|
HC ALPHA 1 ANTITRYPSIN GENOTYPE
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
30100084
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: BCBS Trust/PPO |
$50.95
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.82
|
|
|
HC ALPHA-1-ANTITRYPSIN PHENOTYPE, S
|
Facility
|
IP
|
$58.65
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
30100612
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$52.78 |
| Rate for Payer: Aetna Commercial |
$49.85
|
| Rate for Payer: BCBS Trust/PPO |
$47.88
|
| Rate for Payer: BCN Commercial |
$45.32
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cofinity Commercial |
$50.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.92
|
| Rate for Payer: Healthscope Commercial |
$52.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.85
|
| Rate for Payer: Nomi Health Commercial |
$48.09
|
| Rate for Payer: PHP Commercial |
$49.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.12
|
| Rate for Payer: Priority Health HMO/PPO |
$51.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.61
|
| Rate for Payer: UHC Core |
$48.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.99
|
|
|
HC ALPHA-1-ANTITRYPSIN PHENOTYPE, S
|
Facility
|
OP
|
$58.65
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
30100612
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$52.78 |
| Rate for Payer: Aetna Commercial |
$49.85
|
| Rate for Payer: Aetna Medicare |
$15.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.33
|
| Rate for Payer: BCBS Complete |
$10.98
|
| Rate for Payer: BCBS MAPPO |
$14.66
|
| Rate for Payer: BCBS Trust/PPO |
$48.22
|
| Rate for Payer: BCN Commercial |
$45.60
|
| Rate for Payer: BCN Medicare Advantage |
$14.66
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cash Price |
$46.92
|
| Rate for Payer: Cofinity Commercial |
$50.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.66
|
| Rate for Payer: Healthscope Commercial |
$52.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.99
|
| Rate for Payer: Mclaren Medicaid |
$10.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.40
|
| Rate for Payer: Meridian Medicaid |
$10.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.85
|
| Rate for Payer: Nomi Health Commercial |
$48.09
|
| Rate for Payer: PACE Senior Care Partners |
$13.93
|
| Rate for Payer: PACE SWMI |
$14.66
|
| Rate for Payer: PHP Commercial |
$49.85
|
| Rate for Payer: PHP Medicare Advantage |
$14.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.12
|
| Rate for Payer: Priority Health HMO/PPO |
$51.03
|
| Rate for Payer: Priority Health Medicare |
$14.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.30
|
| Rate for Payer: Railroad Medicare Medicare |
$14.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.61
|
| Rate for Payer: UHC Core |
$48.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.66
|
| Rate for Payer: UHC Exchange |
$14.66
|
| Rate for Payer: UHC Medicare Advantage |
$14.66
|
| Rate for Payer: UHCCP Medicaid |
$10.45
|
| Rate for Payer: VA VA |
$14.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.99
|
|
|
HC ALPHA DEFENSINS-SF
|
Facility
|
IP
|
$173.40
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200405
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$112.71 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$147.39
|
| Rate for Payer: BCBS Trust/PPO |
$141.55
|
| Rate for Payer: BCN Commercial |
$134.00
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$149.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.39
|
| Rate for Payer: Nomi Health Commercial |
$142.19
|
| Rate for Payer: PHP Commercial |
$147.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.71
|
| Rate for Payer: Priority Health HMO/PPO |
$150.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.59
|
| Rate for Payer: UHC Core |
$144.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.05
|
|
|
HC ALPHA DEFENSINS-SF
|
Facility
|
OP
|
$173.40
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200405
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$147.39
|
| Rate for Payer: Aetna Medicare |
$45.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.19
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS MAPPO |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$142.55
|
| Rate for Payer: BCN Commercial |
$134.82
|
| Rate for Payer: BCN Medicare Advantage |
$43.35
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$149.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.05
|
| Rate for Payer: Mclaren Medicaid |
$8.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.52
|
| Rate for Payer: Meridian Medicaid |
$8.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.39
|
| Rate for Payer: Nomi Health Commercial |
$142.19
|
| Rate for Payer: PACE Senior Care Partners |
$41.18
|
| Rate for Payer: PACE SWMI |
$43.35
|
| Rate for Payer: PHP Commercial |
$147.39
|
| Rate for Payer: PHP Medicare Advantage |
$43.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.71
|
| Rate for Payer: Priority Health HMO/PPO |
$150.86
|
| Rate for Payer: Priority Health Medicare |
$43.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.18
|
| Rate for Payer: Railroad Medicare Medicare |
$43.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.59
|
| Rate for Payer: UHC Core |
$144.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.35
|
| Rate for Payer: UHC Exchange |
$43.35
|
