|
HC ESOPHAGEAL MAPPING CATHETER
|
Facility
|
OP
|
$1,410.81
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$335.07 |
| Max. Negotiated Rate |
$1,269.73 |
| Rate for Payer: Aetna Commercial |
$1,199.19
|
| Rate for Payer: Aetna Medicare |
$366.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.88
|
| Rate for Payer: BCBS Complete |
$564.32
|
| Rate for Payer: BCBS MAPPO |
$352.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.90
|
| Rate for Payer: BCN Commercial |
$1,096.90
|
| Rate for Payer: BCN Medicare Advantage |
$352.70
|
| Rate for Payer: Cash Price |
$1,128.65
|
| Rate for Payer: Cofinity Commercial |
$1,213.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.70
|
| Rate for Payer: Healthscope Commercial |
$1,269.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,058.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$370.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,199.19
|
| Rate for Payer: PACE Senior Care Partners |
$335.07
|
| Rate for Payer: PACE SWMI |
$352.70
|
| Rate for Payer: PHP Commercial |
$1,199.19
|
| Rate for Payer: PHP Medicare Advantage |
$352.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$987.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,227.40
|
| Rate for Payer: Priority Health Medicare |
$352.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$860.45
|
| Rate for Payer: Railroad Medicare Medicare |
$352.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,241.51
|
| Rate for Payer: UHC Core |
$1,178.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.70
|
| Rate for Payer: UHC Medicare Advantage |
$363.28
|
| Rate for Payer: VA VA |
$352.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,058.11
|
|
|
HC ESOPHAGEAL MAPPING CATHETER
|
Facility
|
IP
|
$1,410.81
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
27200028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$860.45 |
| Max. Negotiated Rate |
$1,269.73 |
| Rate for Payer: Aetna Commercial |
$1,199.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.27
|
| Rate for Payer: BCN Commercial |
$1,090.27
|
| Rate for Payer: Cash Price |
$1,128.65
|
| Rate for Payer: Cofinity Commercial |
$1,213.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,128.65
|
| Rate for Payer: Healthscope Commercial |
$1,269.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,058.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,199.19
|
| Rate for Payer: PHP Commercial |
$1,199.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$987.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,227.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$860.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,241.51
|
| Rate for Payer: UHC Core |
$1,178.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,058.11
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
IP
|
$1,350.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$823.51 |
| Max. Negotiated Rate |
$1,215.21 |
| Rate for Payer: Aetna Commercial |
$1,147.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,043.46
|
| Rate for Payer: BCN Commercial |
$1,043.46
|
| Rate for Payer: Cash Price |
$1,080.18
|
| Rate for Payer: Cofinity Commercial |
$1,161.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.18
|
| Rate for Payer: Healthscope Commercial |
$1,215.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.70
|
| Rate for Payer: PHP Commercial |
$1,147.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,174.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$823.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.20
|
| Rate for Payer: UHC Core |
$1,127.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.67
|
|
|
HC ESOPHAGOSCOPY
|
Facility
|
OP
|
$1,350.23
|
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.68 |
| Max. Negotiated Rate |
$1,215.21 |
| Rate for Payer: Aetna Commercial |
$1,147.70
|
| Rate for Payer: Aetna Medicare |
$351.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$421.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$421.95
|
| Rate for Payer: BCBS Complete |
$540.09
|
| Rate for Payer: BCBS MAPPO |
$337.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.80
|
| Rate for Payer: BCN Commercial |
$1,049.80
|
| Rate for Payer: BCN Medicare Advantage |
$337.56
|
| Rate for Payer: Cash Price |
$1,080.18
|
| Rate for Payer: Cofinity Commercial |
$1,161.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.56
|
| Rate for Payer: Healthscope Commercial |
$1,215.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,012.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$354.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.70
|
| Rate for Payer: PACE Senior Care Partners |
$320.68
|
| Rate for Payer: PACE SWMI |
$337.56
|
| Rate for Payer: PHP Commercial |
$1,147.70
|
| Rate for Payer: PHP Medicare Advantage |
$337.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,174.70
|
| Rate for Payer: Priority Health Medicare |
$337.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$823.51
|
| Rate for Payer: Railroad Medicare Medicare |
$337.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.20
|
| Rate for Payer: UHC Core |
$1,127.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.56
|
| Rate for Payer: UHC Medicare Advantage |
$347.68
|
| Rate for Payer: VA VA |
$337.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,012.67
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
OP
|
$1,208.70
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.07 |
| Max. Negotiated Rate |
$1,087.83 |
| Rate for Payer: Aetna Commercial |
$1,027.40
|
| Rate for Payer: Aetna Medicare |
$314.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$377.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$377.72
