|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.28
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCN Commercial |
$3.17
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.47
|
| Rate for Payer: PACE Senior Care Partners |
$0.97
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PHP Commercial |
$3.47
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.55
|
| Rate for Payer: Priority Health Medicare |
$1.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.59
|
| Rate for Payer: UHC Core |
$3.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.02
|
| Rate for Payer: UHC Medicare Advantage |
$1.05
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.06
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
OP
|
$235.05
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$55.82 |
| Max. Negotiated Rate |
$211.54 |
| Rate for Payer: Aetna Commercial |
$199.79
|
| Rate for Payer: Aetna Medicare |
$61.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.45
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$58.76
|
| Rate for Payer: BCBS Trust/PPO |
$182.75
|
| Rate for Payer: BCN Commercial |
$182.75
|
| Rate for Payer: BCN Medicare Advantage |
$58.76
|
| Rate for Payer: Cash Price |
$188.04
|
| Rate for Payer: Cash Price |
$188.04
|
| Rate for Payer: Cofinity Commercial |
$202.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.76
|
| Rate for Payer: Healthscope Commercial |
$211.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.29
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.79
|
| Rate for Payer: PACE Senior Care Partners |
$55.82
|
| Rate for Payer: PACE SWMI |
$58.76
|
| Rate for Payer: PHP Commercial |
$199.79
|
| Rate for Payer: PHP Medicare Advantage |
$58.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.49
|
| Rate for Payer: Priority Health Medicare |
$58.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.36
|
| Rate for Payer: Railroad Medicare Medicare |
$58.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.84
|
| Rate for Payer: UHC Core |
$196.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.76
|
| Rate for Payer: UHC Medicare Advantage |
$60.53
|
| Rate for Payer: VA VA |
$58.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.29
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
IP
|
$235.05
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$143.36 |
| Max. Negotiated Rate |
$211.54 |
| Rate for Payer: Aetna Commercial |
$199.79
|
| Rate for Payer: BCBS Trust/PPO |
$181.65
|
| Rate for Payer: BCN Commercial |
$181.65
|
| Rate for Payer: Cash Price |
$188.04
|
| Rate for Payer: Cofinity Commercial |
$202.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.04
|
| Rate for Payer: Healthscope Commercial |
$211.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.79
|
| Rate for Payer: PHP Commercial |
$199.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.84
|
| Rate for Payer: UHC Core |
$196.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.29
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
IP
|
$347.08
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.68 |
| Max. Negotiated Rate |
$312.37 |
| Rate for Payer: Aetna Commercial |
$295.02
|
| Rate for Payer: BCBS Trust/PPO |
$268.22
|
| Rate for Payer: BCN Commercial |
$268.22
|
| Rate for Payer: Cash Price |
$277.66
|
| Rate for Payer: Cofinity Commercial |
$298.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.66
|
| Rate for Payer: Healthscope Commercial |
$312.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$295.02
|
| Rate for Payer: PHP Commercial |
$295.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.43
|
| Rate for Payer: UHC Core |
$289.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.31
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
OP
|
$347.08
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$312.37 |
| Rate for Payer: Aetna Commercial |
$295.02
|
| Rate for Payer: Aetna Medicare |
$90.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.46
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$86.77
|
| Rate for Payer: BCBS Trust/PPO |
$269.85
|
| Rate for Payer: BCN Commercial |
$269.85
|
| Rate for Payer: BCN Medicare Advantage |
$86.77
|
| Rate for Payer: Cash Price |
$277.66
|
| Rate for Payer: Cash Price |
$277.66
|
| Rate for Payer: Cofinity Commercial |
$298.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.77
|
| Rate for Payer: Healthscope Commercial |
$312.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.31
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$295.02
|
| Rate for Payer: PACE Senior Care Partners |
$82.43
|
| Rate for Payer: PACE SWMI |
$86.77
|
| Rate for Payer: PHP Commercial |
