|
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
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
IP
|
$1,535.61
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,068.78 |
| Max. Negotiated Rate |
$1,382.05 |
| Rate for Payer: Aetna Commercial |
$1,305.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,268.26
|
| Rate for Payer: BCN Commercial |
$1,268.26
|
| Rate for Payer: Cash Price |
$1,228.49
|
| Rate for Payer: Cofinity Commercial |
$1,320.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,228.49
|
| Rate for Payer: Healthscope Commercial |
$1,382.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,151.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,305.27
|
| Rate for Payer: Nomi Health Commercial |
$1,259.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,151.71
|
| Rate for Payer: PHP Commercial |
$1,305.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,335.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,068.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,351.34
|
| Rate for Payer: UHC Core |
$1,282.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,151.71
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
OP
|
$1,535.61
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.73 |
| Max. Negotiated Rate |
$1,382.05 |
| Rate for Payer: Aetna Commercial |
$1,305.27
|
| Rate for Payer: Aetna Medicare |
$399.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$479.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$479.88
|
| Rate for Payer: BCBS Complete |
$284.24
|
| Rate for Payer: BCBS MAPPO |
$383.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.42
|
| Rate for Payer: BCN Commercial |
$1,262.42
|
| Rate for Payer: BCN Medicare Advantage |
$383.90
|
| Rate for Payer: Cash Price |
$1,228.49
|
| Rate for Payer: Cofinity Commercial |
$1,320.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,228.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$383.90
|
| Rate for Payer: Healthscope Commercial |
$1,382.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,151.71
|
| Rate for Payer: Mclaren Medicaid |
$270.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.10
|
| Rate for Payer: Meridian Medicaid |
$284.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$422.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,305.27
|
| Rate for Payer: Nomi Health Commercial |
$1,259.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,151.71
|
| Rate for Payer: PACE Senior Care Partners |
$364.71
|
| Rate for Payer: PACE SWMI |
$383.90
|
| Rate for Payer: PHP Commercial |
$1,305.27
|
| Rate for Payer: PHP Medicare Advantage |
$383.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,335.98
|
| Rate for Payer: Priority Health Medicare |
$387.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,068.78
|
| Rate for Payer: Railroad Medicare Medicare |
$383.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,351.34
|
| Rate for Payer: UHC Core |
$1,282.23
|
| Rate for Payer: UHC Exchange |
$383.90
|
| Rate for Payer: UHC Medicaid |
$270.73
|
| Rate for Payer: UHC Medicare Advantage |
$383.90
|
| Rate for Payer: UHCCP Medicaid |
$270.73
|
| Rate for Payer: VA VA |
$383.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,151.71
|
|
|
HC GASTRIN LEVEL
|
Facility
|
OP
|
$43.51
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$39.16 |
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna Medicare |
$11.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.60
|
| Rate for Payer: BCBS Complete |
$8.05
|
| Rate for Payer: BCBS MAPPO |
$10.88
|
| Rate for Payer: BCBS Trust/PPO |
$35.77
|
| Rate for Payer: BCN Commercial |
$35.77
|
| Rate for Payer: BCN Medicare Advantage |
$10.88
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Commercial |
$37.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.88
|
| Rate for Payer: Healthscope Commercial |
$39.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.63
|
| Rate for Payer: Mclaren Medicaid |
$7.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.42
|
| Rate for Payer: Meridian Medicaid |
$8.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Nomi Health Commercial |
$35.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.63
|
| Rate for Payer: PACE Senior Care Partners |
$10.33
|
| Rate for Payer: PACE SWMI |
$10.88
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: PHP Medicare Advantage |
$10.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.85
|
| Rate for Payer: Priority Health Medicare |
$10.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.28
|
| Rate for Payer: Railroad Medicare Medicare |
$10.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.29
|
| Rate for Payer: UHC Core |
$36.33
|
| Rate for Payer: UHC Exchange |
$10.88
|
| Rate for Payer: UHC Medicaid |
$7.67
|
| Rate for Payer: UHC Medicare Advantage |
$10.88
|