|
| Rate for Payer: BCBS Complete |
$483.48
|
| Rate for Payer: BCBS MAPPO |
$302.18
|
| Rate for Payer: BCBS Trust/PPO |
$939.76
|
| Rate for Payer: BCN Commercial |
$939.76
|
| Rate for Payer: BCN Medicare Advantage |
$302.18
|
| Rate for Payer: Cash Price |
$966.96
|
| Rate for Payer: Cofinity Commercial |
$1,039.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.18
|
| Rate for Payer: Healthscope Commercial |
$1,087.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$317.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$347.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,027.40
|
| Rate for Payer: PACE Senior Care Partners |
$287.07
|
| Rate for Payer: PACE SWMI |
$302.18
|
| Rate for Payer: PHP Commercial |
$1,027.40
|
| Rate for Payer: PHP Medicare Advantage |
$302.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,051.57
|
| Rate for Payer: Priority Health Medicare |
$302.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$737.19
|
| Rate for Payer: Railroad Medicare Medicare |
$302.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.66
|
| Rate for Payer: UHC Core |
$1,009.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$302.18
|
| Rate for Payer: UHC Medicare Advantage |
$311.24
|
| Rate for Payer: VA VA |
$302.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.52
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
IP
|
$1,208.70
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$737.19 |
| Max. Negotiated Rate |
$1,087.83 |
| Rate for Payer: Aetna Commercial |
$1,027.40
|
| Rate for Payer: BCBS Trust/PPO |
$934.08
|
| Rate for Payer: BCN Commercial |
$934.08
|
| Rate for Payer: Cash Price |
$966.96
|
| Rate for Payer: Cofinity Commercial |
$1,039.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.96
|
| Rate for Payer: Healthscope Commercial |
$1,087.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,027.40
|
| Rate for Payer: PHP Commercial |
$1,027.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,051.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$737.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.66
|
| Rate for Payer: UHC Core |
$1,009.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.52
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.45 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: BCBS Trust/PPO |
$80.40
|
| Rate for Payer: BCN Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.56
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.51
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: BCBS MAPPO |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$80.89
|
| Rate for Payer: BCN Commercial |
$80.89
|
| Rate for Payer: BCN Medicare Advantage |
$26.01
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.01
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: PACE Senior Care Partners |
$24.71
|
| Rate for Payer: PACE SWMI |
$26.01
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.51
|
| Rate for Payer: Priority Health Medicare |
$26.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.45
|
| Rate for Payer: Railroad Medicare Medicare |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.56
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.01
|
| Rate for Payer: UHC Medicare Advantage |
$26.79
|
| Rate for Payer: VA VA |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: BCBS Trust/PPO |
$41.73
|
| Rate for Payer: BCN Commercial |
$41.73
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$46.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.20
|
| Rate for Payer: Healthscope Commercial |
$48.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.90
|
| Rate for Payer: PHP Commercial |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.52
|
| Rate for Payer: UHC Core |
$45.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.50
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$14.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.88
|
| Rate for Payer: BCBS Complete |
$21.65
|
| Rate for Payer: BCBS MAPPO |
$13.50
|
| Rate for Payer: BCBS Trust/PPO |
$41.98
|
| Rate for Payer: BCN Commercial |
$41.98
|
| Rate for Payer: BCN Medicare Advantage |
$13.50
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$46.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$48.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.50
|
| Rate for Payer: Mclaren Medicaid |
$20.62
|
| Rate for Payer: Meridian Medicaid |
$21.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.90
|
| Rate for Payer: PACE Senior Care Partners |
$12.82
|
| Rate for Payer: PACE SWMI |
$13.50
|
| Rate for Payer: PHP Commercial |
$45.90
|
| Rate for Payer: PHP Medicare Advantage |
$13.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.98
|
| Rate for Payer: Priority Health Medicare |
$13.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.52
|
| Rate for Payer: UHC Core |
$45.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.50
|
| Rate for Payer: UHC Medicare Advantage |
$13.90
|
| Rate for Payer: VA VA |
$13.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.50
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.91
|
| Rate for Payer: BCBS Complete |
$21.65
|
| Rate for Payer: BCBS MAPPO |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$59.48
|
| Rate for Payer: BCN Commercial |
$59.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$20.62
|
| Rate for Payer: Meridian Medicaid |
$21.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Senior Care Partners |
$18.17
|
| Rate for Payer: PACE SWMI |
$19.12
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$19.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Medicare |
