|
HC FUSARIUM PROLIFERATUM IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC FUSARIUM PROLIFERATUM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
OP
|
$520.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$91.71 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$442.17
|
| Rate for Payer: Aetna Medicare |
$135.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.56
|
| Rate for Payer: BCBS Complete |
$96.29
|
| Rate for Payer: BCBS MAPPO |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$427.66
|
| Rate for Payer: BCN Commercial |
$427.66
|
| Rate for Payer: BCN Medicare Advantage |
$130.05
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$447.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.05
|
| Rate for Payer: Healthscope Commercial |
$468.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.15
|
| Rate for Payer: Mclaren Medicaid |
$91.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.55
|
| Rate for Payer: Meridian Medicaid |
$96.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.15
|
| Rate for Payer: PACE Senior Care Partners |
$123.55
|
| Rate for Payer: PACE SWMI |
$130.05
|
| Rate for Payer: PHP Commercial |
$442.17
|
| Rate for Payer: PHP Medicare Advantage |
$130.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$452.57
|
| Rate for Payer: Priority Health Medicare |
$131.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.06
|
| Rate for Payer: Railroad Medicare Medicare |
$130.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.78
|
| Rate for Payer: UHC Core |
$434.37
|
| Rate for Payer: UHC Exchange |
$130.05
|
| Rate for Payer: UHC Medicaid |
$91.71
|
| Rate for Payer: UHC Medicare Advantage |
$130.05
|
| Rate for Payer: UHCCP Medicaid |
$91.71
|
| Rate for Payer: VA VA |
$130.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.15
|
|
|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
IP
|
$520.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$362.06 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$442.17
|
| Rate for Payer: BCBS Trust/PPO |
$429.63
|
| Rate for Payer: BCN Commercial |
$429.63
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$447.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Healthscope Commercial |
$468.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.15
|
| Rate for Payer: PHP Commercial |
$442.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$452.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.78
|
| Rate for Payer: UHC Core |
$434.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.15
|
|
|
HC GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Medicare |
$31.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.39
|
| Rate for Payer: BCBS Complete |
$22.15
|
| Rate for Payer: BCBS MAPPO |
$29.91
|
| Rate for Payer: BCBS Trust/PPO |
$98.36
|
| Rate for Payer: BCN Commercial |
$98.36
|
| Rate for Payer: BCN Medicare Advantage |
$29.91
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.91
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.74
|
| Rate for Payer: Mclaren Medicaid |
$21.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.41
|
| Rate for Payer: Meridian Medicaid |
$22.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PACE Senior Care Partners |
$28.42
|
| Rate for Payer: PACE SWMI |
$29.91
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: PHP Medicare Advantage |
$29.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$104.10
|
| Rate for Payer: Priority Health Medicare |
$30.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.28
|
| Rate for Payer: Railroad Medicare Medicare |
$29.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.29
|
| Rate for Payer: UHC Core |
$99.91
|
| Rate for Payer: UHC Exchange |
$29.91
|
| Rate for Payer: UHC Medicaid |
$21.09
|
| Rate for Payer: UHC Medicare Advantage |
$29.91
|
| Rate for Payer: UHCCP Medicaid |
$21.09
|
| Rate for Payer: VA VA |
$29.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.74
|
|
|
HC GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: BCBS Trust/PPO |
$98.82
|
| Rate for Payer: BCN Commercial |
$98.82
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$104.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.29
|
| Rate for Payer: UHC Core |
$99.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.74
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
IP
|
$49.88
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: BCBS Trust/PPO |
$41.20
|
| Rate for Payer: BCN Commercial |
$41.20
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Nomi Health Commercial |
$40.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.89
|
| Rate for Payer: UHC Core |
$41.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.41
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
OP
|
$49.88
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.59
|
