|
HC ESOPH IMPEDENCE MONITOR/MANOMETRY
|
Facility
|
OP
|
$1,451.42
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$344.71 |
| Max. Negotiated Rate |
$1,306.28 |
| Rate for Payer: Aetna Commercial |
$1,233.71
|
| Rate for Payer: Aetna Medicare |
$377.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$453.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$453.57
|
| Rate for Payer: BCBS Complete |
$580.57
|
| Rate for Payer: BCBS MAPPO |
$362.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,193.21
|
| Rate for Payer: BCN Commercial |
$1,128.48
|
| Rate for Payer: BCN Medicare Advantage |
$362.86
|
| Rate for Payer: Cash Price |
$1,161.14
|
| Rate for Payer: Cofinity Commercial |
$1,248.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,161.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.86
|
| Rate for Payer: Healthscope Commercial |
$1,306.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,088.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$417.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,233.71
|
| Rate for Payer: Nomi Health Commercial |
$1,190.16
|
| Rate for Payer: PACE Senior Care Partners |
$344.71
|
| Rate for Payer: PACE SWMI |
$362.86
|
| Rate for Payer: PHP Commercial |
$1,233.71
|
| Rate for Payer: PHP Medicare Advantage |
$362.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.42
|
| Rate for Payer: Priority Health HMO/PPO |
$1,262.74
|
| Rate for Payer: Priority Health Medicare |
$366.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$972.45
|
| Rate for Payer: Railroad Medicare Medicare |
$362.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,277.25
|
| Rate for Payer: UHC Core |
$1,211.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$362.86
|
| Rate for Payer: UHC Exchange |
$362.86
|
| Rate for Payer: UHC Medicare Advantage |
$362.86
|
| Rate for Payer: VA VA |
$362.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,088.56
|
|
|
HC ESOPH IMPEDENCE MONITOR/MANOMETRY
|
Facility
|
IP
|
$1,451.42
|
|
| Hospital Charge Code |
75000003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$943.42 |
| Max. Negotiated Rate |
$1,306.28 |
| Rate for Payer: Aetna Commercial |
$1,233.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,184.79
|
| Rate for Payer: BCN Commercial |
$1,121.66
|
| Rate for Payer: Cash Price |
$1,161.14
|
| Rate for Payer: Cofinity Commercial |
$1,248.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,161.14
|
| Rate for Payer: Healthscope Commercial |
$1,306.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,088.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,233.71
|
| Rate for Payer: Nomi Health Commercial |
$1,190.16
|
| Rate for Payer: PHP Commercial |
$1,233.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.42
|
| Rate for Payer: Priority Health HMO/PPO |
$1,262.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$972.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,277.25
|
| Rate for Payer: UHC Core |
$1,211.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,088.56
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
OP
|
$1,232.87
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.81 |
| Max. Negotiated Rate |
$1,109.58 |
| Rate for Payer: Aetna Commercial |
$1,047.94
|
| Rate for Payer: Aetna Medicare |
$320.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$385.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$385.27
|
| Rate for Payer: BCBS Complete |
$493.15
|
| Rate for Payer: BCBS MAPPO |
$308.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,013.54
|
| Rate for Payer: BCN Commercial |
$958.56
|
| Rate for Payer: BCN Medicare Advantage |
$308.22
|
| Rate for Payer: Cash Price |
$986.30
|
| Rate for Payer: Cofinity Commercial |
$1,060.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$986.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.22
|
| Rate for Payer: Healthscope Commercial |
$1,109.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$924.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$323.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$354.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,047.94
|
| Rate for Payer: Nomi Health Commercial |
$1,010.95
|
| Rate for Payer: PACE Senior Care Partners |
$292.81
|
| Rate for Payer: PACE SWMI |
$308.22
|
| Rate for Payer: PHP Commercial |
$1,047.94
|
| Rate for Payer: PHP Medicare Advantage |
$308.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.37
|
| Rate for Payer: Priority Health HMO/PPO |
$1,072.60
|
| Rate for Payer: Priority Health Medicare |
$311.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$826.02
|
| Rate for Payer: Railroad Medicare Medicare |
$308.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,084.93
|
| Rate for Payer: UHC Core |
$1,029.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.22
|
| Rate for Payer: UHC Exchange |
$308.22
|
| Rate for Payer: UHC Medicare Advantage |
$308.22
|
| Rate for Payer: VA VA |
$308.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$924.65
|
|
|
HC ESOSURE ESOPHAGEAL DEVICE
|
Facility
|
IP
|
$1,232.87
|
|
| Hospital Charge Code |
27200326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$801.37 |