| Rate for Payer: UHCCP Medicaid |
$7.67
|
| Rate for Payer: VA VA |
$10.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.63
|
|
|
HC GASTRIN LEVEL
|
Facility
|
IP
|
$43.51
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$39.16 |
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: BCBS Trust/PPO |
$35.93
|
| Rate for Payer: BCN Commercial |
$35.93
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Commercial |
$37.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$39.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Nomi Health Commercial |
$35.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.63
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.29
|
| Rate for Payer: UHC Core |
$36.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.63
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
IP
|
$3.55
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.93
|
| Rate for Payer: BCN Commercial |
$2.93
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.02
|
| Rate for Payer: Nomi Health Commercial |
$2.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.66
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.12
|
| Rate for Payer: UHC Core |
$2.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.66
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
OP
|
$3.55
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna Medicare |
$0.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.11
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: BCBS MAPPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.92
|
| Rate for Payer: BCN Commercial |
$2.92
|
| Rate for Payer: BCN Medicare Advantage |
$0.89
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.89
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.66
|
| Rate for Payer: Mclaren Medicaid |
$0.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.93
|
| Rate for Payer: Meridian Medicaid |
$0.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.02
|
| Rate for Payer: Nomi Health Commercial |
$2.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.66
|
| Rate for Payer: PACE Senior Care Partners |
$0.84
|
| Rate for Payer: PACE SWMI |
$0.89
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: PHP Medicare Advantage |
$0.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.09
|
| Rate for Payer: Priority Health Medicare |
$0.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.47
|
| Rate for Payer: Railroad Medicare Medicare |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.12
|
| Rate for Payer: UHC Core |
$2.96
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Medicaid |
$0.63
|
| Rate for Payer: UHC Medicare Advantage |
$0.89
|
| Rate for Payer: UHCCP Medicaid |
$0.63
|
| Rate for Payer: VA VA |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.66
|
|
|
HC GASTROSCOPY
|
Facility
|
IP
|
$2,001.39
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,392.97 |
| Max. Negotiated Rate |
$1,801.25 |
| Rate for Payer: Aetna Commercial |
$1,701.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,652.95
|
| Rate for Payer: BCN Commercial |
$1,652.95
|
| Rate for Payer: Cash Price |
$1,601.11
|
| Rate for Payer: Cofinity Commercial |
$1,721.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,601.11
|
| Rate for Payer: Healthscope Commercial |
$1,801.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,501.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,701.18
|
| Rate for Payer: Nomi Health Commercial |
$1,641.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,501.04
|
| Rate for Payer: PHP Commercial |
$1,701.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,741.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,392.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,761.22
|
| Rate for Payer: UHC Core |
$1,671.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,501.04
|
|
|
HC GASTROSCOPY
|
Facility
|
OP
|
$2,001.39
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$352.85 |
| Max. Negotiated Rate |
$1,801.25 |
| Rate for Payer: Aetna Commercial |
$1,701.18
|
| Rate for Payer: Aetna Medicare |
$520.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$625.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$625.43
|
| Rate for Payer: BCBS Complete |
$370.46
|
| Rate for Payer: BCBS MAPPO |
$500.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,645.34
|
| Rate for Payer: BCN Commercial |
$1,645.34
|
| Rate for Payer: BCN Medicare Advantage |
$500.35
|
| Rate for Payer: Cash Price |
$1,601.11
|
| Rate for Payer: Cofinity Commercial |
$1,721.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,601.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$500.35
|
| Rate for Payer: Healthscope Commercial |
$1,801.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,501.04
|
| Rate for Payer: Mclaren Medicaid |
