|
HC AMNISURE ROM
|
Facility
|
OP
|
$211.71
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
30000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$190.54 |
| Rate for Payer: Aetna Commercial |
$179.95
|
| Rate for Payer: Aetna Medicare |
$55.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.16
|
| Rate for Payer: BCBS Complete |
$39.19
|
| Rate for Payer: BCBS MAPPO |
$52.93
|
| Rate for Payer: BCBS Trust/PPO |
$174.05
|
| Rate for Payer: BCN Commercial |
$174.05
|
| Rate for Payer: BCN Medicare Advantage |
$52.93
|
| Rate for Payer: Cash Price |
$169.37
|
| Rate for Payer: Cofinity Commercial |
$182.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.93
|
| Rate for Payer: Healthscope Commercial |
$190.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.78
|
| Rate for Payer: Mclaren Medicaid |
$37.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.57
|
| Rate for Payer: Meridian Medicaid |
$39.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.95
|
| Rate for Payer: Nomi Health Commercial |
$173.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.78
|
| Rate for Payer: PACE Senior Care Partners |
$50.28
|
| Rate for Payer: PACE SWMI |
$52.93
|
| Rate for Payer: PHP Commercial |
$179.95
|
| Rate for Payer: PHP Medicare Advantage |
$52.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.19
|
| Rate for Payer: Priority Health Medicare |
$53.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.35
|
| Rate for Payer: Railroad Medicare Medicare |
$52.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.30
|
| Rate for Payer: UHC Core |
$176.78
|
| Rate for Payer: UHC Exchange |
$52.93
|
| Rate for Payer: UHC Medicaid |
$37.32
|
| Rate for Payer: UHC Medicare Advantage |
$52.93
|
| Rate for Payer: UHCCP Medicaid |
$37.32
|
| Rate for Payer: VA VA |
$52.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.78
|
|
|
HC AMNISURE ROM
|
Facility
|
IP
|
$211.71
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
30000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.35 |
| Max. Negotiated Rate |
$190.54 |
| Rate for Payer: Aetna Commercial |
$179.95
|
| Rate for Payer: BCBS Trust/PPO |
$174.85
|
| Rate for Payer: BCN Commercial |
$174.85
|
| Rate for Payer: Cash Price |
$169.37
|
| Rate for Payer: Cofinity Commercial |
$182.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.37
|
| Rate for Payer: Healthscope Commercial |
$190.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.95
|
| Rate for Payer: Nomi Health Commercial |
$173.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.78
|
| Rate for Payer: PHP Commercial |
$179.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.30
|
| Rate for Payer: UHC Core |
$176.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.78
|
|
|
HC AMPA-R AB CBA, SERUM
|
Facility
|
IP
|
$520.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$362.06 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$442.17
|
| Rate for Payer: BCBS Trust/PPO |
$429.63
|
| Rate for Payer: BCN Commercial |
$429.63
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$447.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Healthscope Commercial |
$468.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.15
|
| Rate for Payer: PHP Commercial |
$442.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$452.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.78
|
| Rate for Payer: UHC Core |
$434.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.15
|
|
|
HC AMPA-R AB CBA, SERUM
|
Facility
|
OP
|
$520.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$91.71 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$442.17
|
| Rate for Payer: Aetna Medicare |
$135.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.56
|
| Rate for Payer: BCBS Complete |
$96.29
|
| Rate for Payer: BCBS MAPPO |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$427.66
|
| Rate for Payer: BCN Commercial |
$427.66
|
| Rate for Payer: BCN Medicare Advantage |
$130.05
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Commercial |
$447.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.05
|
| Rate for Payer: Healthscope Commercial |
$468.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.15
|
| Rate for Payer: Mclaren Medicaid |
$91.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.55
|
| Rate for Payer: Meridian Medicaid |
$96.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$426.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.15
|
| Rate for Payer: PACE Senior Care Partners |
$123.55
|
| Rate for Payer: PACE SWMI |
$130.05
|
| Rate for Payer: PHP Commercial |
$442.17
|
| Rate for Payer: PHP Medicare Advantage |
$130.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$452.57
|
| Rate for Payer: Priority Health Medicare |
$131.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.06
|
| Rate for Payer: Railroad Medicare Medicare |
$130.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.78
|
| Rate for Payer: UHC Core |
$434.37
|
| Rate for Payer: UHC Exchange |
$130.05
|
| Rate for Payer: UHC Medicaid |
$91.71
|
| Rate for Payer: UHC Medicare Advantage |
$130.05
|
| Rate for Payer: UHCCP Medicaid |