| Max. Negotiated Rate |
$1,109.58 |
| Rate for Payer: Aetna Commercial |
$1,047.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.39
|
| Rate for Payer: BCN Commercial |
$952.76
|
| Rate for Payer: Cash Price |
$986.30
|
| Rate for Payer: Cofinity Commercial |
$1,060.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$986.30
|
| Rate for Payer: Healthscope Commercial |
$1,109.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$924.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,047.94
|
| Rate for Payer: Nomi Health Commercial |
$1,010.95
|
| Rate for Payer: PHP Commercial |
$1,047.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.37
|
| Rate for Payer: Priority Health HMO/PPO |
$1,072.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$826.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,084.93
|
| Rate for Payer: UHC Core |
$1,029.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$924.65
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.98 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: BCBS Trust/PPO |
$86.63
|
| Rate for Payer: BCN Commercial |
$82.01
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: Priority Health HMO/PPO |
$92.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.39
|
| Rate for Payer: UHC Core |
$88.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.59
|
|
|
HC E- STIM ATTENDED PER 15 MIN
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 97032
|
| Hospital Charge Code |
42000014
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna Medicare |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.16
|
| Rate for Payer: BCBS Complete |
$42.45
|
| Rate for Payer: BCBS MAPPO |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$87.24
|
| Rate for Payer: BCN Commercial |
$82.51
|
| Rate for Payer: BCN Medicare Advantage |
$26.53
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.53
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: PACE Senior Care Partners |
$25.20
|
| Rate for Payer: PACE SWMI |
$26.53
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: PHP Medicare Advantage |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.98
|
| Rate for Payer: Priority Health HMO/PPO |
$92.32
|
| Rate for Payer: Priority Health Medicare |
$26.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.10
|
| Rate for Payer: Railroad Medicare Medicare |
$26.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.39
|
| Rate for Payer: UHC Core |
$88.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.53
|
| Rate for Payer: UHC Exchange |
$26.53
|
| Rate for Payer: UHC Medicare Advantage |
$26.53
|
| Rate for Payer: VA VA |
$26.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.59
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$14.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.21
|
| Rate for Payer: BCBS Complete |
$21.21
|
| Rate for Payer: BCBS MAPPO |
$13.77
|
| Rate for Payer: BCBS Trust/PPO |
$45.28
|
| Rate for Payer: BCN Commercial |
$42.82
|
| Rate for Payer: BCN Medicare Advantage |
$13.77
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.31
|
| Rate for Payer: Mclaren Medicaid |
$20.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.46
|
| Rate for Payer: Meridian Medicaid |
$21.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: Nomi Health Commercial |
$45.17
|
| Rate for Payer: PACE Senior Care Partners |
$13.08
|
| Rate for Payer: PACE SWMI |
$13.77
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: PHP Medicare Advantage |
$13.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health HMO/PPO |
$47.92
|
| Rate for Payer: Priority Health Medicare |
$13.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.90
|
| Rate for Payer: Railroad Medicare Medicare |
$13.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.47
|
| Rate for Payer: UHC Core |
$45.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.77
|
| Rate for Payer: UHC Exchange |
$13.77
|
| Rate for Payer: UHC Medicare Advantage |
$13.77
|
| Rate for Payer: UHCCP Medicaid |
$20.20
|
| Rate for Payer: VA VA |
$13.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.31
|
|
|
HC ESTRADIAL, MASS SPEC, S
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100737
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: BCBS Trust/PPO |
$44.96
|
| Rate for Payer: BCN Commercial |
$42.57
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: Nomi Health Commercial |
$45.17
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health HMO/PPO |
$47.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.47
|
| Rate for Payer: UHC Core |
$45.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.31
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$21.21
|
| Rate for Payer: BCBS MAPPO |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.15
|
| Rate for Payer: BCN Commercial |
$60.67
|
| Rate for Payer: BCN Medicare Advantage |
$19.51
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$20.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: Meridian Medicaid |
$21.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Senior Care Partners |
$18.53
|
| Rate for Payer: PACE SWMI |