$352.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$525.36
|
| Rate for Payer: Meridian Medicaid |
$370.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$575.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$550.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,701.18
|
| Rate for Payer: Nomi Health Commercial |
$1,641.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,501.04
|
| Rate for Payer: PACE Senior Care Partners |
$475.33
|
| Rate for Payer: PACE SWMI |
$500.35
|
| Rate for Payer: PHP Commercial |
$1,701.18
|
| Rate for Payer: PHP Medicare Advantage |
$500.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$352.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,741.21
|
| Rate for Payer: Priority Health Medicare |
$505.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,392.97
|
| Rate for Payer: Railroad Medicare Medicare |
$500.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,761.22
|
| Rate for Payer: UHC Core |
$1,671.16
|
| Rate for Payer: UHC Exchange |
$500.35
|
| Rate for Payer: UHC Medicaid |
$352.85
|
| Rate for Payer: UHC Medicare Advantage |
$500.35
|
| Rate for Payer: UHCCP Medicaid |
$352.85
|
| Rate for Payer: VA VA |
$500.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,501.04
|
|
|
HC GEL SKIN/WOUND ANTIMICROBIAL ANASEPT
|
Facility
|
IP
|
$81.82
|
|
| Hospital Charge Code |
27000708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$73.64 |
| Rate for Payer: Aetna Commercial |
$69.55
|
| Rate for Payer: BCBS Trust/PPO |
$67.58
|
| Rate for Payer: BCN Commercial |
$67.58
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cofinity Commercial |
$70.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.46
|
| Rate for Payer: Healthscope Commercial |
$73.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.55
|
| Rate for Payer: Nomi Health Commercial |
$67.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.37
|
| Rate for Payer: PHP Commercial |
$69.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.00
|
| Rate for Payer: UHC Core |
$68.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.37
|
|
|
HC GEL SKIN/WOUND ANTIMICROBIAL ANASEPT
|
Facility
|
OP
|
$81.82
|
|
| Hospital Charge Code |
27000708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$73.64 |
| Rate for Payer: Aetna Commercial |
$69.55
|
| Rate for Payer: Aetna Medicare |
$21.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.57
|
| Rate for Payer: BCBS Complete |
$15.14
|
| Rate for Payer: BCBS MAPPO |
$20.45
|
| Rate for Payer: BCBS Trust/PPO |
$67.26
|
| Rate for Payer: BCN Commercial |
$67.26
|
| Rate for Payer: BCN Medicare Advantage |
$20.45
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cofinity Commercial |
$70.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.45
|
| Rate for Payer: Healthscope Commercial |
$73.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.37
|
| Rate for Payer: Mclaren Medicaid |
$14.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.48
|
| Rate for Payer: Meridian Medicaid |
$15.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.55
|
| Rate for Payer: Nomi Health Commercial |
$67.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.37
|
| Rate for Payer: PACE Senior Care Partners |
$19.43
|
| Rate for Payer: PACE SWMI |
$20.45
|
| Rate for Payer: PHP Commercial |
$69.55
|
| Rate for Payer: PHP Medicare Advantage |
$20.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.18
|
| Rate for Payer: Priority Health Medicare |
$20.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.95
|
| Rate for Payer: Railroad Medicare Medicare |
$20.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.00
|
| Rate for Payer: UHC Core |
$68.32
|
| Rate for Payer: UHC Exchange |
$20.45
|
| Rate for Payer: UHC Medicaid |
$14.42
|
| Rate for Payer: UHC Medicare Advantage |
$20.45
|
| Rate for Payer: UHCCP Medicaid |
$14.42
|
| Rate for Payer: VA VA |
$20.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.37
|
|
|
HC GELSYN-3 FOR INTRA-ARTICULAR INJ, 0.1 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600259
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.00
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS MAPPO |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.00
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$0.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: Meridian Medicaid |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.00
|
| Rate for Payer: PACE SWMI |
$0.00
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$0.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicaid |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: UHCCP Medicaid |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC GELSYN-3 FOR INTRA-ARTICULAR INJ, 0.1 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
OP
|
$152.92
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$26.96 |