$91.71
|
| Rate for Payer: VA VA |
$130.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.15
|
|
|
HC AMPA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200417
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Medicare |
$31.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.39
|
| Rate for Payer: BCBS Complete |
$22.15
|
| Rate for Payer: BCBS MAPPO |
$29.91
|
| Rate for Payer: BCBS Trust/PPO |
$98.36
|
| Rate for Payer: BCN Commercial |
$98.36
|
| Rate for Payer: BCN Medicare Advantage |
$29.91
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.91
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.74
|
| Rate for Payer: Mclaren Medicaid |
$21.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.41
|
| Rate for Payer: Meridian Medicaid |
$22.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PACE Senior Care Partners |
$28.42
|
| Rate for Payer: PACE SWMI |
$29.91
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: PHP Medicare Advantage |
$29.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$104.10
|
| Rate for Payer: Priority Health Medicare |
$30.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.28
|
| Rate for Payer: Railroad Medicare Medicare |
$29.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.29
|
| Rate for Payer: UHC Core |
$99.91
|
| Rate for Payer: UHC Exchange |
$29.91
|
| Rate for Payer: UHC Medicaid |
$21.09
|
| Rate for Payer: UHC Medicare Advantage |
$29.91
|
| Rate for Payer: UHCCP Medicaid |
$21.09
|
| Rate for Payer: VA VA |
$29.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.74
|
|
|
HC AMPA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200417
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: BCBS Trust/PPO |
$98.82
|
| Rate for Payer: BCN Commercial |
$98.82
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$104.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.29
|
| Rate for Payer: UHC Core |
$99.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.74
|
|
|
HC AMP FINGER/THUMB W DIRECT CLOSURE
|
Facility
|
IP
|
$4,957.82
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
45000090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,450.64 |
| Max. Negotiated Rate |
$4,462.04 |
| Rate for Payer: Aetna Commercial |
$4,214.15
|
| Rate for Payer: BCBS Trust/PPO |
$4,094.66
|
| Rate for Payer: BCN Commercial |
$4,094.66
|
| Rate for Payer: Cash Price |
$3,966.26
|
| Rate for Payer: Cofinity Commercial |
$4,263.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,966.26
|
| Rate for Payer: Healthscope Commercial |
$4,462.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,718.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,214.15
|
| Rate for Payer: Nomi Health Commercial |
$4,065.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,718.36
|
| Rate for Payer: PHP Commercial |
$4,214.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,313.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,450.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,362.88
|
| Rate for Payer: UHC Core |
$4,139.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,718.36
|
|
|
HC AMP FINGER/THUMB W DIRECT CLOSURE
|
Facility
|
OP
|
$4,957.82
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
45000090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$4,462.04 |
| Rate for Payer: Aetna Commercial |
$4,214.15
|
| Rate for Payer: Aetna Medicare |
$1,289.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,549.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,549.32
|
| Rate for Payer: BCBS Complete |
$917.69
|
| Rate for Payer: BCBS MAPPO |
$1,239.45
|
| Rate for Payer: BCBS Trust/PPO |
$4,075.82
|
| Rate for Payer: BCN Commercial |
$4,075.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,239.45
|
| Rate for Payer: Cash Price |
$3,966.26
|
| Rate for Payer: Cash Price |
$3,966.26
|
| Rate for Payer: Cofinity Commercial |
$4,263.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,966.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,239.45
|
| Rate for Payer: Healthscope Commercial |
$4,462.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,718.36
|
| Rate for Payer: Mclaren Medicaid |
$874.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,301.43
|
| Rate for Payer: Meridian Medicaid |
$917.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,425.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,363.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,214.15
|
| Rate for Payer: Nomi Health Commercial |
$4,065.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,718.36
|
| Rate for Payer: PACE Senior Care Partners |
$1,177.48
|
| Rate for Payer: PACE SWMI |
$1,239.45
|
| Rate for Payer: PHP Commercial |
$4,214.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,239.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$874.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,313.30
|
| Rate for Payer: Priority Health Medicare |
$1,251.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,450.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,239.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,362.88
|
| Rate for Payer: UHC Core |