| Rate for Payer: UHC Medicare Advantage |
$43.35
|
| Rate for Payer: UHCCP Medicaid |
$8.34
|
| Rate for Payer: VA VA |
$43.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.05
|
|
|
HC ALPHA FETOPROTEIN AMNIOTIC
|
Facility
|
OP
|
$74.56
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
30200001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$67.10 |
| Rate for Payer: Aetna Commercial |
$63.38
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$12.91
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$61.30
|
| Rate for Payer: BCN Commercial |
$57.97
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$59.65
|
| Rate for Payer: Cash Price |
$59.65
|
| Rate for Payer: Cofinity Commercial |
$64.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$67.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.92
|
| Rate for Payer: Mclaren Medicaid |
$12.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.38
|
| Rate for Payer: Nomi Health Commercial |
$61.14
|
| Rate for Payer: PACE Senior Care Partners |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$63.38
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.46
|
| Rate for Payer: Priority Health HMO/PPO |
$64.87
|
| Rate for Payer: Priority Health Medicare |
$18.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.96
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.61
|
| Rate for Payer: UHC Core |
$62.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$12.29
|
| Rate for Payer: VA VA |
$18.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.92
|
|
|
HC ALPHA FETOPROTEIN AMNIOTIC
|
Facility
|
IP
|
$74.56
|
|
|
Service Code
|
CPT 82106
|
| Hospital Charge Code |
30200001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.46 |
| Max. Negotiated Rate |
$67.10 |
| Rate for Payer: Aetna Commercial |
$63.38
|
| Rate for Payer: BCBS Trust/PPO |
$60.86
|
| Rate for Payer: BCN Commercial |
$57.62
|
| Rate for Payer: Cash Price |
$59.65
|
| Rate for Payer: Cofinity Commercial |
$64.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.65
|
| Rate for Payer: Healthscope Commercial |
$67.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.38
|
| Rate for Payer: Nomi Health Commercial |
$61.14
|
| Rate for Payer: PHP Commercial |
$63.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.46
|
| Rate for Payer: Priority Health HMO/PPO |
$64.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.61
|
| Rate for Payer: UHC Core |
$62.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.92
|
|
|
HC ALPHA FETOPROTEIN SERUM
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100087
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$28.14
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC ALPHA FETOPROTEIN SERUM
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100087
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$9.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.38
|
| Rate for Payer: BCBS Complete |
$12.73
|
| Rate for Payer: BCBS MAPPO |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.93
|
| Rate for Payer: BCN Commercial |
$28.31
|
| Rate for Payer: BCN Medicare Advantage |
$9.10
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.10
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Mclaren Medicaid |
$12.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.56
|
| Rate for Payer: Meridian Medicaid |
$12.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.65
|
| Rate for Payer: PACE SWMI |
$9.10
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Medicare |
$9.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: Railroad Medicare Medicare |
$9.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.10
|
| Rate for Payer: UHC Exchange |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$9.10
|
| Rate for Payer: UHCCP Medicaid |
$12.12
|
| Rate for Payer: VA VA |
$9.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC ALPHA FETOPROTEIN TUMOR MARKER
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100086
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna Commercial |
$54.82
|
| Rate for Payer: Aetna Medicare |
$16.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.16
|
| Rate for Payer: BCBS Complete |
$12.73
|
| Rate for Payer: BCBS MAPPO |
$16.12
|
| Rate for Payer: BCBS Trust/PPO |
$53.03
|
| Rate for Payer: BCN Commercial |
$50.15
|
| Rate for Payer: BCN Medicare Advantage |
$16.12
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.12
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.38
|
| Rate for Payer: Mclaren Medicaid |
$12.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.93
|
| Rate for Payer: Meridian Medicaid |
$12.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.82
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: PACE Senior Care Partners |
$15.32
|
| Rate for Payer: PACE SWMI |
$16.12
|
| Rate for Payer: PHP Commercial |
$54.82
|
| Rate for Payer: PHP Medicare Advantage |
$16.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.92
|
| Rate for Payer: Priority Health HMO/PPO |
$56.12
|
| Rate for Payer: Priority Health Medicare |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.22
|
| Rate for Payer: Railroad Medicare Medicare |
$16.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.76
|
| Rate for Payer: UHC Core |
$53.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.12
|
| Rate for Payer: UHC Exchange |
$16.12
|
| Rate for Payer: UHC Medicare Advantage |
