|
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
|
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 |
$38.23
|
| 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 |
$38.23
|
|
|
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 |
$38.23
|
| 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 |
$38.23
|
|
|
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 |
$89.27
|
| 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 |
$89.27
|
|
|
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 |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$97.85
|
| Rate for Payer: BCN Commercial |
$92.54
|
| Rate for Payer: BCN Medicare Advantage |
$29.75
|
| 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 |
$29.75
|
| Rate for Payer: Healthscope Commercial |
$107.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.27
|
| 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 |
$29.75
|
| Rate for Payer: PHP Commercial |
$101.17
|
| Rate for Payer: PHP Medicare Advantage |
$29.75
|
| 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 |
$29.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.74
|
| Rate for Payer: UHC Core |
$99.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.75
|
| Rate for Payer: UHC Exchange |
$29.75
|
| Rate for Payer: UHC Medicare Advantage |
$29.75
|
| Rate for Payer: UHCCP Medicaid |
$46.91
|
| Rate for Payer: VA VA |
$29.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.27
|
|
|
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
|
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 |
$127.75
|
| 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 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 |
$127.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
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 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 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 |
$41.05
|
| Rate for Payer: BCBS Trust/PPO |
$135.01
|
| Rate for Payer: BCN Commercial |
$127.68
|
| Rate for Payer: BCN Medicare Advantage |
$41.05
|
| 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 |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$147.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.17
|
| 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 |
$41.05
|
| Rate for Payer: PHP Commercial |
$139.59
|
| Rate for Payer: PHP Medicare Advantage |
$41.05
|
| 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 |
$41.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.51
|
| Rate for Payer: UHC Core |
$137.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.05
|
| Rate for Payer: UHC Exchange |
$41.05
|
| Rate for Payer: UHC Medicare Advantage |
$41.05
|
| Rate for Payer: UHCCP Medicaid |
$10.77
|
| Rate for Payer: VA VA |
$41.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.17
|
|
|
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 |
$123.17
|
| 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 |
$123.17
|
|
|
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 |
$96.31
|
| 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 |
$96.31
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
OP
|
$128.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$115.58 |
| Rate for Payer: Aetna Commercial |
$109.16
|
| Rate for Payer: Aetna Medicare |
$33.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.13
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$32.10
|
| Rate for Payer: BCBS Trust/PPO |
$105.57
|
| Rate for Payer: BCN Commercial |
$99.85
|
| Rate for Payer: BCN Medicare Advantage |
$32.10
|
| Rate for Payer: Cash Price |
$102.74
|
| 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: Health Alliance Plan Medicare Advantage |
$32.10
|
| Rate for Payer: Healthscope Commercial |
$115.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.31
|
| Rate for Payer: Mclaren Medicaid |
$44.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.71
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.16
|
| Rate for Payer: Nomi Health Commercial |
$105.30
|
| Rate for Payer: PACE Senior Care Partners |
$30.50
|
| Rate for Payer: PACE SWMI |
$32.10
|
| Rate for Payer: PHP Commercial |
$109.16
|
| Rate for Payer: PHP Medicare Advantage |
$32.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.47
|
| Rate for Payer: Priority Health HMO/PPO |
$111.73
|
| Rate for Payer: Priority Health Medicare |
$32.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.04
|
| Rate for Payer: Railroad Medicare Medicare |
$32.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.01
|
| Rate for Payer: UHC Core |
$107.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.10
|
| Rate for Payer: UHC Exchange |
$32.10
|
| Rate for Payer: UHC Medicare Advantage |
$32.10
|
| Rate for Payer: UHCCP Medicaid |
$44.93
|
| Rate for Payer: VA VA |
$32.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.31
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
IP
|
$1,546.41
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,005.17 |
| Max. Negotiated Rate |
$1,391.77 |
| Rate for Payer: Aetna Commercial |
$1,314.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.33
|
| Rate for Payer: BCN Commercial |
