|
| Rate for Payer: Cash Price |
$620.16
|
| Rate for Payer: Cofinity Commercial |
$542.64
|
| Rate for Payer: Cofinity Commercial |
$666.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$542.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.16
|
| Rate for Payer: Healthscope Commercial |
$697.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$542.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$581.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$658.92
|
| Rate for Payer: PHP Commercial |
$658.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.88
|
| Rate for Payer: Priority Health SBD |
$488.38
|
| Rate for Payer: UMR Bronson Commercial |
$341.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$581.40
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
OP
|
$3,121.20
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$2,809.08 |
| Rate for Payer: Aetna American Axle |
$2,028.78
|
| Rate for Payer: Aetna Commercial |
$2,653.02
|
| Rate for Payer: Aetna Medicare |
$45.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,028.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.14
|
| Rate for Payer: BCBS Complete |
$24.83
|
| Rate for Payer: BCBS MAPPO |
$44.11
|
| Rate for Payer: BCN Medicare Advantage |
$44.11
|
| Rate for Payer: Cash Price |
$2,496.96
|
| Rate for Payer: Cash Price |
$2,496.96
|
| Rate for Payer: Cofinity Commercial |
$2,684.23
|
| Rate for Payer: Cofinity Commercial |
$2,184.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,184.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,496.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$2,809.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,184.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,340.90
|
| Rate for Payer: Mclaren Medicaid |
$23.64
|
| Rate for Payer: Mclaren Medicare |
$44.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.32
|
| Rate for Payer: Meridian Medicaid |
$24.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,653.02
|
| Rate for Payer: PACE Medicare |
$41.90
|
| Rate for Payer: PACE SWMI |
$44.11
|
| Rate for Payer: PHP Commercial |
$2,653.02
|
| Rate for Payer: PHP Medicare Advantage |
$44.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,028.78
|
| Rate for Payer: Priority Health Medicare |
$44.11
|
| Rate for Payer: Priority Health SBD |
$1,966.36
|
| Rate for Payer: Railroad Medicare Medicare |
$44.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.11
|
| Rate for Payer: UHC Exchange |
$84.30
|
| Rate for Payer: UHC Medicare Advantage |
$44.11
|
| Rate for Payer: UHCCP Medicaid |
$23.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,154.84
|
| Rate for Payer: VA VA |
$44.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,340.90
|
|
|
HC INJECTION, ABATACEPT, 10 MG
|
Facility
|
IP
|
$3,121.20
|
|
|
Service Code
|
CPT J0129
|
| Hospital Charge Code |
63600087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,373.33 |
| Max. Negotiated Rate |
$2,809.08 |
| Rate for Payer: Aetna American Axle |
$2,028.78
|
| Rate for Payer: Aetna Commercial |
$2,653.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,028.78
|
| Rate for Payer: Cash Price |
$2,496.96
|
| Rate for Payer: Cofinity Commercial |
$2,184.84
|
| Rate for Payer: Cofinity Commercial |
$2,684.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,184.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,496.96
|
| Rate for Payer: Healthscope Commercial |
$2,809.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,184.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,340.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,653.02
|
| Rate for Payer: PHP Commercial |
$2,653.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,028.78
|
| Rate for Payer: Priority Health SBD |
$1,966.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,373.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,340.90
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UMR Bronson Commercial |
$27.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT J0696
|
| Hospital Charge Code |
63600088
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna American Axle |
$40.57
|
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: BCBS Complete |
$24.97
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: Aetna American Axle |
$6.63
|
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna Medicare |
$4.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.89
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: BCBS MAPPO |
$3.91
|
| Rate for Payer: BCN Medicare Advantage |
$3.91
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.91
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.65
|
| Rate for Payer: Mclaren Medicaid |
$2.10
|
| Rate for Payer: Mclaren Medicare |
$3.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.11
|
| Rate for Payer: Meridian Medicaid |
$2.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: PACE Medicare |
$3.71
|
| Rate for Payer: PACE SWMI |
$3.91
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: PHP Medicare Advantage |
$3.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health Medicare |
$3.91
|
| Rate for Payer: Priority Health SBD |
$6.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.91
|
| Rate for Payer: UHC Exchange |
$7.47
|
| Rate for Payer: UHC Medicare Advantage |
$3.91
|
| Rate for Payer: UHCCP Medicaid |
$2.10
|
| Rate for Payer: UMR Bronson Commercial |
$3.77
|
| Rate for Payer: VA VA |
$3.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.65
|
|
|
HC INJECTION, CERTOLIZUMAB PEGOL, 1 MG
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
CPT J0717
|
| Hospital Charge Code |
63600090
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna American Axle |
$6.63
|
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.63
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$7.14
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.63
|
| Rate for Payer: Priority Health SBD |
$6.43
|
| Rate for Payer: UMR Bronson Commercial |
$4.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.65
|
|