$4,139.78
|
| Rate for Payer: UHC Exchange |
$1,239.45
|
| Rate for Payer: UHC Medicaid |
$874.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,239.45
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$1,239.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,718.36
|
|
|
HC AMP FINGER/THUMB W FLAP
|
Facility
|
OP
|
$4,751.30
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
45000091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$4,276.17 |
| Rate for Payer: Aetna Commercial |
$4,038.61
|
| Rate for Payer: Aetna Medicare |
$1,235.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,484.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,484.78
|
| Rate for Payer: BCBS Complete |
$879.47
|
| Rate for Payer: BCBS MAPPO |
$1,187.83
|
| Rate for Payer: BCBS Trust/PPO |
$3,906.04
|
| Rate for Payer: BCN Commercial |
$3,906.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,187.83
|
| Rate for Payer: Cash Price |
$3,801.04
|
| Rate for Payer: Cash Price |
$3,801.04
|
| Rate for Payer: Cofinity Commercial |
$4,086.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,801.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,187.83
|
| Rate for Payer: Healthscope Commercial |
$4,276.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,563.47
|
| Rate for Payer: Mclaren Medicaid |
$837.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.22
|
| Rate for Payer: Meridian Medicaid |
$879.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,366.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,306.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,038.61
|
| Rate for Payer: Nomi Health Commercial |
$3,896.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,563.47
|
| Rate for Payer: PACE Senior Care Partners |
$1,128.43
|
| Rate for Payer: PACE SWMI |
$1,187.83
|
| Rate for Payer: PHP Commercial |
$4,038.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,187.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,133.63
|
| Rate for Payer: Priority Health Medicare |
$1,199.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,306.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,187.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,181.14
|
| Rate for Payer: UHC Core |
$3,967.34
|
| Rate for Payer: UHC Exchange |
$1,187.83
|
| Rate for Payer: UHC Medicaid |
$837.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,187.83
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$1,187.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,563.47
|
|
|
HC AMP FINGER/THUMB W FLAP
|
Facility
|
IP
|
$4,751.30
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
45000091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,306.90 |
| Max. Negotiated Rate |
$4,276.17 |
| Rate for Payer: Aetna Commercial |
$4,038.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,924.10
|
| Rate for Payer: BCN Commercial |
$3,924.10
|
| Rate for Payer: Cash Price |
$3,801.04
|
| Rate for Payer: Cofinity Commercial |
$4,086.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,801.04
|
| Rate for Payer: Healthscope Commercial |
$4,276.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,563.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,038.61
|
| Rate for Payer: Nomi Health Commercial |
$3,896.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,563.47
|
| Rate for Payer: PHP Commercial |
$4,038.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,133.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,306.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,181.14
|
| Rate for Payer: UHC Core |
$3,967.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,563.47
|
|
|
HC AMPHETAMINES 3 OR 4
|
Facility
|
OP
|
$38.49
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
30000173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna Medicare |
$10.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.03
|
| Rate for Payer: BCBS Complete |
$7.12
|
| Rate for Payer: BCBS MAPPO |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$31.64
|
| Rate for Payer: BCN Commercial |
$31.64
|
| Rate for Payer: BCN Medicare Advantage |
$9.62
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.87
|
| Rate for Payer: Mclaren Medicaid |
$6.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.10
|
| Rate for Payer: Meridian Medicaid |
$7.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.87
|
| Rate for Payer: PACE Senior Care Partners |
$9.14
|
| Rate for Payer: PACE SWMI |
$9.62
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: PHP Medicare Advantage |
$9.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.49
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.87
|
| Rate for Payer: UHC Core |
$32.14
|
| Rate for Payer: UHC Exchange |
$9.62
|
| Rate for Payer: UHC Medicaid |
$6.79
|
| Rate for Payer: UHC Medicare Advantage |
$9.62
|
| Rate for Payer: UHCCP Medicaid |
$6.79
|
| Rate for Payer: VA VA |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.87
|
|
|
HC AMPHETAMINES 3 OR 4
|
Facility
|
IP
|
$38.49
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
30000173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: BCBS Trust/PPO |