$19.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: Railroad Medicare Medicare |
$19.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.12
|
| Rate for Payer: UHC Medicare Advantage |
$19.70
|
| Rate for Payer: VA VA |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: BCBS Trust/PPO |
$59.12
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC ESTRIOL
|
Facility
|
IP
|
$49.98
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.48
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.98
|
| Rate for Payer: UHC Core |
$41.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.48
|
|
|
HC ESTRIOL
|
Facility
|
OP
|
$49.98
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna Medicare |
$12.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.62
|
| Rate for Payer: BCBS Complete |
$18.74
|
| Rate for Payer: BCBS MAPPO |
$12.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.86
|
| Rate for Payer: BCN Commercial |
$38.86
|
| Rate for Payer: BCN Medicare Advantage |
$12.50
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.48
|
| Rate for Payer: Mclaren Medicaid |
$17.84
|
| Rate for Payer: Meridian Medicaid |
$18.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.48
|
| Rate for Payer: PACE Senior Care Partners |
$11.87
|
| Rate for Payer: PACE SWMI |
$12.50
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: PHP Medicare Advantage |
$12.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.48
|
| Rate for Payer: Priority Health Medicare |
$12.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.48
|
| Rate for Payer: Railroad Medicare Medicare |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.98
|
| Rate for Payer: UHC Core |
$41.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.50
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: VA VA |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.48
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
IP
|
$115.87
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.67 |
| Max. Negotiated Rate |
$104.28 |
| Rate for Payer: Aetna Commercial |
$98.49
|
| Rate for Payer: BCBS Trust/PPO |
$89.54
|
| Rate for Payer: BCN Commercial |
$89.54
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cofinity Commercial |
$99.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.70
|
| Rate for Payer: Healthscope Commercial |
$104.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.49
|
| Rate for Payer: PHP Commercial |
$98.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.97
|
| Rate for Payer: UHC Core |
$96.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.90
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
OP
|
$115.87
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$104.28 |
| Rate for Payer: Aetna Commercial |
$98.49
|
| Rate for Payer: Aetna Medicare |
$30.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.21
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$28.97
|
| Rate for Payer: BCBS Trust/PPO |
$90.09
|
| Rate for Payer: BCN Commercial |
$90.09
|
| Rate for Payer: BCN Medicare Advantage |
$28.97
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cofinity Commercial |
$99.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.97
|
| Rate for Payer: Healthscope Commercial |
$104.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.90
|
| Rate for Payer: Mclaren Medicaid |
$64.86
|
| Rate for Payer: Meridian Medicaid |
$68.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.49
|
| Rate for Payer: PACE Senior Care Partners |
$27.52
|
| Rate for Payer: PACE SWMI |
$28.97
|
| Rate for Payer: PHP Commercial |
$98.49
|
| Rate for Payer: PHP Medicare Advantage |
$28.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.81
|
| Rate for Payer: Priority Health Medicare |
$28.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.67
|
| Rate for Payer: Railroad Medicare Medicare |
$28.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.97
|
| Rate for Payer: UHC Core |
$96.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.97
|
| Rate for Payer: UHC Medicare Advantage |
$29.84
|
| Rate for Payer: VA VA |
$28.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.90
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
OP
|
$116.69
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$105.02 |
| Rate for Payer: Aetna Commercial |
$99.19
|
| Rate for Payer: Aetna Medicare |
$30.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.47
|
| Rate for Payer: BCBS Complete |
$50.28
|
| Rate for Payer: BCBS MAPPO |
$29.17
|
| Rate for Payer: BCBS Trust/PPO |
$90.73
|
| Rate for Payer: BCN Commercial |
$90.73
|
| Rate for Payer: BCN Medicare Advantage |
$29.17
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$100.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.17
|
| Rate for Payer: Healthscope Commercial |
$105.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.52
|
| Rate for Payer: Mclaren Medicaid |
$47.88
|
| Rate for Payer: Meridian Medicaid |
$50.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.19
|
| Rate for Payer: PACE Senior Care Partners |
$27.71
|
| Rate for Payer: PACE SWMI |
$29.17
|
| Rate for Payer: PHP Commercial |
$99.19
|
| Rate for Payer: PHP Medicare Advantage |
$29.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.52
|
| Rate for Payer: Priority Health Medicare |
$29.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.17
|
| Rate for Payer: Railroad Medicare Medicare |
$29.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.69
|
| Rate for Payer: UHC Core |
$97.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.17
|
| Rate for Payer: UHC Medicare Advantage |
$30.05
|
| Rate for Payer: VA VA |
$29.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.52