| Rate for Payer: BCBS Complete |
$9.23
|
| Rate for Payer: BCBS MAPPO |
$12.47
|
| Rate for Payer: BCBS Trust/PPO |
$41.01
|
| Rate for Payer: BCN Commercial |
$41.01
|
| Rate for Payer: BCN Medicare Advantage |
$12.47
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.47
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.41
|
| Rate for Payer: Mclaren Medicaid |
$8.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.09
|
| Rate for Payer: Meridian Medicaid |
$9.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Nomi Health Commercial |
$40.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PACE Senior Care Partners |
$11.85
|
| Rate for Payer: PACE SWMI |
$12.47
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: PHP Medicare Advantage |
$12.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.40
|
| Rate for Payer: Priority Health Medicare |
$12.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.72
|
| Rate for Payer: Railroad Medicare Medicare |
$12.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.89
|
| Rate for Payer: UHC Core |
$41.65
|
| Rate for Payer: UHC Exchange |
$12.47
|
| Rate for Payer: UHC Medicaid |
$8.79
|
| Rate for Payer: UHC Medicare Advantage |
$12.47
|
| Rate for Payer: UHCCP Medicaid |
$8.79
|
| Rate for Payer: VA VA |
$12.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.41
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$1.82
|
| Rate for Payer: BCN Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Nomi Health Commercial |
$1.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.65
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.65
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Medicare |
$0.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.69
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS MAPPO |
$0.55
|
| Rate for Payer: BCBS Trust/PPO |
$1.81
|
| Rate for Payer: BCN Commercial |
$1.81
|
| Rate for Payer: BCN Medicare Advantage |
$0.55
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.55
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.65
|
| Rate for Payer: Mclaren Medicaid |
$0.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.58
|
| Rate for Payer: Meridian Medicaid |
$0.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Nomi Health Commercial |
$1.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.65
|
| Rate for Payer: PACE Senior Care Partners |
$0.52
|
| Rate for Payer: PACE SWMI |
$0.55
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: PHP Medicare Advantage |
$0.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.91
|
| Rate for Payer: Priority Health Medicare |
$0.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.53
|
| Rate for Payer: Railroad Medicare Medicare |
$0.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.84
|
| Rate for Payer: UHC Exchange |
$0.55
|
| Rate for Payer: UHC Medicaid |
$0.39
|
| Rate for Payer: UHC Medicare Advantage |
$0.55
|
| Rate for Payer: UHCCP Medicaid |
$0.39
|
| Rate for Payer: VA VA |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.65
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.35 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.00
|
| Rate for Payer: BCN Commercial |
$55.00
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.60
|
| Rate for Payer: UHC Core |
$55.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.94
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare |
$17.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.81
|
| Rate for Payer: BCBS Complete |
$12.33
|
| Rate for Payer: BCBS MAPPO |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCN Commercial |
$54.74
|
| Rate for Payer: BCN Medicare Advantage |
$16.65
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.94
|
| Rate for Payer: Mclaren Medicaid |
$11.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.48
|
| Rate for Payer: Meridian Medicaid |
$12.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: PACE Senior Care Partners |
$15.82
|
| Rate for Payer: PACE SWMI |
$16.65
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: PHP Medicare Advantage |
$16.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.93
|
| Rate for Payer: Priority Health Medicare |
$16.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$16.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.60
|
| Rate for Payer: UHC Core |
$55.60
|
| Rate for Payer: UHC Exchange |
$16.65
|
| Rate for Payer: UHC Medicaid |
$11.74
|
| Rate for Payer: UHC Medicare Advantage |
$16.65
|
| Rate for Payer: UHCCP Medicaid |
$11.74
|
| Rate for Payer: VA VA |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.94
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
OP
|
$95.51
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna Medicare |
$24.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$17.68
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$78.52