$31.79
|
| Rate for Payer: BCN Commercial |
$31.79
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.87
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.87
|
| Rate for Payer: UHC Core |
$32.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.87
|
|
|
HC AMPHETAMINE URIN
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000139
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Medicare |
$28.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.77
|
| Rate for Payer: BCBS Complete |
$20.59
|
| Rate for Payer: BCBS MAPPO |
$27.81
|
| Rate for Payer: BCBS Trust/PPO |
$91.46
|
| Rate for Payer: BCN Commercial |
$91.46
|
| Rate for Payer: BCN Medicare Advantage |
$27.81
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.81
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.44
|
| Rate for Payer: Mclaren Medicaid |
$19.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.20
|
| Rate for Payer: Meridian Medicaid |
$20.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PACE Senior Care Partners |
$26.42
|
| Rate for Payer: PACE SWMI |
$27.81
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Medicare Advantage |
$27.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.79
|
| Rate for Payer: Priority Health Medicare |
$28.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.43
|
| Rate for Payer: Railroad Medicare Medicare |
$27.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.90
|
| Rate for Payer: UHC Core |
$92.89
|
| Rate for Payer: UHC Exchange |
$27.81
|
| Rate for Payer: UHC Medicaid |
$19.61
|
| Rate for Payer: UHC Medicare Advantage |
$27.81
|
| Rate for Payer: UHCCP Medicaid |
$19.61
|
| Rate for Payer: VA VA |
$27.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.44
|
|
|
HC AMPHETAMINE URIN
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000139
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.43 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: BCBS Trust/PPO |
$91.88
|
| Rate for Payer: BCN Commercial |
$91.88
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$91.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.90
|
| Rate for Payer: UHC Core |
$92.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.44
|
|
|
HC AMPHETAMINE URN CMPT
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
30100570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna Commercial |
$27.41
|
| Rate for Payer: Aetna Medicare |
$8.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.08
|
| Rate for Payer: BCBS Complete |
$5.97
|
| Rate for Payer: BCBS MAPPO |
$8.06
|
| Rate for Payer: BCBS Trust/PPO |
$26.51
|
| Rate for Payer: BCN Commercial |
$26.51
|
| Rate for Payer: BCN Medicare Advantage |
$8.06
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$27.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$29.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.19
|
| Rate for Payer: Mclaren Medicaid |
$5.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.47
|
| Rate for Payer: Meridian Medicaid |
$5.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: PACE Senior Care Partners |
$7.66
|
| Rate for Payer: PACE SWMI |
$8.06
|
| Rate for Payer: PHP Commercial |
$27.41
|
| Rate for Payer: PHP Medicare Advantage |
$8.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.06
|
| Rate for Payer: Priority Health Medicare |
$8.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.45
|
| Rate for Payer: Railroad Medicare Medicare |
$8.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.38
|
| Rate for Payer: UHC Core |
$26.93
|
| Rate for Payer: UHC Exchange |
$8.06
|
| Rate for Payer: UHC Medicaid |
$5.69
|
| Rate for Payer: UHC Medicare Advantage |
$8.06
|
| Rate for Payer: UHCCP Medicaid |
$5.69
|
| Rate for Payer: VA VA |
$8.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.19
|
|
|
HC AMPHETAMINE URN CMPT
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
30100570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna Commercial |
$27.41
|
| Rate for Payer: BCBS Trust/PPO |
$26.64
|
| Rate for Payer: BCN Commercial |
$26.64
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$27.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$29.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: PHP Commercial |
$27.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.38
|
| Rate for Payer: UHC Core |
$26.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.19
|
|
|
HC AMPHIPHYSIN WESTERN BLOT
|
Facility
|
OP
|
$296.51
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100677
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.27 |
| Max. Negotiated Rate |
$266.86 |
| Rate for Payer: Aetna Commercial |
$252.03
|
| Rate for Payer: Aetna Medicare |
$77.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.66
|
| Rate for Payer: BCBS Complete |
$54.88
|
| Rate for Payer: BCBS MAPPO |
$74.13
|
| Rate for Payer: BCBS Trust/PPO |
$243.76
|
| Rate for Payer: BCN Commercial |
$243.76
|
| Rate for Payer: BCN Medicare Advantage |
$74.13
|
| Rate for Payer: Cash Price |
$237.21
|
| Rate for Payer: Cofinity Commercial |
$255.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.13
|
| Rate for Payer: Healthscope Commercial |