$19.51
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: Railroad Medicare Medicare |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.51
|
| Rate for Payer: UHC Exchange |
$19.51
|
| Rate for Payer: UHC Medicare Advantage |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$20.20
|
| Rate for Payer: VA VA |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC ESTRADIOL LEVEL
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
30100192
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: BCBS Trust/PPO |
$63.70
|
| Rate for Payer: BCN Commercial |
$60.30
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC ESTRIOL
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: BCBS Trust/PPO |
$41.61
|
| Rate for Payer: BCN Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health HMO/PPO |
$44.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.86
|
| Rate for Payer: UHC Core |
$42.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.24
|
|
|
HC ESTRIOL
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
30100195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.93
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: BCBS MAPPO |
$12.74
|
| Rate for Payer: BCBS Trust/PPO |
$41.91
|
| Rate for Payer: BCN Commercial |
$39.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.74
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.24
|
| Rate for Payer: Mclaren Medicaid |
$17.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.38
|
| Rate for Payer: Meridian Medicaid |
$18.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.74
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: PHP Medicare Advantage |
$12.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health HMO/PPO |
$44.35
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.16
|
| Rate for Payer: Railroad Medicare Medicare |
$12.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.86
|
| Rate for Payer: UHC Core |
$42.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.74
|
| Rate for Payer: UHC Exchange |
$12.74
|
| Rate for Payer: UHC Medicare Advantage |
$12.74
|
| Rate for Payer: UHCCP Medicaid |
$17.48
|
| Rate for Payer: VA VA |
$12.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.24
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
IP
|
$118.19
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.82 |
| Max. Negotiated Rate |
$106.37 |
| Rate for Payer: Aetna Commercial |
$100.46
|
| Rate for Payer: BCBS Trust/PPO |
$96.48
|
| Rate for Payer: BCN Commercial |
$91.34
|
| Rate for Payer: Cash Price |
$94.55
|
| Rate for Payer: Cofinity Commercial |
$101.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.55
|
| Rate for Payer: Healthscope Commercial |
$106.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.46
|
| Rate for Payer: Nomi Health Commercial |
$96.92
|
| Rate for Payer: PHP Commercial |
$100.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.82
|
| Rate for Payer: Priority Health HMO/PPO |
$102.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.01
|
| Rate for Payer: UHC Core |
$98.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.64
|
|
|
HC ESTROGEN RECEPTOR
|
Facility
|
OP
|
$118.19
|
|
|
Service Code
|
CPT 84233
|
| Hospital Charge Code |
30100416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$106.37 |
| Rate for Payer: Aetna Commercial |
$100.46
|
| Rate for Payer: Aetna Medicare |
$30.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.93
|
| Rate for Payer: BCBS Complete |
$66.72
|
| Rate for Payer: BCBS MAPPO |
$29.55
|
| Rate for Payer: BCBS Trust/PPO |
$97.16
|
| Rate for Payer: BCN Commercial |
$91.89
|
| Rate for Payer: BCN Medicare Advantage |
$29.55
|
| Rate for Payer: Cash Price |
$94.55
|
| Rate for Payer: Cash Price |
$94.55
|
| Rate for Payer: Cofinity Commercial |
$101.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.55
|
| Rate for Payer: Healthscope Commercial |
$106.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.64
|
| Rate for Payer: Mclaren Medicaid |
$63.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.02
|
| Rate for Payer: Meridian Medicaid |
$66.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.46
|
| Rate for Payer: Nomi Health Commercial |
$96.92
|
| Rate for Payer: PACE Senior Care Partners |
$28.07
|
| Rate for Payer: PACE SWMI |
$29.55
|
| Rate for Payer: PHP Commercial |
$100.46
|
| Rate for Payer: PHP Medicare Advantage |
$29.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.82
|
| Rate for Payer: Priority Health HMO/PPO |
$102.83
|
| Rate for Payer: Priority Health Medicare |
$29.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.19
|
| Rate for Payer: Railroad Medicare Medicare |
$29.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.01
|
| Rate for Payer: UHC Core |
$98.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.55
|
| Rate for Payer: UHC Exchange |
$29.55
|
| Rate for Payer: UHC Medicare Advantage |
$29.55
|
| Rate for Payer: UHCCP Medicaid |
$63.54
|
| Rate for Payer: VA VA |
$29.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.64
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
IP
|
$119.02
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.36 |