$16.12
|
| Rate for Payer: UHCCP Medicaid |
$12.12
|
| Rate for Payer: VA VA |
$16.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.38
|
|
|
HC ALPHA FETOPROTEIN TUMOR MARKER
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
30100086
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna Commercial |
$54.82
|
| Rate for Payer: BCBS Trust/PPO |
$52.65
|
| Rate for Payer: BCN Commercial |
$49.85
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.82
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: PHP Commercial |
$54.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.92
|
| Rate for Payer: Priority Health HMO/PPO |
$56.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.76
|
| Rate for Payer: UHC Core |
$53.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.38
|
|
|
HC ALPHA-GLOBIN GENE ANALYSIS
|
Facility
|
IP
|
$421.61
|
|
|
Service Code
|
CPT 81269
|
| Hospital Charge Code |
31000088
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$274.05 |
| Max. Negotiated Rate |
$379.45 |
| Rate for Payer: Aetna Commercial |
$358.37
|
| Rate for Payer: BCBS Trust/PPO |
$344.16
|
| Rate for Payer: BCN Commercial |
$325.82
|
| Rate for Payer: Cash Price |
$337.29
|
| Rate for Payer: Cofinity Commercial |
$362.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.29
|
| Rate for Payer: Healthscope Commercial |
$379.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.37
|
| Rate for Payer: Nomi Health Commercial |
$345.72
|
| Rate for Payer: PHP Commercial |
$358.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.05
|
| Rate for Payer: Priority Health HMO/PPO |
$366.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.02
|
| Rate for Payer: UHC Core |
$352.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.21
|
|
|
HC ALPHA-GLOBIN GENE ANALYSIS
|
Facility
|
OP
|
$421.61
|
|
|
Service Code
|
CPT 81269
|
| Hospital Charge Code |
31000088
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.13 |
| Max. Negotiated Rate |
$379.45 |
| Rate for Payer: Aetna Commercial |
$358.37
|
| Rate for Payer: Aetna Medicare |
$109.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.75
|
| Rate for Payer: BCBS Complete |
$153.66
|
| Rate for Payer: BCBS MAPPO |
$105.40
|
| Rate for Payer: BCBS Trust/PPO |
$346.61
|
| Rate for Payer: BCN Commercial |
$327.80
|
| Rate for Payer: BCN Medicare Advantage |
$105.40
|
| Rate for Payer: Cash Price |
$337.29
|
| Rate for Payer: Cash Price |
$337.29
|
| Rate for Payer: Cofinity Commercial |
$362.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.40
|
| Rate for Payer: Healthscope Commercial |
$379.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.21
|
| Rate for Payer: Mclaren Medicaid |
$146.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.67
|
| Rate for Payer: Meridian Medicaid |
$153.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.37
|
| Rate for Payer: Nomi Health Commercial |
$345.72
|
| Rate for Payer: PACE Senior Care Partners |
$100.13
|
| Rate for Payer: PACE SWMI |
$105.40
|
| Rate for Payer: PHP Commercial |
$358.37
|
| Rate for Payer: PHP Medicare Advantage |
$105.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.05
|
| Rate for Payer: Priority Health HMO/PPO |
$366.80
|
| Rate for Payer: Priority Health Medicare |
$106.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.48
|
| Rate for Payer: Railroad Medicare Medicare |
$105.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.02
|
| Rate for Payer: UHC Core |
$352.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.40
|
| Rate for Payer: UHC Exchange |
$105.40
|
| Rate for Payer: UHC Medicare Advantage |
$105.40
|
| Rate for Payer: UHCCP Medicaid |
$146.34
|
| Rate for Payer: VA VA |
$105.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.21
|
|
|
HC ALTEPLASE RECOMBINANT, PER 1 MG
|
Facility
|
OP
|
$88.43
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
63600144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: Aetna Medicare |
$22.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.63
|
| Rate for Payer: BCBS Complete |
$69.45
|
| Rate for Payer: BCBS MAPPO |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$72.70
|
| Rate for Payer: BCN Commercial |
$68.75
|
| Rate for Payer: BCN Medicare Advantage |
$22.11
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$76.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.11
|
| Rate for Payer: Healthscope Commercial |
$79.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.32
|
| Rate for Payer: Mclaren Medicaid |
$66.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.21
|
| Rate for Payer: Meridian Medicaid |
$69.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: Nomi Health Commercial |
$72.51
|
| Rate for Payer: PACE Senior Care Partners |
$21.00
|
| Rate for Payer: PACE SWMI |
$22.11
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: PHP Medicare Advantage |
$22.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.48
|
| Rate for Payer: Priority Health HMO/PPO |
$76.93
|
| Rate for Payer: Priority Health Medicare |
$22.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.25
|
| Rate for Payer: Railroad Medicare Medicare |
$22.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.82
|
| Rate for Payer: UHC Core |
$73.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.11
|
| Rate for Payer: UHC Exchange |
$22.11
|
| Rate for Payer: UHC Medicare Advantage |