| Max. Negotiated Rate |
$137.63 |
| Rate for Payer: Aetna Commercial |
$129.98
|
| Rate for Payer: Aetna Medicare |
$39.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.79
|
| Rate for Payer: BCBS Complete |
$28.31
|
| Rate for Payer: BCBS MAPPO |
$38.23
|
| Rate for Payer: BCBS Trust/PPO |
$125.72
|
| Rate for Payer: BCN Commercial |
$125.72
|
| Rate for Payer: BCN Medicare Advantage |
$38.23
|
| Rate for Payer: Cash Price |
$122.34
|
| Rate for Payer: Cofinity Commercial |
$131.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.23
|
| Rate for Payer: Healthscope Commercial |
$137.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.69
|
| Rate for Payer: Mclaren Medicaid |
$26.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.14
|
| Rate for Payer: Meridian Medicaid |
$28.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.98
|
| Rate for Payer: Nomi Health Commercial |
$125.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.69
|
| Rate for Payer: PACE Senior Care Partners |
$36.32
|
| Rate for Payer: PACE SWMI |
$38.23
|
| Rate for Payer: PHP Commercial |
$129.98
|
| Rate for Payer: PHP Medicare Advantage |
$38.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.04
|
| Rate for Payer: Priority Health Medicare |
$38.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.43
|
| Rate for Payer: Railroad Medicare Medicare |
$38.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.57
|
| Rate for Payer: UHC Core |
$127.69
|
| Rate for Payer: UHC Exchange |
$38.23
|
| Rate for Payer: UHC Medicaid |
$26.96
|
| Rate for Payer: UHC Medicare Advantage |
$38.23
|
| Rate for Payer: UHCCP Medicaid |
$26.96
|
| Rate for Payer: VA VA |
$38.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.69
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
IP
|
$152.92
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$106.43 |
| Max. Negotiated Rate |
$137.63 |
| Rate for Payer: Aetna Commercial |
$129.98
|
| Rate for Payer: BCBS Trust/PPO |
$126.30
|
| Rate for Payer: BCN Commercial |
$126.30
|
| Rate for Payer: Cash Price |
$122.34
|
| Rate for Payer: Cofinity Commercial |
$131.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.34
|
| Rate for Payer: Healthscope Commercial |
$137.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.98
|
| Rate for Payer: Nomi Health Commercial |
$125.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.69
|
| Rate for Payer: PHP Commercial |
$129.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$133.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.57
|
| Rate for Payer: UHC Core |
$127.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.69
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
OP
|
$601.51
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$106.05 |
| Max. Negotiated Rate |
$541.36 |
| Rate for Payer: Aetna Commercial |
$511.28
|
| Rate for Payer: Aetna Medicare |
$156.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$187.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$187.97
|
| Rate for Payer: BCBS Complete |
$111.34
|
| Rate for Payer: BCBS MAPPO |
$150.38
|
| Rate for Payer: BCBS Trust/PPO |
$494.50
|
| Rate for Payer: BCN Commercial |
$494.50
|
| Rate for Payer: BCN Medicare Advantage |
$150.38
|
| Rate for Payer: Cash Price |
$481.21
|
| Rate for Payer: Cofinity Commercial |
$517.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.38
|
| Rate for Payer: Healthscope Commercial |
$541.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.13
|
| Rate for Payer: Mclaren Medicaid |
$106.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.90
|
| Rate for Payer: Meridian Medicaid |
$111.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$165.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.28
|
| Rate for Payer: Nomi Health Commercial |
$493.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.13
|
| Rate for Payer: PACE Senior Care Partners |
$142.86
|
| Rate for Payer: PACE SWMI |
$150.38
|
| Rate for Payer: PHP Commercial |
$511.28
|
| Rate for Payer: PHP Medicare Advantage |
$150.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$523.31
|
| Rate for Payer: Priority Health Medicare |
$151.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$418.65
|
| Rate for Payer: Railroad Medicare Medicare |
$150.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$529.33
|
| Rate for Payer: UHC Core |
$502.26
|
| Rate for Payer: UHC Exchange |
$150.38
|
| Rate for Payer: UHC Medicaid |
$106.05
|
| Rate for Payer: UHC Medicare Advantage |
$150.38
|
| Rate for Payer: UHCCP Medicaid |
$106.05
|
| Rate for Payer: VA VA |
$150.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.13
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
IP
|
$601.51
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$418.65 |
| Max. Negotiated Rate |
$541.36 |
| Rate for Payer: Aetna Commercial |