|
| Rate for Payer: BCN Commercial |
$78.52
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Commercial |
$82.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$16.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$17.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Nomi Health Commercial |
$78.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PACE Senior Care Partners |
$22.68
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$81.18
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.09
|
| Rate for Payer: Priority Health Medicare |
$24.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.47
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.05
|
| Rate for Payer: UHC Core |
$79.75
|
| Rate for Payer: UHC Exchange |
$23.88
|
| Rate for Payer: UHC Medicaid |
$16.84
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$16.84
|
| Rate for Payer: VA VA |
$23.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.63
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
IP
|
$95.51
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.47 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: BCBS Trust/PPO |
$78.88
|
| Rate for Payer: BCN Commercial |
$78.88
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Commercial |
$82.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Nomi Health Commercial |
$78.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PHP Commercial |
$81.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.05
|
| Rate for Payer: UHC Core |
$79.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.63
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
OP
|
$144.76
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$130.28 |
| Rate for Payer: Aetna Commercial |
$123.05
|
| Rate for Payer: Aetna Medicare |
$37.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.24
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS MAPPO |
$36.19
|
| Rate for Payer: BCBS Trust/PPO |
$119.01
|
| Rate for Payer: BCN Commercial |
$119.01
|
| Rate for Payer: BCN Medicare Advantage |
$36.19
|
| Rate for Payer: Cash Price |
$115.81
|
| Rate for Payer: Cofinity Commercial |
$124.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.19
|
| Rate for Payer: Healthscope Commercial |
$130.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.57
|
| Rate for Payer: Mclaren Medicaid |
$25.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.00
|
| Rate for Payer: Meridian Medicaid |
$26.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.05
|
| Rate for Payer: Nomi Health Commercial |
$118.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.57
|
| Rate for Payer: PACE Senior Care Partners |
$34.38
|
| Rate for Payer: PACE SWMI |
$36.19
|
| Rate for Payer: PHP Commercial |
$123.05
|
| Rate for Payer: PHP Medicare Advantage |
$36.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$125.94
|
| Rate for Payer: Priority Health Medicare |
$36.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.75
|
| Rate for Payer: Railroad Medicare Medicare |
$36.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.39
|
| Rate for Payer: UHC Core |
$120.87
|
| Rate for Payer: UHC Exchange |
$36.19
|
| Rate for Payer: UHC Medicaid |
$25.52
|
| Rate for Payer: UHC Medicare Advantage |
$36.19
|
| Rate for Payer: UHCCP Medicaid |
$25.52
|
| Rate for Payer: VA VA |
$36.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.57
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
IP
|
$144.76
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$130.28 |
| Rate for Payer: Aetna Commercial |
$123.05
|
| Rate for Payer: BCBS Trust/PPO |
$119.56
|
| Rate for Payer: BCN Commercial |
$119.56
|
| Rate for Payer: Cash Price |
$115.81
|
| Rate for Payer: Cofinity Commercial |
$124.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.81
|
| Rate for Payer: Healthscope Commercial |
$130.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.05
|
| Rate for Payer: Nomi Health Commercial |
$118.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.57
|
| Rate for Payer: PHP Commercial |
$123.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$125.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.39
|
| Rate for Payer: UHC Core |
$120.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.57
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.73
|
| Rate for Payer: UHC Core |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.18
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.32
|
| Rate for Payer: BCBS Complete |
$0.78
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.49
|
| Rate for Payer: BCN Commercial |
$3.49
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.18
|
| Rate for Payer: Mclaren Medicaid |
$0.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.11
|
| Rate for Payer: Meridian Medicaid |
$0.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: PACE Senior Care Partners |