$22.11
|
| Rate for Payer: UHCCP Medicaid |
$66.14
|
| Rate for Payer: VA VA |
$22.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.32
|
|
|
HC ALTEPLASE RECOMBINANT, PER 1 MG
|
Facility
|
IP
|
$88.43
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
63600144
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$79.59 |
| Rate for Payer: Aetna Commercial |
$75.17
|
| Rate for Payer: BCBS Trust/PPO |
$72.19
|
| Rate for Payer: BCN Commercial |
$68.34
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cofinity Commercial |
$76.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.74
|
| Rate for Payer: Healthscope Commercial |
$79.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.17
|
| Rate for Payer: Nomi Health Commercial |
$72.51
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.48
|
| Rate for Payer: Priority Health HMO/PPO |
$76.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.82
|
| Rate for Payer: UHC Core |
$73.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.32
|
|
|
HC ALTERNARIA IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC ALTERNARIA IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200027
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC ALUMINUM
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
30100088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: BCBS Trust/PPO |
$45.86
|
| Rate for Payer: BCN Commercial |
$43.42
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.52
|
| Rate for Payer: Priority Health HMO/PPO |
$48.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.44
|
| Rate for Payer: UHC Core |
$46.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.14
|
|
|
HC ALUMINUM
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
30100088
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$14.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.56
|
| Rate for Payer: BCBS Complete |
$19.34
|
| Rate for Payer: BCBS MAPPO |
$14.04
|
| Rate for Payer: BCBS Trust/PPO |
$46.19
|
| Rate for Payer: BCN Commercial |
$43.68
|
| Rate for Payer: BCN Medicare Advantage |
$14.04
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.04
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$18.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.75
|
| Rate for Payer: Meridian Medicaid |
$19.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: PACE Senior Care Partners |
$13.34
|
| Rate for Payer: PACE SWMI |
$14.04
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: PHP Medicare Advantage |
$14.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.52
|
| Rate for Payer: Priority Health HMO/PPO |
$48.88
|
| Rate for Payer: Priority Health Medicare |
$14.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.64
|
| Rate for Payer: Railroad Medicare Medicare |
$14.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.44
|
| Rate for Payer: UHC Core |
$46.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.04
|
| Rate for Payer: UHC Exchange |
$14.04
|
| Rate for Payer: UHC Medicare Advantage |
$14.04
|
| Rate for Payer: UHCCP Medicaid |
$18.42
|
| Rate for Payer: VA VA |
$14.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.14
|
|
|
HC AMIKACIN LEVEL
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$70.60 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna Medicare |
$20.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.52
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS MAPPO |
$19.61
|
| Rate for Payer: BCBS Trust/PPO |
$64.49
|
| Rate for Payer: BCN Commercial |
$60.99
|
| Rate for Payer: BCN Medicare Advantage |
$19.61
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$70.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.84
|
| Rate for Payer: Mclaren Medicaid |
$10.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.59
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: PACE Senior Care Partners |
$18.63
|
| Rate for Payer: PACE SWMI |
$19.61
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: PHP Medicare Advantage |
$19.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: Priority Health HMO/PPO |
$68.25
|
| Rate for Payer: Priority Health Medicare |
$19.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.56
|
| Rate for Payer: Railroad Medicare Medicare |
$19.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.04
|
| Rate for Payer: UHC Core |
$65.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.61
|
| Rate for Payer: UHC Exchange |
$19.61
|
| Rate for Payer: UHC Medicare Advantage |
$19.61
|
| Rate for Payer: UHCCP Medicaid |
$10.90
|
| Rate for Payer: VA VA |
$19.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.84
|
|
|
HC AMIKACIN LEVEL
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
30100006
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.99 |
| Max. Negotiated Rate |
$70.60 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: BCBS Trust/PPO |
$64.04
|
| Rate for Payer: BCN Commercial |
$60.63
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$70.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$64.33
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.99
|
| Rate for Payer: Priority Health HMO/PPO |
$68.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.04
|
| Rate for Payer: UHC Core |
$65.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.84
|
|
|
HC AMINO ACID FRACTIONATION
|
Facility
|
OP
|
$158.14