$295.02
|
| Rate for Payer: PHP Medicare Advantage |
$86.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.96
|
| Rate for Payer: Priority Health Medicare |
$86.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.68
|
| Rate for Payer: Railroad Medicare Medicare |
$86.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.43
|
| Rate for Payer: UHC Core |
$289.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.77
|
| Rate for Payer: UHC Medicare Advantage |
$89.37
|
| Rate for Payer: VA VA |
$86.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.31
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
IP
|
$382.76
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.45 |
| Max. Negotiated Rate |
$344.48 |
| Rate for Payer: Aetna Commercial |
$325.35
|
| Rate for Payer: BCBS Trust/PPO |
$295.80
|
| Rate for Payer: BCN Commercial |
$295.80
|
| Rate for Payer: Cash Price |
$306.21
|
| Rate for Payer: Cofinity Commercial |
$329.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.21
|
| Rate for Payer: Healthscope Commercial |
$344.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.35
|
| Rate for Payer: PHP Commercial |
$325.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.83
|
| Rate for Payer: UHC Core |
$319.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.07
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
OP
|
$382.76
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.91 |
| Max. Negotiated Rate |
$344.48 |
| Rate for Payer: Aetna Commercial |
$325.35
|
| Rate for Payer: Aetna Medicare |
$99.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.61
|
| Rate for Payer: BCBS Complete |
$153.10
|
| Rate for Payer: BCBS MAPPO |
$95.69
|
| Rate for Payer: BCBS Trust/PPO |
$297.60
|
| Rate for Payer: BCN Commercial |
$297.60
|
| Rate for Payer: BCN Medicare Advantage |
$95.69
|
| Rate for Payer: Cash Price |
$306.21
|
| Rate for Payer: Cofinity Commercial |
$329.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.69
|
| Rate for Payer: Healthscope Commercial |
$344.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.35
|
| Rate for Payer: PACE Senior Care Partners |
$90.91
|
| Rate for Payer: PACE SWMI |
$95.69
|
| Rate for Payer: PHP Commercial |
$325.35
|
| Rate for Payer: PHP Medicare Advantage |
$95.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.00
|
| Rate for Payer: Priority Health Medicare |
$95.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.45
|
| Rate for Payer: Railroad Medicare Medicare |
$95.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.83
|
| Rate for Payer: UHC Core |
$319.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.69
|
| Rate for Payer: UHC Medicare Advantage |
$98.56
|
| Rate for Payer: VA VA |
$95.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.07
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
IP
|
$1,416.93
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$864.19 |
| Max. Negotiated Rate |
$1,275.24 |
| Rate for Payer: Aetna Commercial |
$1,204.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,095.00
|
| Rate for Payer: BCN Commercial |
$1,095.00
|
| Rate for Payer: Cash Price |
$1,133.54
|
| Rate for Payer: Cofinity Commercial |
$1,218.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,133.54
|
| Rate for Payer: Healthscope Commercial |
$1,275.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,062.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.39
|
| Rate for Payer: PHP Commercial |
$1,204.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,232.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$864.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,246.90
|
| Rate for Payer: UHC Core |
$1,183.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,062.70
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
OP
|
$1,416.93
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$336.52 |
| Max. Negotiated Rate |
$1,275.24 |
| Rate for Payer: Aetna Commercial |
$1,204.39
|
| Rate for Payer: Aetna Medicare |
$368.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.79
|
| Rate for Payer: BCBS Complete |
$372.29
|
| Rate for Payer: BCBS MAPPO |
$354.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.66
|
| Rate for Payer: BCN Commercial |
$1,101.66
|
| Rate for Payer: BCN Medicare Advantage |
$354.23
|
| Rate for Payer: Cash Price |
$1,133.54
|
| Rate for Payer: Cash Price |
$1,133.54
|
| Rate for Payer: Cofinity Commercial |
$1,218.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,133.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.23
|
| Rate for Payer: Healthscope Commercial |
$1,275.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,062.70