$511.28
|
| Rate for Payer: BCBS Trust/PPO |
$496.79
|
| Rate for Payer: BCN Commercial |
$496.79
|
| Rate for Payer: Cash Price |
$481.21
|
| Rate for Payer: Cofinity Commercial |
$517.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.21
|
| Rate for Payer: Healthscope Commercial |
$541.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.28
|
| Rate for Payer: Nomi Health Commercial |
$493.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.13
|
| Rate for Payer: PHP Commercial |
$511.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$523.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$418.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$529.33
|
| Rate for Payer: UHC Core |
$502.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.13
|
|
|
HC GENERAL ANESTHESIA PER MINUTE
|
Facility
|
OP
|
$16.32
|
|
| Hospital Charge Code |
37000024
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna Medicare |
$4.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.10
|
| Rate for Payer: BCBS Complete |
$3.02
|
| Rate for Payer: BCBS MAPPO |
$4.08
|
| Rate for Payer: BCBS Trust/PPO |
$13.42
|
| Rate for Payer: BCN Commercial |
$13.42
|
| Rate for Payer: BCN Medicare Advantage |
$4.08
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Mclaren Medicaid |
$2.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.28
|
| Rate for Payer: Meridian Medicaid |
$3.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.24
|
| Rate for Payer: PACE Senior Care Partners |
$3.88
|
| Rate for Payer: PACE SWMI |
$4.08
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: PHP Medicare Advantage |
$4.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.20
|
| Rate for Payer: Priority Health Medicare |
$4.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.36
|
| Rate for Payer: Railroad Medicare Medicare |
$4.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.36
|
| Rate for Payer: UHC Core |
$13.63
|
| Rate for Payer: UHC Exchange |
$4.08
|
| Rate for Payer: UHC Medicaid |
$2.88
|
| Rate for Payer: UHC Medicare Advantage |
$4.08
|
| Rate for Payer: UHCCP Medicaid |
$2.88
|
| Rate for Payer: VA VA |
$4.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
|
|
HC GENERAL ANESTHESIA PER MINUTE
|
Facility
|
IP
|
$16.32
|
|
| Hospital Charge Code |
37000024
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.48
|
| Rate for Payer: BCN Commercial |
$13.48
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.24
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.36
|
| Rate for Payer: UHC Core |
$13.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
IP
|
$235.33
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$163.79 |
| Max. Negotiated Rate |
$211.80 |
| Rate for Payer: Aetna Commercial |
$200.03
|
| Rate for Payer: BCBS Trust/PPO |
$194.36
|
| Rate for Payer: BCN Commercial |
$194.36
|
| Rate for Payer: Cash Price |
$188.26
|
| Rate for Payer: Cofinity Commercial |
$202.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.26
|
| Rate for Payer: Healthscope Commercial |
$211.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.03
|
| Rate for Payer: Nomi Health Commercial |
$192.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.50
|
| Rate for Payer: PHP Commercial |
$200.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.09
|
| Rate for Payer: UHC Core |
$196.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.50
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
OP
|
$235.33
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.49 |
| Max. Negotiated Rate |
$211.80 |
| Rate for Payer: Aetna Commercial |
$200.03
|
| Rate for Payer: Aetna Medicare |
$61.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.54
|
| Rate for Payer: BCBS Complete |
$43.56
|
| Rate for Payer: BCBS MAPPO |
$58.83
|
| Rate for Payer: BCBS Trust/PPO |
$193.46
|
| Rate for Payer: BCN Commercial |
$193.46
|
| Rate for Payer: BCN Medicare Advantage |
$58.83
|
| Rate for Payer: Cash Price |
$188.26
|
| Rate for Payer: Cofinity Commercial |
$202.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.83
|
| Rate for Payer: Healthscope Commercial |
$211.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.50
|
| Rate for Payer: Mclaren Medicaid |
$41.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.77
|
| Rate for Payer: Meridian Medicaid |
$43.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.03
|
| Rate for Payer: Nomi Health Commercial |
$192.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.50
|
| Rate for Payer: PACE Senior Care Partners |
$55.89
|
| Rate for Payer: PACE SWMI |
$58.83
|
| Rate for Payer: PHP Commercial |
$200.03
|
| Rate for Payer: PHP Medicare Advantage |
$58.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.74
|
| Rate for Payer: Priority Health Medicare |
$59.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.79
|
