|
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 |
$54.83
|
| 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 |
$54.83
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: PHP Commercial |
$54.83
|
| 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 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 |
$54.83
|
| 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 |
$54.83
|
| 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 |
$54.83
|
| 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-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 |
$71.71
|
| 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 |
$68.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.21
|
| Rate for Payer: Meridian Medicaid |
$71.71
|
| 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 |
$68.29
|
| 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 |
$68.29
|
| 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 |
$42.13
|
| 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 |
$42.13
|
|
|
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 |
$42.13
|
| 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 |
$42.13
|
|
|
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 |
$70.61 |
| 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 |
$70.61
|
| 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 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 |
$70.61 |
| 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 |
$70.61
|
| 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 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 |
$118.61
|
| 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 |
$118.61
|
|
|
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 |
$39.53
|
| Rate for Payer: BCBS Trust/PPO |
$130.01
|
| Rate for Payer: BCN Commercial |
$122.95
|
| Rate for Payer: BCN Medicare Advantage |
$39.53
|
| 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 |
$39.53
|
| Rate for Payer: Healthscope Commercial |
$142.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.61
|
| 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 |
$39.53
|
| Rate for Payer: PHP Commercial |
$134.42
|
| Rate for Payer: PHP Medicare Advantage |
$39.53
|
| 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 |
$39.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.16
|
| Rate for Payer: UHC Core |
$132.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.53
|
| Rate for Payer: UHC Exchange |
$39.53
|
| Rate for Payer: UHC Medicare Advantage |
$39.53
|
| Rate for Payer: UHCCP Medicaid |
$12.20
|
| Rate for Payer: VA VA |
$39.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.61
|
|
|
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
|
|
|
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 RANDOM URINE
|
Facility
|
OP
|
$213.28
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$191.95 |
| Rate for Payer: Aetna Commercial |
$181.29
|
| Rate for Payer: Aetna Medicare |
$55.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.65
|
| Rate for Payer: BCBS Complete |
$12.81
|
| Rate for Payer: BCBS MAPPO |
$53.32
|
| Rate for Payer: BCBS Trust/PPO |
$175.34
|
| Rate for Payer: BCN Commercial |
$165.83
|
| Rate for Payer: BCN Medicare Advantage |
$53.32
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$183.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.32
|
| Rate for Payer: Healthscope Commercial |
$191.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.96
|
| Rate for Payer: Mclaren Medicaid |
$12.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.99
|
| Rate for Payer: Meridian Medicaid |
$12.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: Nomi Health Commercial |
$174.89
|
| Rate for Payer: PACE Senior Care Partners |
$50.65
|
| Rate for Payer: PACE SWMI |
$53.32
|
| Rate for Payer: PHP Commercial |
$181.29
|
| Rate for Payer: PHP Medicare Advantage |
$53.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health HMO/PPO |
$185.55
|
| Rate for Payer: Priority Health Medicare |
$53.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.90
|
| Rate for Payer: Railroad Medicare Medicare |
$53.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.69
|
| Rate for Payer: UHC Core |
$178.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.32
|
| Rate for Payer: UHC Exchange |
$53.32
|
| Rate for Payer: UHC Medicare Advantage |
$53.32
|
| Rate for Payer: UHCCP Medicaid |
$12.20
|
| Rate for Payer: VA VA |
$53.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.96
|
|
|
HC AMINO ACID QUANT RANDOM URINE
|
Facility
|
IP
|
$213.28
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
30100092
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$138.63 |
| Max. Negotiated Rate |
$191.95 |
| Rate for Payer: Aetna Commercial |
$181.29
|
| Rate for Payer: BCBS Trust/PPO |
$174.10
|
| Rate for Payer: BCN Commercial |
$164.82
|
| Rate for Payer: Cash Price |
$170.62
|
| Rate for Payer: Cofinity Commercial |
$183.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.62
|
| Rate for Payer: Healthscope Commercial |
$191.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.29
|
| Rate for Payer: Nomi Health Commercial |
$174.89
|
| Rate for Payer: PHP Commercial |
$181.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.63
|
| Rate for Payer: Priority Health HMO/PPO |
$185.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.69
|
| Rate for Payer: UHC Core |
$178.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.96
|
|
|
HC AMINOLEVULINIC ACID URINE
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
30100089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.89 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna Medicare |
$22.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.41
|
| Rate for Payer: BCBS Complete |
$12.49
|
| Rate for Payer: BCBS MAPPO |
$21.93
|
| Rate for Payer: BCBS Trust/PPO |
$72.11
|
| Rate for Payer: BCN Commercial |
$68.20
|
| Rate for Payer: BCN Medicare Advantage |
$21.93
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.79
|
| Rate for Payer: Mclaren Medicaid |
$11.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.03