|
| Rate for Payer: Mclaren Medicaid |
$354.56
|
| Rate for Payer: Meridian Medicaid |
$372.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$371.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,204.39
|
| Rate for Payer: PACE Senior Care Partners |
$336.52
|
| Rate for Payer: PACE SWMI |
$354.23
|
| Rate for Payer: PHP Commercial |
$1,204.39
|
| Rate for Payer: PHP Medicare Advantage |
$354.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,232.73
|
| Rate for Payer: Priority Health Medicare |
$354.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$864.19
|
| Rate for Payer: Railroad Medicare Medicare |
$354.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,246.90
|
| Rate for Payer: UHC Core |
$1,183.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.23
|
| Rate for Payer: UHC Medicare Advantage |
$364.86
|
| Rate for Payer: VA VA |
$354.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,062.70
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
IP
|
$1,475.98
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$900.20 |
| Max. Negotiated Rate |
$1,328.38 |
| Rate for Payer: Aetna Commercial |
$1,254.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.64
|
| Rate for Payer: BCN Commercial |
$1,140.64
|
| Rate for Payer: Cash Price |
$1,180.78
|
| Rate for Payer: Cofinity Commercial |
$1,269.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.78
|
| Rate for Payer: Healthscope Commercial |
$1,328.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,106.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,254.58
|
| Rate for Payer: PHP Commercial |
$1,254.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,284.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$900.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,298.86
|
| Rate for Payer: UHC Core |
$1,232.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,106.98
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
OP
|
$1,475.98
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.56 |
| Max. Negotiated Rate |
$1,328.38 |
| Rate for Payer: Aetna Commercial |
$1,254.58
|
| Rate for Payer: Aetna Medicare |
$383.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$461.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$461.24
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$369.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,147.57
|
| Rate for Payer: BCN Commercial |
$1,147.57
|
| Rate for Payer: BCN Medicare Advantage |
$369.00
|
| Rate for Payer: Cash Price |
$1,180.78
|
| Rate for Payer: Cash Price |
$1,180.78
|
| Rate for Payer: Cofinity Commercial |
$1,269.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,180.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$369.00
|
| Rate for Payer: Healthscope Commercial |
$1,328.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,106.98
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$387.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$424.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,254.58
|
| Rate for Payer: PACE Senior Care Partners |
$350.55
|
| Rate for Payer: PACE SWMI |
$369.00
|
| Rate for Payer: PHP Commercial |
$1,254.58
|
| Rate for Payer: PHP Medicare Advantage |
$369.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,284.10
|
| Rate for Payer: Priority Health Medicare |
$369.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$900.20
|
| Rate for Payer: Railroad Medicare Medicare |
$369.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,298.86
|
| Rate for Payer: UHC Core |
$1,232.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$369.00
|
| Rate for Payer: UHC Medicare Advantage |
$380.06
|
| Rate for Payer: VA VA |
$369.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,106.98
|
|
|
HC GASTRIN LEVEL
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.51 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna Commercial |
$35.55
|
| Rate for Payer: BCBS Trust/PPO |
$32.32
|
| Rate for Payer: BCN Commercial |
$32.32
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$37.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: PHP Commercial |
$35.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.80
|
| Rate for Payer: UHC Core |
$34.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.36
|
|
|
HC GASTRIN LEVEL
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna Commercial |
$35.55
|
| Rate for Payer: Aetna Medicare |
$10.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.07
|
| Rate for Payer: BCBS Complete |
$13.66
|
| Rate for Payer: BCBS MAPPO |
$10.46
|
| Rate for Payer: BCBS Trust/PPO |
$32.52
|
| Rate for Payer: BCN Commercial |
$32.52
|
| Rate for Payer: BCN Medicare Advantage |