$1,195.07
|
| Rate for Payer: Cash Price |
$1,237.13
|
| Rate for Payer: Cofinity Commercial |
$1,329.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,237.13
|
| Rate for Payer: Healthscope Commercial |
$1,391.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.45
|
| Rate for Payer: Nomi Health Commercial |
$1,268.06
|
| Rate for Payer: PHP Commercial |
$1,314.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,345.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,036.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,360.84
|
| Rate for Payer: UHC Core |
$1,291.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.81
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
OP
|
$1,546.41
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$367.27 |
| Max. Negotiated Rate |
$1,391.77 |
| Rate for Payer: Aetna Commercial |
$1,314.45
|
| Rate for Payer: Aetna Medicare |
$402.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$483.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$483.25
|
| Rate for Payer: BCBS Complete |
$618.56
|
| Rate for Payer: BCBS MAPPO |
$386.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.30
|
| Rate for Payer: BCN Commercial |
$1,202.33
|
| Rate for Payer: BCN Medicare Advantage |
$386.60
|
| Rate for Payer: Cash Price |
$1,237.13
|
| Rate for Payer: Cofinity Commercial |
$1,329.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,237.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.60
|
| Rate for Payer: Healthscope Commercial |
$1,391.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$405.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$444.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.45
|
| Rate for Payer: Nomi Health Commercial |
$1,268.06
|
| Rate for Payer: PACE Senior Care Partners |
$367.27
|
| Rate for Payer: PACE SWMI |
$386.60
|
| Rate for Payer: PHP Commercial |
$1,314.45
|
| Rate for Payer: PHP Medicare Advantage |
$386.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,345.38
|
| Rate for Payer: Priority Health Medicare |
$390.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,036.09
|
| Rate for Payer: Railroad Medicare Medicare |
$386.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,360.84
|
| Rate for Payer: UHC Core |
$1,291.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$386.60
|
| Rate for Payer: UHC Exchange |
$386.60
|
| Rate for Payer: UHC Medicare Advantage |
$386.60
|
| Rate for Payer: VA VA |
$386.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.81
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
OP
|
$300.99
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.49 |
| Max. Negotiated Rate |
$270.89 |
| Rate for Payer: Aetna Commercial |
$255.84
|
| Rate for Payer: Aetna Medicare |
$78.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.06
|
| Rate for Payer: BCBS Complete |
$85.37
|
| Rate for Payer: BCBS MAPPO |
$75.25
|
| Rate for Payer: BCBS Trust/PPO |
$247.44
|
| Rate for Payer: BCN Commercial |
$234.02
|
| Rate for Payer: BCN Medicare Advantage |
$75.25
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cofinity Commercial |
$258.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.25
|
| Rate for Payer: Healthscope Commercial |
$270.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.74
|
| Rate for Payer: Mclaren Medicaid |
$81.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.01
|
| Rate for Payer: Meridian Medicaid |
$85.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.84
|
| Rate for Payer: Nomi Health Commercial |
$246.81
|
| Rate for Payer: PACE Senior Care Partners |
$71.49
|
| Rate for Payer: PACE SWMI |
$75.25
|
| Rate for Payer: PHP Commercial |
$255.84
|
| Rate for Payer: PHP Medicare Advantage |
$75.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.64
|
| Rate for Payer: Priority Health HMO/PPO |
$261.86
|
| Rate for Payer: Priority Health Medicare |
$76.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.66
|
| Rate for Payer: Railroad Medicare Medicare |
$75.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.87
|
| Rate for Payer: UHC Core |
$251.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.25
|
| Rate for Payer: UHC Exchange |
$75.25
|
| Rate for Payer: UHC Medicare Advantage |
$75.25
|
| Rate for Payer: UHCCP Medicaid |
$81.30
|
| Rate for Payer: VA VA |
$75.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.74
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
IP
|
$300.99
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.64 |
| Max. Negotiated Rate |
$270.89 |
| Rate for Payer: Aetna Commercial |
$255.84
|
| Rate for Payer: BCBS Trust/PPO |
$245.70
|
| Rate for Payer: BCN Commercial |
$232.61
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cofinity Commercial |
$258.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.79
|
| Rate for Payer: Healthscope Commercial |
$270.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.84
|
| Rate for Payer: Nomi Health Commercial |
$246.81
|
| Rate for Payer: PHP Commercial |
$255.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.64
|
| Rate for Payer: Priority Health HMO/PPO |
$261.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.87
|
| Rate for Payer: UHC Core |