|
| Rate for Payer: Meridian Medicaid |
$12.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.56
|
| Rate for Payer: Nomi Health Commercial |
$71.93
|
| Rate for Payer: PACE Senior Care Partners |
$20.83
|
| Rate for Payer: PACE SWMI |
$21.93
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: PHP Medicare Advantage |
$21.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health HMO/PPO |
$76.32
|
| Rate for Payer: Priority Health Medicare |
$22.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.77
|
| Rate for Payer: Railroad Medicare Medicare |
$21.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.19
|
| Rate for Payer: UHC Core |
$73.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.93
|
| Rate for Payer: UHC Exchange |
$21.93
|
| Rate for Payer: UHC Medicare Advantage |
$21.93
|
| Rate for Payer: UHCCP Medicaid |
$11.89
|
| Rate for Payer: VA VA |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.79
|
|
|
HC AMINOLEVULINIC ACID URINE
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
CPT 82135
|
| Hospital Charge Code |
30100089
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: BCBS Trust/PPO |
$71.61
|
| Rate for Payer: BCN Commercial |
$67.79
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.56
|
| Rate for Payer: Nomi Health Commercial |
$71.93
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.02
|
| Rate for Payer: Priority Health HMO/PPO |
$76.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.19
|
| Rate for Payer: UHC Core |
$73.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.79
|
|
|
HC AMIODARONE/CORDARONE LEVEL
|
Facility
|
IP
|
$39.85
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$35.87 |
| Rate for Payer: Aetna Commercial |
$33.87
|
| Rate for Payer: BCBS Trust/PPO |
$32.53
|
| Rate for Payer: BCN Commercial |
$30.80
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.88
|
| Rate for Payer: Healthscope Commercial |
$35.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.87
|
| Rate for Payer: Nomi Health Commercial |
$32.68
|
| Rate for Payer: PHP Commercial |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO |
$34.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.07
|
| Rate for Payer: UHC Core |
$33.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.89
|
|
|
HC AMIODARONE/CORDARONE LEVEL
|
Facility
|
OP
|
$39.85
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100287
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$35.87 |
| Rate for Payer: Aetna Commercial |
$33.87
|
| Rate for Payer: Aetna Medicare |
$10.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.45
|
| Rate for Payer: BCBS Complete |
$18.29
|
| Rate for Payer: BCBS MAPPO |
$9.96
|
| Rate for Payer: BCBS Trust/PPO |
$32.76
|
| Rate for Payer: BCN Commercial |
$30.98
|
| Rate for Payer: BCN Medicare Advantage |
$9.96
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.96
|
| Rate for Payer: Healthscope Commercial |
$35.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.89
|
| Rate for Payer: Mclaren Medicaid |
$17.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.46
|
| Rate for Payer: Meridian Medicaid |
$18.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.87
|
| Rate for Payer: Nomi Health Commercial |
$32.68
|
| Rate for Payer: PACE Senior Care Partners |
$9.46
|
| Rate for Payer: PACE SWMI |
$9.96
|
| Rate for Payer: PHP Commercial |
$33.87
|
| Rate for Payer: PHP Medicare Advantage |
$9.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO |
$34.67
|
| Rate for Payer: Priority Health Medicare |
$10.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.70
|
| Rate for Payer: Railroad Medicare Medicare |
$9.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.07
|
| Rate for Payer: UHC Core |
$33.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.96
|
| Rate for Payer: UHC Exchange |
$9.96
|
| Rate for Payer: UHC Medicare Advantage |
$9.96
|
| Rate for Payer: UHCCP Medicaid |
$17.42
|
| Rate for Payer: VA VA |
$9.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.89
|
|
|
HC AMITRIPTYLINE
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: BCBS Trust/PPO |
$35.80
|
| Rate for Payer: BCN Commercial |
$33.90
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: Nomi Health Commercial |
$35.97
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health HMO/PPO |
$38.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC AMITRIPTYLINE
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
30100563
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna Medicare |
$11.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.71
|
| Rate for Payer: BCBS Complete |
$17.54
|
| Rate for Payer: BCBS MAPPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$36.06
|
| Rate for Payer: BCN Commercial |
$34.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.96
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.96
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: Nomi Health Commercial |
$35.97
|
| Rate for Payer: PACE Senior Care Partners |
$10.42
|
| Rate for Payer: PACE SWMI |
$10.96
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: PHP Medicare Advantage |
$10.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health HMO/PPO |
$38.16
|
| Rate for Payer: Priority Health Medicare |
$11.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.39
|
| Rate for Payer: Railroad Medicare Medicare |
$10.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$36.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.96
|
| Rate for Payer: UHC Exchange |
$10.96
|
| Rate for Payer: UHC Medicare Advantage |
$10.96
|
| Rate for Payer: VA VA |
$10.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC AMMONIA LEVEL
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
30100094
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: BCBS Trust/PPO |
$40.77
|
| Rate for Payer: BCN Commercial |
$38.59
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO |
$43.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.95
|
| Rate for Payer: UHC Core |
$41.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.45
|
|