$10.46
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.46
|
| Rate for Payer: Healthscope Commercial |
$37.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.36
|
| Rate for Payer: Mclaren Medicaid |
$13.01
|
| Rate for Payer: Meridian Medicaid |
$13.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: PACE Senior Care Partners |
$9.93
|
| Rate for Payer: PACE SWMI |
$10.46
|
| Rate for Payer: PHP Commercial |
$35.55
|
| Rate for Payer: PHP Medicare Advantage |
$10.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.38
|
| Rate for Payer: Priority Health Medicare |
$10.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.51
|
| Rate for Payer: Railroad Medicare Medicare |
$10.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.80
|
| Rate for Payer: UHC Core |
$34.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.46
|
| Rate for Payer: UHC Medicare Advantage |
$10.77
|
| Rate for Payer: VA VA |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.36
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
OP
|
$3.41
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare |
$0.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.07
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.65
|
| Rate for Payer: BCN Commercial |
$2.65
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.90
|
| Rate for Payer: PACE Senior Care Partners |
$0.81
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.97
|
| Rate for Payer: Priority Health Medicare |
$0.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.08
|
| Rate for Payer: Railroad Medicare Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.85
|
| Rate for Payer: UHC Medicare Advantage |
$0.88
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
IP
|
$3.41
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$3.07 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.64
|
| Rate for Payer: BCN Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.90
|
| Rate for Payer: PHP Commercial |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.56
|
|
|
HC GASTROSCOPY
|
Facility
|
OP
|
$1,923.68
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.87 |
| Max. Negotiated Rate |
$1,731.31 |
| Rate for Payer: Aetna Commercial |
$1,635.13
|
| Rate for Payer: Aetna Medicare |
$500.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$601.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$601.15
|
| Rate for Payer: BCBS Complete |
$769.47
|
| Rate for Payer: BCBS MAPPO |
$480.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,495.66
|
| Rate for Payer: BCN Commercial |
$1,495.66
|
| Rate for Payer: BCN Medicare Advantage |
$480.92
|
| Rate for Payer: Cash Price |
$1,538.94
|
| Rate for Payer: Cofinity Commercial |
$1,654.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.92
|
| Rate for Payer: Healthscope Commercial |
$1,731.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,635.13
|
| Rate for Payer: PACE Senior Care Partners |
$456.87
|
| Rate for Payer: PACE SWMI |
$480.92
|
| Rate for Payer: PHP Commercial |
$1,635.13
|
| Rate for Payer: PHP Medicare Advantage |
$480.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,673.60
|
| Rate for Payer: Priority Health Medicare |
$480.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,173.25
|
| Rate for Payer: Railroad Medicare Medicare |
$480.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,692.84
|
| Rate for Payer: UHC Core |
$1,606.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.92
|
| Rate for Payer: UHC Medicare Advantage |
$495.35
|
| Rate for Payer: VA VA |
$480.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.76
|
|
|
HC GASTROSCOPY
|
Facility
|
IP
|
$1,923.68
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,173.25 |
| Max. Negotiated Rate |
$1,731.31 |
| Rate for Payer: Aetna Commercial |
$1,635.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,486.62
|
| Rate for Payer: BCN Commercial |
$1,486.62
|
| Rate for Payer: Cash Price |
$1,538.94
|
| Rate for Payer: Cofinity Commercial |
$1,654.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.94
|
| Rate for Payer: Healthscope Commercial |
$1,731.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,635.13
|
| Rate for Payer: PHP Commercial |
$1,635.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,346.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,673.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,173.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,692.84
|
| Rate for Payer: UHC Core |
$1,606.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.76
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
OP
|
$146.98
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$132.28 |