| Rate for Payer: Railroad Medicare Medicare |
$58.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.09
|
| Rate for Payer: UHC Core |
$196.50
|
| Rate for Payer: UHC Exchange |
$58.83
|
| Rate for Payer: UHC Medicaid |
$41.49
|
| Rate for Payer: UHC Medicare Advantage |
$58.83
|
| Rate for Payer: UHCCP Medicaid |
$41.49
|
| Rate for Payer: VA VA |
$58.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.50
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
OP
|
$125.47
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$112.92 |
| Rate for Payer: Aetna Commercial |
$106.65
|
| Rate for Payer: Aetna Medicare |
$32.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.21
|
| Rate for Payer: BCBS Complete |
$23.22
|
| Rate for Payer: BCBS MAPPO |
$31.37
|
| Rate for Payer: BCBS Trust/PPO |
$103.15
|
| Rate for Payer: BCN Commercial |
$103.15
|
| Rate for Payer: BCN Medicare Advantage |
$31.37
|
| Rate for Payer: Cash Price |
$100.38
|
| Rate for Payer: Cofinity Commercial |
$107.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.37
|
| Rate for Payer: Healthscope Commercial |
$112.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.10
|
| Rate for Payer: Mclaren Medicaid |
$22.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.94
|
| Rate for Payer: Meridian Medicaid |
$23.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.65
|
| Rate for Payer: Nomi Health Commercial |
$102.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.10
|
| Rate for Payer: PACE Senior Care Partners |
$29.80
|
| Rate for Payer: PACE SWMI |
$31.37
|
| Rate for Payer: PHP Commercial |
$106.65
|
| Rate for Payer: PHP Medicare Advantage |
$31.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$109.16
|
| Rate for Payer: Priority Health Medicare |
$31.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.33
|
| Rate for Payer: Railroad Medicare Medicare |
$31.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.41
|
| Rate for Payer: UHC Core |
$104.77
|
| Rate for Payer: UHC Exchange |
$31.37
|
| Rate for Payer: UHC Medicaid |
$22.12
|
| Rate for Payer: UHC Medicare Advantage |
$31.37
|
| Rate for Payer: UHCCP Medicaid |
$22.12
|
| Rate for Payer: VA VA |
$31.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.10
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
IP
|
$125.47
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.33 |
| Max. Negotiated Rate |
$112.92 |
| Rate for Payer: Aetna Commercial |
$106.65
|
| Rate for Payer: BCBS Trust/PPO |
$103.63
|
| Rate for Payer: BCN Commercial |
$103.63
|
| Rate for Payer: Cash Price |
$100.38
|
| Rate for Payer: Cofinity Commercial |
$107.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.38
|
| Rate for Payer: Healthscope Commercial |
$112.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.65
|
| Rate for Payer: Nomi Health Commercial |
$102.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.10
|
| Rate for Payer: PHP Commercial |
$106.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$109.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.41
|
| Rate for Payer: UHC Core |
$104.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.10
|
|
|
HC GGTP
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.24 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: BCBS Trust/PPO |
$58.43
|
| Rate for Payer: BCN Commercial |
$58.43
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.26
|
| Rate for Payer: UHC Core |
$59.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC GGTP
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$18.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.11
|
| Rate for Payer: BCBS Complete |
$13.10
|
| Rate for Payer: BCBS MAPPO |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$58.16
|
| Rate for Payer: BCN Commercial |
$58.16
|
| Rate for Payer: BCN Medicare Advantage |
$17.69
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.69
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Mclaren Medicaid |
$12.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.57
|
| Rate for Payer: Meridian Medicaid |
$13.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PACE Senior Care Partners |
$16.80
|
| Rate for Payer: PACE SWMI |
$17.69
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: PHP Medicare Advantage |
$17.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.55
|
| Rate for Payer: Priority Health Medicare |
$17.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.24
|
| Rate for Payer: Railroad Medicare Medicare |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.26
|
| Rate for Payer: UHC Core |
$59.08
|
| Rate for Payer: UHC Exchange |
$17.69
|
| Rate for Payer: UHC Medicaid |
$12.47
|
| Rate for Payer: UHC Medicare Advantage |
$17.69
|
| Rate for Payer: UHCCP Medicaid |
$12.47
|
| Rate for Payer: VA VA |
$17.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