$266.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.38
|
| Rate for Payer: Mclaren Medicaid |
$52.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.83
|
| Rate for Payer: Meridian Medicaid |
$54.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.03
|
| Rate for Payer: Nomi Health Commercial |
$243.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.38
|
| Rate for Payer: PACE Senior Care Partners |
$70.42
|
| Rate for Payer: PACE SWMI |
$74.13
|
| Rate for Payer: PHP Commercial |
$252.03
|
| Rate for Payer: PHP Medicare Advantage |
$74.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$257.96
|
| Rate for Payer: Priority Health Medicare |
$74.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.37
|
| Rate for Payer: Railroad Medicare Medicare |
$74.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.93
|
| Rate for Payer: UHC Core |
$247.59
|
| Rate for Payer: UHC Exchange |
$74.13
|
| Rate for Payer: UHC Medicaid |
$52.27
|
| Rate for Payer: UHC Medicare Advantage |
$74.13
|
| Rate for Payer: UHCCP Medicaid |
$52.27
|
| Rate for Payer: VA VA |
$74.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.38
|
|
|
HC AMPHIPHYSIN WESTERN BLOT
|
Facility
|
IP
|
$296.51
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100677
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$206.37 |
| Max. Negotiated Rate |
$266.86 |
| Rate for Payer: Aetna Commercial |
$252.03
|
| Rate for Payer: BCBS Trust/PPO |
$244.89
|
| Rate for Payer: BCN Commercial |
$244.89
|
| Rate for Payer: Cash Price |
$237.21
|
| Rate for Payer: Cofinity Commercial |
$255.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.21
|
| Rate for Payer: Healthscope Commercial |
$266.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.03
|
| Rate for Payer: Nomi Health Commercial |
$243.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.38
|
| Rate for Payer: PHP Commercial |
$252.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$257.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.93
|
| Rate for Payer: UHC Core |
$247.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.38
|
|
|
HC AMPUTATION TOE INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$9,426.02
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
76100428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,661.81 |
| Max. Negotiated Rate |
$8,483.42 |
| Rate for Payer: Aetna Commercial |
$8,012.12
|
| Rate for Payer: Aetna Medicare |
$2,450.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,945.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,945.63
|
| Rate for Payer: BCBS Complete |
$1,744.76
|
| Rate for Payer: BCBS MAPPO |
$2,356.51
|
| Rate for Payer: BCBS Trust/PPO |
$7,749.13
|
| Rate for Payer: BCN Commercial |
$7,749.13
|
| Rate for Payer: BCN Medicare Advantage |
$2,356.51
|
| Rate for Payer: Cash Price |
$7,540.82
|
| Rate for Payer: Cofinity Commercial |
$8,106.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,540.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,356.51
|
| Rate for Payer: Healthscope Commercial |
$8,483.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,069.52
|
| Rate for Payer: Mclaren Medicaid |
$1,661.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,474.33
|
| Rate for Payer: Meridian Medicaid |
$1,744.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,709.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,592.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,012.12
|
| Rate for Payer: Nomi Health Commercial |
$7,729.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,069.52
|
| Rate for Payer: PACE Senior Care Partners |
$2,238.68
|
| Rate for Payer: PACE SWMI |
$2,356.51
|
| Rate for Payer: PHP Commercial |
$8,012.12
|
| Rate for Payer: PHP Medicare Advantage |
$2,356.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,661.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,200.64
|
| Rate for Payer: Priority Health Medicare |
$2,380.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,560.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2,356.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,294.90
|
| Rate for Payer: UHC Core |
$7,870.73
|
| Rate for Payer: UHC Exchange |
$2,356.51
|
| Rate for Payer: UHC Medicaid |
$1,661.81
|
| Rate for Payer: UHC Medicare Advantage |
$2,356.51
|
| Rate for Payer: UHCCP Medicaid |
$1,661.81
|
| Rate for Payer: VA VA |
$2,356.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,069.52
|
|
|
HC AMPUTATION TOE INTERPHALANGEAL JOINT
|
Facility
|
IP
|
$9,426.02
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
76100428
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,560.51 |
| Max. Negotiated Rate |
$8,483.42 |
| Rate for Payer: Aetna Commercial |
$8,012.12
|
| Rate for Payer: BCBS Trust/PPO |
$7,784.95
|
| Rate for Payer: BCN Commercial |
$7,784.95
|
| Rate for Payer: Cash Price |
$7,540.82
|
| Rate for Payer: Cofinity Commercial |
$8,106.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,540.82
|
| Rate for Payer: Healthscope Commercial |
$8,483.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,069.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,012.12