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100091
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$142.33 |
| Rate for Payer: Aetna Commercial |
$134.42
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.42
|
| Rate for Payer: BCBS Complete |
$12.81
|
| Rate for Payer: BCBS MAPPO |
$39.54
|
| Rate for Payer: BCBS Trust/PPO |
$130.01
|
| Rate for Payer: BCN Commercial |
$122.95
|
| Rate for Payer: BCN Medicare Advantage |
$39.54
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cofinity Commercial |
$136.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.54
|
| Rate for Payer: Healthscope Commercial |
$142.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.60
|
| Rate for Payer: Mclaren Medicaid |
$12.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.51
|
| Rate for Payer: Meridian Medicaid |
$12.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.42
|
| Rate for Payer: Nomi Health Commercial |
$129.67
|
| Rate for Payer: PACE Senior Care Partners |
$37.56
|
| Rate for Payer: PACE SWMI |
$39.54
|
| Rate for Payer: PHP Commercial |
$134.42
|
| Rate for Payer: PHP Medicare Advantage |
$39.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.79
|
| Rate for Payer: Priority Health HMO/PPO |
$137.58
|
| Rate for Payer: Priority Health Medicare |
$39.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.95
|
| Rate for Payer: Railroad Medicare Medicare |
$39.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.16
|
| Rate for Payer: UHC Core |
$132.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.54
|
| Rate for Payer: UHC Exchange |
$39.54
|
| Rate for Payer: UHC Medicare Advantage |
$39.54
|
| Rate for Payer: UHCCP Medicaid |
$12.20
|
| Rate for Payer: VA VA |
$39.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.60
|
|
|
HC AMINO ACID FRACTIONATION
|
Facility
|
IP
|
$158.14
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100091
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.79 |
| Max. Negotiated Rate |
$142.33 |
| Rate for Payer: Aetna Commercial |
$134.42
|
| Rate for Payer: BCBS Trust/PPO |
$129.09
|
| Rate for Payer: BCN Commercial |
$122.21
|
| Rate for Payer: Cash Price |
$126.51
|
| Rate for Payer: Cofinity Commercial |
$136.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.51
|
| Rate for Payer: Healthscope Commercial |
$142.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.42
|
| Rate for Payer: Nomi Health Commercial |
$129.67
|
| Rate for Payer: PHP Commercial |
$134.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.79
|
| Rate for Payer: Priority Health HMO/PPO |
$137.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.16
|
| Rate for Payer: UHC Core |
$132.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.60
|
|
|
HC AMINO ACID QUANT CSF
|
Facility
|
IP
|
$234.09
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$152.16 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$198.98
|
| Rate for Payer: BCBS Trust/PPO |
$191.09
|
| Rate for Payer: BCN Commercial |
$180.90
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$201.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Healthscope Commercial |
$210.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: Nomi Health Commercial |
$191.95
|
| Rate for Payer: PHP Commercial |
$198.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.16
|
| Rate for Payer: Priority Health HMO/PPO |
$203.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.00
|
| Rate for Payer: UHC Core |
$195.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.57
|
|
|
HC AMINO ACID QUANT CSF
|
Facility
|
OP
|
$234.09
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100093
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$198.98
|
| Rate for Payer: Aetna Medicare |
$60.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.15
|
| Rate for Payer: BCBS Complete |
$12.81
|
| Rate for Payer: BCBS MAPPO |
$58.52
|
| Rate for Payer: BCBS Trust/PPO |
$192.45
|
| Rate for Payer: BCN Commercial |
$182.00
|
| Rate for Payer: BCN Medicare Advantage |
$58.52
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cash Price |
$187.27
|
| Rate for Payer: Cofinity Commercial |
$201.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.52
|
| Rate for Payer: Healthscope Commercial |
$210.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.57
|
| Rate for Payer: Mclaren Medicaid |
$12.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.45
|
| Rate for Payer: Meridian Medicaid |
$12.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.98
|
| Rate for Payer: Nomi Health Commercial |
$191.95
|
| Rate for Payer: PACE Senior Care Partners |
$55.60
|
| Rate for Payer: PACE SWMI |
$58.52
|
| Rate for Payer: PHP Commercial |
$198.98
|
| Rate for Payer: PHP Medicare Advantage |
$58.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.16
|
| Rate for Payer: Priority Health HMO/PPO |
$203.66
|
| Rate for Payer: Priority Health Medicare |
$59.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.84
|
| Rate for Payer: Railroad Medicare Medicare |
$58.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.00
|
| Rate for Payer: UHC Core |
$195.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.52
|
| Rate for Payer: UHC Exchange |
$58.52
|
| Rate for Payer: UHC Medicare Advantage |
$58.52
|
| Rate for Payer: UHCCP Medicaid |
$12.20
|
| Rate for Payer: VA VA |
$58.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.57
|
|
