|
HC LEVETIRACETAM LEVEL
|
Facility
|
IP
|
$75.28
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.91 |
| Max. Negotiated Rate |
$67.75 |
| Rate for Payer: Aetna Commercial |
$63.99
|
| Rate for Payer: BCBS Trust/PPO |
$58.18
|
| Rate for Payer: BCN Commercial |
$58.18
|
| Rate for Payer: Cash Price |
$60.22
|
| Rate for Payer: Cofinity Commercial |
$64.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.22
|
| Rate for Payer: Healthscope Commercial |
$67.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.99
|
| Rate for Payer: PHP Commercial |
$63.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.25
|
| Rate for Payer: UHC Core |
$62.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.46
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
OP
|
$75.28
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$67.75 |
| Rate for Payer: Aetna Commercial |
$63.99
|
| Rate for Payer: Aetna Medicare |
$19.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.52
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: BCBS MAPPO |
$18.82
|
| Rate for Payer: BCBS Trust/PPO |
$58.53
|
| Rate for Payer: BCN Commercial |
$58.53
|
| Rate for Payer: BCN Medicare Advantage |
$18.82
|
| Rate for Payer: Cash Price |
$60.22
|
| Rate for Payer: Cash Price |
$60.22
|
| Rate for Payer: Cofinity Commercial |
$64.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.82
|
| Rate for Payer: Healthscope Commercial |
$67.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.46
|
| Rate for Payer: Mclaren Medicaid |
$9.78
|
| Rate for Payer: Meridian Medicaid |
$10.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.99
|
| Rate for Payer: PACE Senior Care Partners |
$17.88
|
| Rate for Payer: PACE SWMI |
$18.82
|
| Rate for Payer: PHP Commercial |
$63.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.49
|
| Rate for Payer: Priority Health Medicare |
$18.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.91
|
| Rate for Payer: Railroad Medicare Medicare |
$18.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.25
|
| Rate for Payer: UHC Core |
$62.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.82
|
| Rate for Payer: UHC Medicare Advantage |
$19.38
|
| Rate for Payer: VA VA |
$18.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.46
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
OP
|
$3,771.29
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$895.68 |
| Max. Negotiated Rate |
$3,394.16 |
| Rate for Payer: Aetna Commercial |
$3,205.60
|
| Rate for Payer: Aetna Medicare |
$980.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,178.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,178.53
|
| Rate for Payer: BCBS Complete |
$1,508.52
|
| Rate for Payer: BCBS MAPPO |
$942.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,932.18
|
| Rate for Payer: BCN Commercial |
$2,932.18
|
| Rate for Payer: BCN Medicare Advantage |
$942.82
|
| Rate for Payer: Cash Price |
$3,017.03
|
| Rate for Payer: Cofinity Commercial |
$3,243.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,017.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$942.82
|
| Rate for Payer: Healthscope Commercial |
$3,394.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,828.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$989.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,084.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,205.60
|
| Rate for Payer: PACE Senior Care Partners |
$895.68
|
| Rate for Payer: PACE SWMI |
$942.82
|
| Rate for Payer: PHP Commercial |
$3,205.60
|
| Rate for Payer: PHP Medicare Advantage |
$942.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,639.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,281.02
|
| Rate for Payer: Priority Health Medicare |
$942.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,300.11
|
| Rate for Payer: Railroad Medicare Medicare |
$942.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,318.74
|
| Rate for Payer: UHC Core |
$3,149.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$942.82
|
| Rate for Payer: UHC Medicare Advantage |
$971.11
|
| Rate for Payer: VA VA |
$942.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,828.47
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
IP
|
$3,771.29
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,300.11 |
| Max. Negotiated Rate |
$3,394.16 |
| Rate for Payer: Aetna Commercial |
$3,205.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,914.45
|
| Rate for Payer: BCN Commercial |
$2,914.45
|
| Rate for Payer: Cash Price |
$3,017.03
|
| Rate for Payer: Cofinity Commercial |
$3,243.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,017.03
|
| Rate for Payer: Healthscope Commercial |
$3,394.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,828.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,205.60
|
| Rate for Payer: PHP Commercial |
$3,205.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,639.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,281.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,300.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,318.74
|
| Rate for Payer: UHC Core |
$3,149.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,828.47