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
IP
|
$116.69
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.17 |
| Max. Negotiated Rate |
$105.02 |
| Rate for Payer: Aetna Commercial |
$99.19
|
| Rate for Payer: BCBS Trust/PPO |
$90.18
|
| Rate for Payer: BCN Commercial |
$90.18
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$100.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$105.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.19
|
| Rate for Payer: PHP Commercial |
$99.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.69
|
| Rate for Payer: UHC Core |
$97.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.52
|
|
|
HC ESTRONE
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna Medicare |
$16.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.40
|
| Rate for Payer: BCBS Complete |
$19.33
|
| Rate for Payer: BCBS MAPPO |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$50.76
|
| Rate for Payer: BCN Commercial |
$50.76
|
| Rate for Payer: BCN Medicare Advantage |
$16.32
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Mclaren Medicaid |
$18.41
|
| Rate for Payer: Meridian Medicaid |
$19.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PACE Senior Care Partners |
$15.50
|
| Rate for Payer: PACE SWMI |
$16.32
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: PHP Medicare Advantage |
$16.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.79
|
| Rate for Payer: Priority Health Medicare |
$16.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.81
|
| Rate for Payer: Railroad Medicare Medicare |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.32
|
| Rate for Payer: UHC Medicare Advantage |
$16.81
|
| Rate for Payer: VA VA |
$16.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC ESTRONE
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.81 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$50.45
|
| Rate for Payer: BCN Commercial |
$50.45
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.48 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$115.92
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.00
|
| Rate for Payer: UHC Core |
$125.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.88
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$116.62
|
| Rate for Payer: BCN Commercial |
$116.62
|
| Rate for Payer: BCN Medicare Advantage |
$37.50
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PACE Senior Care Partners |
$35.62
|
| Rate for Payer: PACE SWMI |
$37.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: PHP Medicare Advantage |
$37.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.50
|
| Rate for Payer: Priority Health Medicare |
$37.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.48
|
| Rate for Payer: Railroad Medicare Medicare |
$37.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.00
|
| Rate for Payer: UHC Core |
$125.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.50
|
| Rate for Payer: UHC Medicare Advantage |
$38.62
|
| Rate for Payer: VA VA |
$37.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.50
|
| Rate for Payer: BCBS Complete |
$12.66
|
| Rate for Payer: BCBS MAPPO |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$43.54
|
| Rate for Payer: BCN Commercial |
$43.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.00
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.00
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Mclaren Medicaid |
$12.06
|
| Rate for Payer: Meridian Medicaid |
$12.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PACE Senior Care Partners |
$13.30
|
| Rate for Payer: PACE SWMI |
$14.00
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: PHP Medicare Advantage |
$14.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.72
|
| Rate for Payer: Priority Health Medicare |
$14.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.15
|
| Rate for Payer: Railroad Medicare Medicare |
$14.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$46.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.00
|
| Rate for Payer: UHC Medicare Advantage |
$14.42
|
| Rate for Payer: VA VA |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.15 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: BCBS Trust/PPO |
$43.28
|
| Rate for Payer: BCN Commercial |
$43.28
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$46.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna Medicare |
$41.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.31
|
| Rate for Payer: BCBS Complete |
$11.55
|
| Rate for Payer: BCBS MAPPO |
$40.25
|
| Rate for Payer: BCBS Trust/PPO |
$125.18
|
| Rate for Payer: BCN Commercial |
$125.18
|
| Rate for Payer: BCN Medicare Advantage |
$40.25
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.25
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.75
|
| Rate for Payer: Mclaren Medicaid |
$11.00
|
| Rate for Payer: Meridian Medicaid |
$11.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.85
|
| Rate for Payer: PACE Senior Care Partners |
$38.24
|
| Rate for Payer: PACE SWMI |
$40.25
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: PHP Medicare Advantage |
$40.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.07
|
| Rate for Payer: Priority Health Medicare |
$40.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.19
|
| Rate for Payer: Railroad Medicare Medicare |
$40.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.68
|
| Rate for Payer: UHC Core |
$134.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.25
|
| Rate for Payer: UHC Medicare Advantage |
$41.46
|
| Rate for Payer: VA VA |
$40.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.75
|
|