| Rate for Payer: Aetna Commercial |
$124.93
|
| Rate for Payer: Aetna Medicare |
$38.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.93
|
| Rate for Payer: BCBS Complete |
$58.79
|
| Rate for Payer: BCBS MAPPO |
$36.74
|
| Rate for Payer: BCBS Trust/PPO |
$114.28
|
| Rate for Payer: BCN Commercial |
$114.28
|
| Rate for Payer: BCN Medicare Advantage |
$36.74
|
| Rate for Payer: Cash Price |
$117.58
|
| Rate for Payer: Cofinity Commercial |
$126.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.74
|
| Rate for Payer: Healthscope Commercial |
$132.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.93
|
| Rate for Payer: PACE Senior Care Partners |
$34.91
|
| Rate for Payer: PACE SWMI |
$36.74
|
| Rate for Payer: PHP Commercial |
$124.93
|
| Rate for Payer: PHP Medicare Advantage |
$36.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.87
|
| Rate for Payer: Priority Health Medicare |
$36.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.64
|
| Rate for Payer: Railroad Medicare Medicare |
$36.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.34
|
| Rate for Payer: UHC Core |
$122.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.74
|
| Rate for Payer: UHC Medicare Advantage |
$37.85
|
| Rate for Payer: VA VA |
$36.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.24
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
IP
|
$146.98
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$89.64 |
| Max. Negotiated Rate |
$132.28 |
| Rate for Payer: Aetna Commercial |
$124.93
|
| Rate for Payer: BCBS Trust/PPO |
$113.59
|
| Rate for Payer: BCN Commercial |
$113.59
|
| Rate for Payer: Cash Price |
$117.58
|
| Rate for Payer: Cofinity Commercial |
$126.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.58
|
| Rate for Payer: Healthscope Commercial |
$132.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.93
|
| Rate for Payer: PHP Commercial |
$124.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.34
|
| Rate for Payer: UHC Core |
$122.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.24
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
IP
|
$578.16
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$352.62 |
| Max. Negotiated Rate |
$520.34 |
| Rate for Payer: Aetna Commercial |
$491.44
|
| Rate for Payer: BCBS Trust/PPO |
$446.80
|
| Rate for Payer: BCN Commercial |
$446.80
|
| Rate for Payer: Cash Price |
$462.53
|
| Rate for Payer: Cofinity Commercial |
$497.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.53
|
| Rate for Payer: Healthscope Commercial |
$520.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$491.44
|
| Rate for Payer: PHP Commercial |
$491.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$503.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$352.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.78
|
| Rate for Payer: UHC Core |
$482.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.62
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
OP
|
$578.16
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$137.31 |
| Max. Negotiated Rate |
$520.34 |
| Rate for Payer: Aetna Commercial |
$491.44
|
| Rate for Payer: Aetna Medicare |
$150.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$180.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$180.68
|
| Rate for Payer: BCBS Complete |
$231.26
|
| Rate for Payer: BCBS MAPPO |
$144.54
|
| Rate for Payer: BCBS Trust/PPO |
$449.52
|
| Rate for Payer: BCN Commercial |
$449.52
|
| Rate for Payer: BCN Medicare Advantage |
$144.54
|
| Rate for Payer: Cash Price |
$462.53
|
| Rate for Payer: Cofinity Commercial |
$497.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$462.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.54
|
| Rate for Payer: Healthscope Commercial |
$520.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$433.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$151.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$491.44
|
| Rate for Payer: PACE Senior Care Partners |
$137.31
|
| Rate for Payer: PACE SWMI |
$144.54
|
| Rate for Payer: PHP Commercial |
$491.44
|
| Rate for Payer: PHP Medicare Advantage |
$144.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$404.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$503.00
|
| Rate for Payer: Priority Health Medicare |
$144.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$352.62
|
| Rate for Payer: Railroad Medicare Medicare |
$144.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.78
|
| Rate for Payer: UHC Core |
$482.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.54
|
| Rate for Payer: UHC Medicare Advantage |
$148.88
|