$1.01
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.69
|
| Rate for Payer: Priority Health Medicare |
$1.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.73
|
| Rate for Payer: UHC Core |
$3.54
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicaid |
$0.75
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: UHCCP Medicaid |
$0.75
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.18
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
OP
|
$244.55
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$43.11 |
| Max. Negotiated Rate |
$220.09 |
| Rate for Payer: Aetna Commercial |
$207.87
|
| Rate for Payer: Aetna Medicare |
$63.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.42
|
| Rate for Payer: BCBS Complete |
$45.27
|
| Rate for Payer: BCBS MAPPO |
$61.14
|
| Rate for Payer: BCBS Trust/PPO |
$201.04
|
| Rate for Payer: BCN Commercial |
$201.04
|
| Rate for Payer: BCN Medicare Advantage |
$61.14
|
| Rate for Payer: Cash Price |
$195.64
|
| Rate for Payer: Cofinity Commercial |
$210.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.14
|
| Rate for Payer: Healthscope Commercial |
$220.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.41
|
| Rate for Payer: Mclaren Medicaid |
$43.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.19
|
| Rate for Payer: Meridian Medicaid |
$45.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.87
|
| Rate for Payer: Nomi Health Commercial |
$200.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.41
|
| Rate for Payer: PACE Senior Care Partners |
$58.08
|
| Rate for Payer: PACE SWMI |
$61.14
|
| Rate for Payer: PHP Commercial |
$207.87
|
| Rate for Payer: PHP Medicare Advantage |
$61.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.76
|
| Rate for Payer: Priority Health Medicare |
$61.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.21
|
| Rate for Payer: Railroad Medicare Medicare |
$61.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.20
|
| Rate for Payer: UHC Core |
$204.20
|
| Rate for Payer: UHC Exchange |
$61.14
|
| Rate for Payer: UHC Medicaid |
$43.11
|
| Rate for Payer: UHC Medicare Advantage |
$61.14
|
| Rate for Payer: UHCCP Medicaid |
$43.11
|
| Rate for Payer: VA VA |
$61.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.41
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
IP
|
$244.55
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$220.09 |
| Rate for Payer: Aetna Commercial |
$207.87
|
| Rate for Payer: BCBS Trust/PPO |
$201.97
|
| Rate for Payer: BCN Commercial |
$201.97
|
| Rate for Payer: Cash Price |
$195.64
|
| Rate for Payer: Cofinity Commercial |
$210.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.64
|
| Rate for Payer: Healthscope Commercial |
$220.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.87
|
| Rate for Payer: Nomi Health Commercial |
$200.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.41
|
| Rate for Payer: PHP Commercial |
$207.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.20
|
| Rate for Payer: UHC Core |
$204.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.41
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
OP
|
$361.10
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$324.99 |
| Rate for Payer: Aetna Commercial |
$306.94
|
| Rate for Payer: Aetna Medicare |
$93.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.84
|
| Rate for Payer: BCBS Complete |
$66.84
|
| Rate for Payer: BCBS MAPPO |
$90.28
|
| Rate for Payer: BCBS Trust/PPO |
$296.86
|
| Rate for Payer: BCN Commercial |
$296.86
|
| Rate for Payer: BCN Medicare Advantage |
$90.28
|
| Rate for Payer: Cash Price |
$288.88
|
| Rate for Payer: Cash Price |
$288.88
|
| Rate for Payer: Cofinity Commercial |
$310.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.28
|
| Rate for Payer: Healthscope Commercial |
$324.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.82
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.79
|
| Rate for Payer: Meridian Medicaid |
$66.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$99.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.94
|
| Rate for Payer: Nomi Health Commercial |
$296.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.82
|
| Rate for Payer: PACE Senior Care Partners |
$85.76
|
| Rate for Payer: PACE SWMI |
$90.28
|
| Rate for Payer: PHP Commercial |
$306.94
|
| Rate for Payer: PHP Medicare Advantage |
$90.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.16
|
| Rate for Payer: Priority Health Medicare |
$91.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.33
|
| Rate for Payer: Railroad Medicare Medicare |
$90.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.77
|
| Rate for Payer: UHC Core |
$301.52
|
| Rate for Payer: UHC Exchange |
$90.28
|
| Rate for Payer: UHC Medicaid |
$63.66
|
| Rate for Payer: UHC Medicare Advantage |
$90.28