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.67 |
| 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 |
$14.35
|
| 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 |
$13.67
|
| Rate for Payer: Meridian Medicaid |
$14.35
|
| 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 |
$13.67
|
| 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 LH (LUTEINIZING HORMONE)
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
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 LH PEDS, S
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.78 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$139.10
|
| Rate for Payer: BCN Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
HC LH PEDS, S
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$14.35
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$139.95
|
| Rate for Payer: BCN Commercial |
$139.95
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Mclaren Medicaid |
$13.67
|
| Rate for Payer: Meridian Medicaid |
$14.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PACE Senior Care Partners |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.60
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.78
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
OP
|
$77.52
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$69.77 |
| Rate for Payer: Aetna Commercial |
$65.89
|
| Rate for Payer: Aetna Medicare |
$20.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.22
|
| Rate for Payer: BCBS Complete |
$14.35
|
| Rate for Payer: BCBS MAPPO |
$19.38
|
| Rate for Payer: BCBS Trust/PPO |
$60.27
|
| Rate for Payer: BCN Commercial |
$60.27
|
| Rate for Payer: BCN Medicare Advantage |
$19.38
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$66.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.38
|
| Rate for Payer: Healthscope Commercial |
$69.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.14
|
| Rate for Payer: Mclaren Medicaid |
$13.67
|
| Rate for Payer: Meridian Medicaid |
$14.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.89
|
| Rate for Payer: PACE Senior Care Partners |
$18.41
|
| Rate for Payer: PACE SWMI |
$19.38
|
| Rate for Payer: PHP Commercial |
$65.89
|
| Rate for Payer: PHP Medicare Advantage |
$19.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.44
|
| Rate for Payer: Priority Health Medicare |
$19.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.28
|
| Rate for Payer: Railroad Medicare Medicare |
$19.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.22
|
| Rate for Payer: UHC Core |
$64.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.38
|
| Rate for Payer: UHC Medicare Advantage |
$19.96
|
| Rate for Payer: VA VA |
$19.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.14
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.28 |
| Max. Negotiated Rate |
$69.77 |
| Rate for Payer: Aetna Commercial |
$65.89
|
| Rate for Payer: BCBS Trust/PPO |
$59.91
|
| Rate for Payer: BCN Commercial |
$59.91
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$66.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Healthscope Commercial |
$69.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.89
|
| Rate for Payer: PHP Commercial |
$65.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.22
|
| Rate for Payer: UHC Core |
$64.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.14
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$16.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.31
|
| Rate for Payer: BCBS Complete |
$11.38
|
| Rate for Payer: BCBS MAPPO |
$16.25
|
| Rate for Payer: BCBS Trust/PPO |
$50.54
|
| Rate for Payer: BCN Commercial |
$50.54
|
| Rate for Payer: BCN Medicare Advantage |
$16.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.25
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Mclaren Medicaid |
$10.84
|
| Rate for Payer: Meridian Medicaid |
$11.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Senior Care Partners |
$15.44
|
| Rate for Payer: PACE SWMI |
$16.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$16.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.55
|
| Rate for Payer: Priority Health Medicare |
$16.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.64
|
| Rate for Payer: Railroad Medicare Medicare |
$16.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.20
|
| Rate for Payer: UHC Core |
$54.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.25
|
| Rate for Payer: UHC Medicare Advantage |
$16.74
|
| Rate for Payer: VA VA |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: BCBS Trust/PPO |
$50.23
|
| Rate for Payer: BCN Commercial |
$50.23
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.20
|
| Rate for Payer: UHC Core |
$54.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
HC LIMITED SPECTRAL DOPPLER
|
Facility
|
IP
|
$368.40
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000025
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$224.69 |
| Max. Negotiated Rate |
$331.56 |
| Rate for Payer: Aetna Commercial |
$313.14
|
| Rate for Payer: BCBS Trust/PPO |
$284.70
|
| Rate for Payer: BCN Commercial |
$284.70
|
| Rate for Payer: Cash Price |
$294.72
|