| Max. Negotiated Rate |
$107.12 |
| Rate for Payer: Aetna Commercial |
$101.17
|
| Rate for Payer: BCBS Trust/PPO |
$97.16
|
| Rate for Payer: BCN Commercial |
$91.98
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cofinity Commercial |
$102.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.22
|
| Rate for Payer: Healthscope Commercial |
$107.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.17
|
| Rate for Payer: Nomi Health Commercial |
$97.60
|
| Rate for Payer: PHP Commercial |
$101.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.36
|
| Rate for Payer: Priority Health HMO/PPO |
$103.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.74
|
| Rate for Payer: UHC Core |
$99.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.26
|
|
|
HC ESTROGEN RECEPTOR-PROGESTERONE
|
Facility
|
OP
|
$119.02
|
|
|
Service Code
|
CPT 84234
|
| Hospital Charge Code |
30100417
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$107.12 |
| Rate for Payer: Aetna Commercial |
$101.17
|
| Rate for Payer: Aetna Medicare |
$30.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.19
|
| Rate for Payer: BCBS Complete |
$49.26
|
| Rate for Payer: BCBS MAPPO |
$29.76
|
| Rate for Payer: BCBS Trust/PPO |
$97.85
|
| Rate for Payer: BCN Commercial |
$92.54
|
| Rate for Payer: BCN Medicare Advantage |
$29.76
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Cofinity Commercial |
$102.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.76
|
| Rate for Payer: Healthscope Commercial |
$107.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.26
|
| Rate for Payer: Mclaren Medicaid |
$46.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.24
|
| Rate for Payer: Meridian Medicaid |
$49.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.17
|
| Rate for Payer: Nomi Health Commercial |
$97.60
|
| Rate for Payer: PACE Senior Care Partners |
$28.27
|
| Rate for Payer: PACE SWMI |
$29.76
|
| Rate for Payer: PHP Commercial |
$101.17
|
| Rate for Payer: PHP Medicare Advantage |
$29.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.36
|
| Rate for Payer: Priority Health HMO/PPO |
$103.55
|
| Rate for Payer: Priority Health Medicare |
$30.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.74
|
| Rate for Payer: Railroad Medicare Medicare |
$29.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.74
|
| Rate for Payer: UHC Core |
$99.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.76
|
| Rate for Payer: UHC Exchange |
$29.76
|
| Rate for Payer: UHC Medicare Advantage |
$29.76
|
| Rate for Payer: UHCCP Medicaid |
$46.91
|
| Rate for Payer: VA VA |
$29.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.26
|
|
|
HC ESTRONE
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.82 |
| 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 |
$18.94
|
| Rate for Payer: BCBS MAPPO |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCN Commercial |
$51.77
|
| Rate for Payer: BCN Medicare Advantage |
$16.65
|
| Rate for Payer: Cash Price |
$53.27
|
| 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 |
$18.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.48
|
| Rate for Payer: Meridian Medicaid |
$18.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| 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 |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health HMO/PPO |
$57.93
|
| Rate for Payer: Priority Health Medicare |
$16.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.62
|
| 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 Dual Complete DSNP |
$16.65
|
| Rate for Payer: UHC Exchange |
$16.65
|
| Rate for Payer: UHC Medicare Advantage |
$16.65
|
| Rate for Payer: UHCCP Medicaid |
$18.04
|
| Rate for Payer: VA VA |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.94
|
|
|
HC ESTRONE
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
30100196
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.28 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: BCBS Trust/PPO |
$54.36
|
| Rate for Payer: BCN Commercial |
$51.46
|
| 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: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health HMO/PPO |
$57.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.62
|
| 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 ETHANOL CONFIRM URINE
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$124.89
|
| Rate for Payer: BCN Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC ETHANOL CONFIRM URINE
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100614
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.81
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$125.78
|
| Rate for Payer: BCN Commercial |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PACE Senior Care Partners |
$36.34
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: Railroad Medicare Medicare |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Exchange |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna Medicare |
$14.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.85
|
| Rate for Payer: BCBS Complete |
$12.41
|
| Rate for Payer: BCBS MAPPO |
$14.28
|
| Rate for Payer: BCBS Trust/PPO |
$46.96