| Rate for Payer: VA VA |
$144.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$433.62
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
IP
|
$226.20
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$137.96 |
| Max. Negotiated Rate |
$203.58 |
| Rate for Payer: Aetna Commercial |
$192.27
|
| Rate for Payer: BCBS Trust/PPO |
$174.81
|
| Rate for Payer: BCN Commercial |
$174.81
|
| Rate for Payer: Cash Price |
$180.96
|
| Rate for Payer: Cofinity Commercial |
$194.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.96
|
| Rate for Payer: Healthscope Commercial |
$203.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.27
|
| Rate for Payer: PHP Commercial |
$192.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.06
|
| Rate for Payer: UHC Core |
$188.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.65
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
OP
|
$226.20
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.72 |
| Max. Negotiated Rate |
$203.58 |
| Rate for Payer: Aetna Commercial |
$192.27
|
| Rate for Payer: Aetna Medicare |
$58.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.69
|
| Rate for Payer: BCBS Complete |
$90.48
|
| Rate for Payer: BCBS MAPPO |
$56.55
|
| Rate for Payer: BCBS Trust/PPO |
$175.87
|
| Rate for Payer: BCN Commercial |
$175.87
|
| Rate for Payer: BCN Medicare Advantage |
$56.55
|
| Rate for Payer: Cash Price |
$180.96
|
| Rate for Payer: Cofinity Commercial |
$194.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.55
|
| Rate for Payer: Healthscope Commercial |
$203.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.27
|
| Rate for Payer: PACE Senior Care Partners |
$53.72
|
| Rate for Payer: PACE SWMI |
$56.55
|
| Rate for Payer: PHP Commercial |
$192.27
|
| Rate for Payer: PHP Medicare Advantage |
$56.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.79
|
| Rate for Payer: Priority Health Medicare |
$56.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.96
|
| Rate for Payer: Railroad Medicare Medicare |
$56.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.06
|
| Rate for Payer: UHC Core |
$188.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.55
|
| Rate for Payer: UHC Medicare Advantage |
$58.25
|
| Rate for Payer: VA VA |
$56.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.65
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
OP
|
$120.60
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$108.54 |
| Rate for Payer: Aetna Commercial |
$102.51
|
| Rate for Payer: Aetna Medicare |
$31.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.69
|
| Rate for Payer: BCBS Complete |
$12.69
|
| Rate for Payer: BCBS MAPPO |
$30.15
|
| Rate for Payer: BCBS Trust/PPO |
$93.77
|
| Rate for Payer: BCN Commercial |
$93.77
|
| Rate for Payer: BCN Medicare Advantage |
$30.15
|
| Rate for Payer: Cash Price |
$96.48
|
| Rate for Payer: Cash Price |
$96.48
|
| Rate for Payer: Cofinity Commercial |
$103.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.15
|
| Rate for Payer: Healthscope Commercial |
$108.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.45
|
| Rate for Payer: Mclaren Medicaid |
$12.09
|
| Rate for Payer: Meridian Medicaid |
$12.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.51
|
| Rate for Payer: PACE Senior Care Partners |
$28.64
|
| Rate for Payer: PACE SWMI |
$30.15
|
| Rate for Payer: PHP Commercial |
$102.51
|
| Rate for Payer: PHP Medicare Advantage |
$30.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.92
|
| Rate for Payer: Priority Health Medicare |
$30.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.55
|
| Rate for Payer: Railroad Medicare Medicare |
$30.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.13
|
| Rate for Payer: UHC Core |
$100.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.15
|
| Rate for Payer: UHC Medicare Advantage |
$31.05
|
| Rate for Payer: VA VA |
$30.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.45
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
IP
|
$120.60
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.55 |
| Max. Negotiated Rate |
$108.54 |
| Rate for Payer: Aetna Commercial |
$102.51
|
| Rate for Payer: BCBS Trust/PPO |
$93.20
|
| Rate for Payer: BCN Commercial |
$93.20
|
| Rate for Payer: Cash Price |
$96.48
|
| Rate for Payer: Cofinity Commercial |
$103.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.48
|
| Rate for Payer: Healthscope Commercial |
$108.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.51
|
| Rate for Payer: PHP Commercial |
$102.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.13
|
| Rate for Payer: UHC Core |
$100.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.45
|
|