$251.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.74
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$92.19
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$82.97 |
| Rate for Payer: Aetna Commercial |
$78.36
|
| Rate for Payer: BCBS Trust/PPO |
$75.25
|
| Rate for Payer: BCN Commercial |
$71.24
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cofinity Commercial |
$79.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.75
|
| Rate for Payer: Healthscope Commercial |
$82.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.36
|
| Rate for Payer: Nomi Health Commercial |
$75.60
|
| Rate for Payer: PHP Commercial |
$78.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: Priority Health HMO/PPO |
$80.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.13
|
| Rate for Payer: UHC Core |
$76.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.14
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$92.19
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$97.86 |
| Rate for Payer: Aetna Commercial |
$78.36
|
| Rate for Payer: Aetna Medicare |
$23.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.81
|
| Rate for Payer: BCBS Complete |
$97.86
|
| Rate for Payer: BCBS MAPPO |
$23.05
|
| Rate for Payer: BCBS Trust/PPO |
$75.79
|
| Rate for Payer: BCN Commercial |
$71.68
|
| Rate for Payer: BCN Medicare Advantage |
$23.05
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cofinity Commercial |
$79.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.05
|
| Rate for Payer: Healthscope Commercial |
$82.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.14
|
| Rate for Payer: Mclaren Medicaid |
$93.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.20
|
| Rate for Payer: Meridian Medicaid |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.36
|
| Rate for Payer: Nomi Health Commercial |
$75.60
|
| Rate for Payer: PACE Senior Care Partners |
$21.90
|
| Rate for Payer: PACE SWMI |
$23.05
|
| Rate for Payer: PHP Commercial |
$78.36
|
| Rate for Payer: PHP Medicare Advantage |
$23.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: Priority Health HMO/PPO |
$80.21
|
| Rate for Payer: Priority Health Medicare |
$23.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.77
|
| Rate for Payer: Railroad Medicare Medicare |
$23.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.13
|
| Rate for Payer: UHC Core |
$76.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.05
|
| Rate for Payer: UHC Exchange |
$23.05
|
| Rate for Payer: UHC Medicare Advantage |
$23.05
|
| Rate for Payer: UHCCP Medicaid |
$93.19
|
| Rate for Payer: VA VA |
$23.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.14
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
IP
|
$261.73
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$170.12 |
| Max. Negotiated Rate |
$235.56 |
| Rate for Payer: Aetna Commercial |
$222.47
|
| Rate for Payer: BCBS Trust/PPO |
$213.65
|
| Rate for Payer: BCN Commercial |
$202.26
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cofinity Commercial |
$225.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.38
|
| Rate for Payer: Healthscope Commercial |
$235.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.47
|
| Rate for Payer: Nomi Health Commercial |
$214.62
|
| Rate for Payer: PHP Commercial |
$222.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.12
|
| Rate for Payer: Priority Health HMO/PPO |
$227.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.32
|
| Rate for Payer: UHC Core |
$218.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.30
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
OP
|
$261.73
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$62.16 |
| Max. Negotiated Rate |
$235.56 |
| Rate for Payer: Aetna Commercial |
$222.47
|
| Rate for Payer: Aetna Medicare |
$68.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.79
|
| Rate for Payer: BCBS Complete |
$104.69
|
| Rate for Payer: BCBS MAPPO |
$65.43
|
| Rate for Payer: BCBS Trust/PPO |
$215.17
|
| Rate for Payer: BCN Commercial |
$203.50
|
| Rate for Payer: BCN Medicare Advantage |
$65.43
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cofinity Commercial |
$225.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.43
|
| Rate for Payer: Healthscope Commercial |
$235.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.47
|
| Rate for Payer: Nomi Health Commercial |
$214.62
|
| Rate for Payer: PACE Senior Care Partners |
$62.16
|
| Rate for Payer: PACE SWMI |
$65.43
|
| Rate for Payer: PHP Commercial |
$222.47
|
| Rate for Payer: PHP Medicare Advantage |
$65.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.12
|
| Rate for Payer: Priority Health HMO/PPO |
$227.71
|
| Rate for Payer: Priority Health Medicare |
$66.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.36
|
| Rate for Payer: Railroad Medicare Medicare |
$65.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.32
|
| Rate for Payer: UHC Core |
$218.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.43
|
| Rate for Payer: UHC Exchange |
$65.43
|
| Rate for Payer: UHC Medicare Advantage |
$65.43
|
| Rate for Payer: VA VA |
$65.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.30
|
|