|
| Rate for Payer: Nomi Health Commercial |
$7,729.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,069.52
|
| Rate for Payer: PHP Commercial |
$8,012.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,200.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,560.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,294.90
|
| Rate for Payer: UHC Core |
$7,870.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,069.52
|
|
|
HC AMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$41.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.00
|
| Rate for Payer: BCBS Complete |
$29.62
|
| Rate for Payer: BCBS MAPPO |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.54
|
| Rate for Payer: BCN Commercial |
$131.54
|
| Rate for Payer: BCN Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Mclaren Medicaid |
$28.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.00
|
| Rate for Payer: Meridian Medicaid |
$29.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PACE Senior Care Partners |
$38.00
|
| Rate for Payer: PACE SWMI |
$40.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: PHP Medicare Advantage |
$40.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Medicare |
$40.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: Railroad Medicare Medicare |
$40.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: UHC Exchange |
$40.00
|
| Rate for Payer: UHC Medicaid |
$28.21
|
| Rate for Payer: UHC Medicare Advantage |
$40.00
|
| Rate for Payer: UHCCP Medicaid |
$850.00
|
| Rate for Payer: VA VA |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC AMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$132.14
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC AMYLASE FLUID
|
Facility
|
IP
|
$62.84
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$56.56 |
| Rate for Payer: Aetna Commercial |
$53.41
|
| Rate for Payer: BCBS Trust/PPO |
$51.90
|
| Rate for Payer: BCN Commercial |
$51.90
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$54.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.27
|
| Rate for Payer: Healthscope Commercial |
$56.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.41
|
| Rate for Payer: Nomi Health Commercial |
$51.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.13
|
| Rate for Payer: PHP Commercial |
$53.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.30
|
| Rate for Payer: UHC Core |
$52.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.13
|
|
|
HC AMYLASE FLUID
|
Facility
|
OP
|
$62.84
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$56.56 |
| Rate for Payer: Aetna Commercial |
$53.41
|
| Rate for Payer: Aetna Medicare |
$16.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.64
|
| Rate for Payer: BCBS Complete |
$11.63
|
| Rate for Payer: BCBS MAPPO |
$15.71
|
| Rate for Payer: BCBS Trust/PPO |
$51.66
|
| Rate for Payer: BCN Commercial |
$51.66
|
| Rate for Payer: BCN Medicare Advantage |
$15.71
|
| Rate for Payer: Cash Price |
$50.27
|
| Rate for Payer: Cofinity Commercial |
$54.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$56.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.13
|
| Rate for Payer: Mclaren Medicaid |
$11.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.50
|
| Rate for Payer: Meridian Medicaid |
$11.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.41
|
| Rate for Payer: Nomi Health Commercial |
$51.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.13
|
| Rate for Payer: PACE Senior Care Partners |
$14.92
|
| Rate for Payer: PACE SWMI |
$15.71
|
| Rate for Payer: PHP Commercial |
$53.41
|
| Rate for Payer: PHP Medicare Advantage |
$15.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.67
|
| Rate for Payer: Priority Health Medicare |
$15.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.74
|
| Rate for Payer: Railroad Medicare Medicare |
$15.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.30
|
| Rate for Payer: UHC Core |
$52.47
|
| Rate for Payer: UHC Exchange |
$15.71
|
| Rate for Payer: UHC Medicaid |
$11.08
|
| Rate for Payer: UHC Medicare Advantage |
$15.71
|
| Rate for Payer: UHCCP Medicaid |
$11.08
|
| Rate for Payer: VA VA |
$15.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.13
|
|
|
HC AMYLASE PANCREATIC CYST FLUID
|
Facility
|
IP
|
$217.76
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100711
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$151.56 |
| Max. Negotiated Rate |
$195.98 |
| Rate for Payer: Aetna Commercial |
$185.10
|
| Rate for Payer: BCBS Trust/PPO |
$179.85
|
| Rate for Payer: BCN Commercial |
$179.85
|
| Rate for Payer: Cash Price |
$174.21
|
| Rate for Payer: Cofinity Commercial |
$187.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.21
|
| Rate for Payer: Healthscope Commercial |
$195.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.10
|
| Rate for Payer: Nomi Health Commercial |
$178.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.32
|
| Rate for Payer: PHP Commercial |
$185.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.63
|
| Rate for Payer: UHC Core |
$181.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.32
|
|