|
| Rate for Payer: BCN Commercial |
$44.41
|
| Rate for Payer: BCN Medicare Advantage |
$14.28
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.28
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.84
|
| Rate for Payer: Mclaren Medicaid |
$11.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.99
|
| Rate for Payer: Meridian Medicaid |
$12.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: PACE Senior Care Partners |
$13.57
|
| Rate for Payer: PACE SWMI |
$14.28
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: PHP Medicare Advantage |
$14.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO |
$49.69
|
| Rate for Payer: Priority Health Medicare |
$14.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.27
|
| Rate for Payer: Railroad Medicare Medicare |
$14.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.27
|
| Rate for Payer: UHC Core |
$47.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.28
|
| Rate for Payer: UHC Exchange |
$14.28
|
| Rate for Payer: UHC Medicare Advantage |
$14.28
|
| Rate for Payer: UHCCP Medicaid |
$11.81
|
| Rate for Payer: VA VA |
$14.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.84
|
|
|
HC ETHOSUXIMIDE/ZARONTIN LEVEL
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
CPT 80168
|
| Hospital Charge Code |
30100029
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: BCBS Trust/PPO |
$46.63
|
| Rate for Payer: BCN Commercial |
$44.14
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO |
$49.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.27
|
| Rate for Payer: UHC Core |
$47.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.84
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
IP
|
$164.22
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: BCBS Trust/PPO |
$134.05
|
| Rate for Payer: BCN Commercial |
$126.91
|
| Rate for Payer: Cash Price |
$131.38
|
| Rate for Payer: Cofinity Commercial |
$141.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.38
|
| Rate for Payer: Healthscope Commercial |
$147.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.59
|
| Rate for Payer: Nomi Health Commercial |
$134.66
|
| Rate for Payer: PHP Commercial |
$139.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.74
|
| Rate for Payer: Priority Health HMO/PPO |
$142.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.51
|
| Rate for Payer: UHC Core |
$137.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.16
|
|
|
HC ETHYLENE GLYCOL
|
Facility
|
OP
|
$164.22
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$147.80 |
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: Aetna Medicare |
$42.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.32
|
| Rate for Payer: BCBS Complete |
$11.31
|
| Rate for Payer: BCBS MAPPO |
$41.06
|
| Rate for Payer: BCBS Trust/PPO |
$135.01
|
| Rate for Payer: BCN Commercial |
$127.68
|
| Rate for Payer: BCN Medicare Advantage |
$41.06
|
| Rate for Payer: Cash Price |
$131.38
|
| Rate for Payer: Cash Price |
$131.38
|
| Rate for Payer: Cofinity Commercial |
$141.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.06
|
| Rate for Payer: Healthscope Commercial |
$147.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.16
|
| Rate for Payer: Mclaren Medicaid |
$10.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.11
|
| Rate for Payer: Meridian Medicaid |
$11.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.59
|
| Rate for Payer: Nomi Health Commercial |
$134.66
|
| Rate for Payer: PACE Senior Care Partners |
$39.00
|
| Rate for Payer: PACE SWMI |
$41.06
|
| Rate for Payer: PHP Commercial |
$139.59
|
| Rate for Payer: PHP Medicare Advantage |
$41.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.74
|
| Rate for Payer: Priority Health HMO/PPO |
$142.87
|
| Rate for Payer: Priority Health Medicare |
$41.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.03
|
| Rate for Payer: Railroad Medicare Medicare |
$41.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.51
|
| Rate for Payer: UHC Core |
$137.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.06
|
| Rate for Payer: UHC Exchange |
$41.06
|
| Rate for Payer: UHC Medicare Advantage |
$41.06
|
| Rate for Payer: UHCCP Medicaid |
$10.77
|
| Rate for Payer: VA VA |
$41.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.16
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
IP
|
$128.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$115.58 |
| Rate for Payer: Aetna Commercial |
$109.16
|
| Rate for Payer: BCBS Trust/PPO |
$104.83
|
| Rate for Payer: BCN Commercial |
$99.24
|
| Rate for Payer: Cash Price |
$102.74
|
| Rate for Payer: Cofinity Commercial |
$110.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.74
|
| Rate for Payer: Healthscope Commercial |
$115.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.16
|
| Rate for Payer: Nomi Health Commercial |
$105.30
|
| Rate for Payer: PHP Commercial |
$109.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.47
|
| Rate for Payer: Priority Health HMO/PPO |
$111.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.01
|
| Rate for Payer: UHC Core |
$107.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.32
|
|