| Rate for Payer: Cofinity Commercial |
$316.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.72
|
| Rate for Payer: Healthscope Commercial |
$331.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$313.14
|
| Rate for Payer: PHP Commercial |
$313.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.19
|
| Rate for Payer: UHC Core |
$307.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.30
|
|
|
HC LIMITED SPECTRAL DOPPLER
|
Facility
|
OP
|
$368.40
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000025
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$331.56 |
| Rate for Payer: Aetna Commercial |
$313.14
|
| Rate for Payer: Aetna Medicare |
$95.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.12
|
| Rate for Payer: BCBS Complete |
$147.36
|
| Rate for Payer: BCBS MAPPO |
$92.10
|
| Rate for Payer: BCBS Trust/PPO |
$286.43
|
| Rate for Payer: BCN Commercial |
$286.43
|
| Rate for Payer: BCN Medicare Advantage |
$92.10
|
| Rate for Payer: Cash Price |
$294.72
|
| Rate for Payer: Cofinity Commercial |
$316.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.10
|
| Rate for Payer: Healthscope Commercial |
$331.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$313.14
|
| Rate for Payer: PACE Senior Care Partners |
$87.50
|
| Rate for Payer: PACE SWMI |
$92.10
|
| Rate for Payer: PHP Commercial |
$313.14
|
| Rate for Payer: PHP Medicare Advantage |
$92.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.51
|
| Rate for Payer: Priority Health Medicare |
$92.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.69
|
| Rate for Payer: Railroad Medicare Medicare |
$92.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.19
|
| Rate for Payer: UHC Core |
$307.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.10
|
| Rate for Payer: UHC Medicare Advantage |
$94.86
|
| Rate for Payer: VA VA |
$92.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.30
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
OP
|
$123.75
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.39 |
| Max. Negotiated Rate |
$111.38 |
| Rate for Payer: Aetna Commercial |
$105.19
|
| Rate for Payer: Aetna Medicare |
$32.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.67
|
| Rate for Payer: BCBS Complete |
$49.50
|
| Rate for Payer: BCBS MAPPO |
$30.94
|
| Rate for Payer: BCBS Trust/PPO |
$96.22
|
| Rate for Payer: BCN Commercial |
$96.22
|
| Rate for Payer: BCN Medicare Advantage |
$30.94
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cofinity Commercial |
$106.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.94
|
| Rate for Payer: Healthscope Commercial |
$111.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.19
|
| Rate for Payer: PACE Senior Care Partners |
$29.39
|
| Rate for Payer: PACE SWMI |
$30.94
|
| Rate for Payer: PHP Commercial |
$105.19
|
| Rate for Payer: PHP Medicare Advantage |
$30.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.66
|
| Rate for Payer: Priority Health Medicare |
$30.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.48
|
| Rate for Payer: Railroad Medicare Medicare |
$30.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.90
|
| Rate for Payer: UHC Core |
$103.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.94
|
| Rate for Payer: UHC Medicare Advantage |
$31.87
|
| Rate for Payer: VA VA |
$30.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.81
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
IP
|
$123.75
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.48 |
| Max. Negotiated Rate |
$111.38 |
| Rate for Payer: Aetna Commercial |
$105.19
|
| Rate for Payer: BCBS Trust/PPO |
$95.63
|
| Rate for Payer: BCN Commercial |
$95.63
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cofinity Commercial |
$106.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.00
|
| Rate for Payer: Healthscope Commercial |
$111.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.19
|
| Rate for Payer: PHP Commercial |
$105.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.90
|
| Rate for Payer: UHC Core |
$103.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.81
|
|
|
HC LINE ISOLATOR (PRESSURE TRANSDUC)
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
27000673
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.89 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: BCBS Trust/PPO |
$69.55
|
| Rate for Payer: BCN Commercial |
$69.55
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.20
|
| Rate for Payer: UHC Core |
$75.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC LINE ISOLATOR (PRESSURE TRANSDUC)
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
27000673
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.38 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare |
$23.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.12
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$22.50
|
| Rate for Payer: BCBS Trust/PPO |
$69.98
|
| Rate for Payer: BCN Commercial |
$69.98
|
| Rate for Payer: BCN Medicare Advantage |
$22.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.50
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PACE Senior Care Partners |
$21.38
|
| Rate for Payer: PACE SWMI |