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$90.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.82
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
IP
|
$361.10
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.33 |
| Max. Negotiated Rate |
$324.99 |
| Rate for Payer: Aetna Commercial |
$306.94
|
| Rate for Payer: BCBS Trust/PPO |
$298.23
|
| Rate for Payer: BCN Commercial |
$298.23
|
| Rate for Payer: Cash Price |
$288.88
|
| Rate for Payer: Cofinity Commercial |
$310.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.88
|
| Rate for Payer: Healthscope Commercial |
$324.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.94
|
| Rate for Payer: Nomi Health Commercial |
$296.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.82
|
| Rate for Payer: PHP Commercial |
$306.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.77
|
| Rate for Payer: UHC Core |
$301.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.82
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
OP
|
$398.23
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.21 |
| Max. Negotiated Rate |
$358.41 |
| Rate for Payer: Aetna Commercial |
$338.50
|
| Rate for Payer: Aetna Medicare |
$103.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.45
|
| Rate for Payer: BCBS Complete |
$73.71
|
| Rate for Payer: BCBS MAPPO |
$99.56
|
| Rate for Payer: BCBS Trust/PPO |
$327.38
|
| Rate for Payer: BCN Commercial |
$327.38
|
| Rate for Payer: BCN Medicare Advantage |
$99.56
|
| Rate for Payer: Cash Price |
$318.58
|
| Rate for Payer: Cofinity Commercial |
$342.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.56
|
| Rate for Payer: Healthscope Commercial |
$358.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.67
|
| Rate for Payer: Mclaren Medicaid |
$70.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.54
|
| Rate for Payer: Meridian Medicaid |
$73.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$109.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.50
|
| Rate for Payer: Nomi Health Commercial |
$326.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.67
|
| Rate for Payer: PACE Senior Care Partners |
$94.58
|
| Rate for Payer: PACE SWMI |
$99.56
|
| Rate for Payer: PHP Commercial |
$338.50
|
| Rate for Payer: PHP Medicare Advantage |
$99.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$346.46
|
| Rate for Payer: Priority Health Medicare |
$100.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.17
|
| Rate for Payer: Railroad Medicare Medicare |
$99.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.44
|
| Rate for Payer: UHC Core |
$332.52
|
| Rate for Payer: UHC Exchange |
$99.56
|
| Rate for Payer: UHC Medicaid |
$70.21
|
| Rate for Payer: UHC Medicare Advantage |
$99.56
|
| Rate for Payer: UHCCP Medicaid |
$70.21
|
| Rate for Payer: VA VA |
$99.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.67
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
IP
|
$398.23
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.17 |
| Max. Negotiated Rate |
$358.41 |
| Rate for Payer: Aetna Commercial |
$338.50
|
| Rate for Payer: BCBS Trust/PPO |
$328.90
|
| Rate for Payer: BCN Commercial |
$328.90
|
| Rate for Payer: Cash Price |
$318.58
|
| Rate for Payer: Cofinity Commercial |
$342.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.58
|
| Rate for Payer: Healthscope Commercial |
$358.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.50
|
| Rate for Payer: Nomi Health Commercial |
$326.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.67
|
| Rate for Payer: PHP Commercial |
$338.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$346.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.44
|
| Rate for Payer: UHC Core |
$332.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.67
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
IP
|
$1,474.18
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,026.03 |
| Max. Negotiated Rate |
$1,326.76 |
| Rate for Payer: Aetna Commercial |
$1,253.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,217.53
|
| Rate for Payer: BCN Commercial |
$1,217.53
|
| Rate for Payer: Cash Price |
$1,179.34
|
| Rate for Payer: Cofinity Commercial |
$1,267.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,179.34
|
| Rate for Payer: Healthscope Commercial |
$1,326.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,105.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,253.05
|
| Rate for Payer: Nomi Health Commercial |
$1,208.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,105.63
|
| Rate for Payer: PHP Commercial |
$1,253.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,282.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,026.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,297.28
|
| Rate for Payer: UHC Core |
$1,230.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,105.63
|
|