$22.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: PHP Medicare Advantage |
$22.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.30
|
| Rate for Payer: Priority Health Medicare |
$22.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.89
|
| Rate for Payer: Railroad Medicare Medicare |
$22.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.20
|
| Rate for Payer: UHC Core |
$75.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.50
|
| Rate for Payer: UHC Medicare Advantage |
$23.18
|
| Rate for Payer: VA VA |
$22.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC LINE VACUUM
|
Facility
|
IP
|
$13.50
|
|
| Hospital Charge Code |
27000665
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: BCBS Trust/PPO |
$10.43
|
| Rate for Payer: BCN Commercial |
$10.43
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.48
|
| Rate for Payer: PHP Commercial |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.88
|
| Rate for Payer: UHC Core |
$11.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
HC LINE VACUUM
|
Facility
|
OP
|
$13.50
|
|
| Hospital Charge Code |
27000665
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$12.15 |
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: Aetna Medicare |
$3.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.22
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: BCBS MAPPO |
$3.38
|
| Rate for Payer: BCBS Trust/PPO |
$10.50
|
| Rate for Payer: BCN Commercial |
$10.50
|
| Rate for Payer: BCN Medicare Advantage |
$3.38
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$12.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.48
|
| Rate for Payer: PACE Senior Care Partners |
$3.21
|
| Rate for Payer: PACE SWMI |
$3.38
|
| Rate for Payer: PHP Commercial |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$3.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.74
|
| Rate for Payer: Priority Health Medicare |
$3.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.88
|
| Rate for Payer: UHC Core |
$11.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.38
|
| Rate for Payer: UHC Medicare Advantage |
$3.48
|
| Rate for Payer: VA VA |
$3.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.12
|
|
|
HC LIPASE
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100279
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.56
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$23.79
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: BCN Medicare Advantage |
$7.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$5.08
|
| Rate for Payer: Meridian Medicaid |
$5.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Senior Care Partners |
$7.27
|
| Rate for Payer: PACE SWMI |
$7.65
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.62
|
| Rate for Payer: Priority Health Medicare |
$7.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.66
|
| Rate for Payer: Railroad Medicare Medicare |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.65
|
| Rate for Payer: UHC Medicare Advantage |
$7.88
|
| Rate for Payer: VA VA |
$7.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC LIPASE
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100279
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$23.65
|
| Rate for Payer: BCN Commercial |
$23.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC LIPASE BF
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$14.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.56
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$14.04
|
| Rate for Payer: BCBS Trust/PPO |
$43.68
|
| Rate for Payer: BCN Commercial |
$43.68
|
| Rate for Payer: BCN Medicare Advantage |
$14.04
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.04
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$5.08
|
| Rate for Payer: Meridian Medicaid |
$5.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.75
|
| Rate for Payer: PACE Senior Care Partners |
$13.34
|
| Rate for Payer: PACE SWMI |
$14.04
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: PHP Medicare Advantage |
$14.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.88
|
| Rate for Payer: Priority Health Medicare |
$14.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.26
|
| Rate for Payer: Railroad Medicare Medicare |
$14.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.44
|
| Rate for Payer: UHC Core |
$46.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.04
|
| Rate for Payer: UHC Medicare Advantage |
$14.47
|
| Rate for Payer: VA VA |
$14.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.14
|
|
|
HC LIPASE BF
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.26 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: BCBS Trust/PPO |
$43.42
|
| Rate for Payer: BCN Commercial |
$43.42
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.75
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.44
|
| Rate for Payer: UHC Core |
$46.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.14
|
|
|
HC LIPID PANEL
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$10.38
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$9.88
|
| Rate for Payer: Meridian Medicaid |
$10.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
