|
HC AMMONIA LEVEL
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
30100094
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna Medicare |
$12.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.61
|
| Rate for Payer: BCBS Complete |
$11.06
|
| Rate for Payer: BCBS MAPPO |
$12.48
|
| Rate for Payer: BCBS Trust/PPO |
$41.06
|
| Rate for Payer: BCN Commercial |
$38.83
|
| Rate for Payer: BCN Medicare Advantage |
$12.48
|
| Rate for Payer: Cash Price |
$39.95
|
| 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: Health Alliance Plan Medicare Advantage |
$12.48
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.45
|
| Rate for Payer: Mclaren Medicaid |
$10.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.11
|
| Rate for Payer: Meridian Medicaid |
$11.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PACE Senior Care Partners |
$11.86
|
| Rate for Payer: PACE SWMI |
$12.48
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: PHP Medicare Advantage |
$12.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO |
$43.45
|
| Rate for Payer: Priority Health Medicare |
$12.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.46
|
| Rate for Payer: Railroad Medicare Medicare |
$12.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.95
|
| Rate for Payer: UHC Core |
$41.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.48
|
| Rate for Payer: UHC Exchange |
$12.48
|
| Rate for Payer: UHC Medicare Advantage |
$12.48
|
| Rate for Payer: UHCCP Medicaid |
$10.53
|
| Rate for Payer: VA VA |
$12.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.45
|
|
|
HC AMNIOCENTESIS
|
Facility
|
IP
|
$816.54
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.75 |
| Max. Negotiated Rate |
$734.89 |
| Rate for Payer: Aetna Commercial |
$694.06
|
| Rate for Payer: BCBS Trust/PPO |
$666.54
|
| Rate for Payer: BCN Commercial |
$631.02
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cofinity Commercial |
$702.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.23
|
| Rate for Payer: Healthscope Commercial |
$734.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.06
|
| Rate for Payer: Nomi Health Commercial |
$669.56
|
| Rate for Payer: PHP Commercial |
$694.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.75
|
| Rate for Payer: Priority Health HMO/PPO |
$710.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$547.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$718.56
|
| Rate for Payer: UHC Core |
$681.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.40
|
|
|
HC AMNIOCENTESIS
|
Facility
|
OP
|
$816.54
|
|
|
Service Code
|
CPT 59001
|
| Hospital Charge Code |
76100006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.93 |
| Max. Negotiated Rate |
$734.89 |
| Rate for Payer: Aetna Commercial |
$694.06
|
| Rate for Payer: Aetna Medicare |
$212.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$255.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$255.17
|
| Rate for Payer: BCBS Complete |
$230.94
|
| Rate for Payer: BCBS MAPPO |
$204.13
|
| Rate for Payer: BCBS Trust/PPO |
$671.28
|
| Rate for Payer: BCN Commercial |
$634.86
|
| Rate for Payer: BCN Medicare Advantage |
$204.13
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cash Price |
$653.23
|
| Rate for Payer: Cofinity Commercial |
$702.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.13
|
| Rate for Payer: Healthscope Commercial |
$734.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.40
|
| Rate for Payer: Mclaren Medicaid |
$219.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.34
|
| Rate for Payer: Meridian Medicaid |
$230.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$694.06
|
| Rate for Payer: Nomi Health Commercial |
$669.56
|
| Rate for Payer: PACE Senior Care Partners |
$193.93
|
| Rate for Payer: PACE SWMI |
$204.13
|
| Rate for Payer: PHP Commercial |
$694.06
|
| Rate for Payer: PHP Medicare Advantage |
$204.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.75
|
| Rate for Payer: Priority Health HMO/PPO |
$710.39
|
| Rate for Payer: Priority Health Medicare |
$206.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$547.08
|
| Rate for Payer: Railroad Medicare Medicare |
$204.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$718.56
|
| Rate for Payer: UHC Core |
$681.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.13
|
| Rate for Payer: UHC Exchange |
$204.13
|
| Rate for Payer: UHC Medicare Advantage |
$204.13
|
| Rate for Payer: UHCCP Medicaid |
$219.93
|
| Rate for Payer: VA VA |
$204.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.40
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
IP
|
$437.63
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
36100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.46 |
| Max. Negotiated Rate |
$393.87 |
| Rate for Payer: Aetna Commercial |
$371.99
|
| Rate for Payer: BCBS Trust/PPO |
$357.24
|
| Rate for Payer: BCN Commercial |
$338.20
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$376.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$393.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: PHP Commercial |
$371.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO |
$380.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.11
|
| Rate for Payer: UHC Core |
$365.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.22
|
|
|
HC AMNIOCENTESIS DIAGNOSTIC
|
Facility
|
OP
|
$437.63
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
36100261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$661.07 |
| Rate for Payer: Aetna Commercial |
$371.99
|
| Rate for Payer: Aetna Medicare |
$113.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.76
|
| Rate for Payer: BCBS Complete |
$661.07
|
| Rate for Payer: BCBS MAPPO |
$109.41
|
| Rate for Payer: BCBS Trust/PPO |
$359.78
|
| Rate for Payer: BCN Commercial |
$340.26
|
| Rate for Payer: BCN Medicare Advantage |
$109.41
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$376.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.41
|
| Rate for Payer: Healthscope Commercial |
$393.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.22
|
| Rate for Payer: Mclaren Medicaid |
$629.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.88
|
| Rate for Payer: Meridian Medicaid |
$661.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: PACE Senior Care Partners |
$103.94
|
| Rate for Payer: PACE SWMI |
$109.41
|
| Rate for Payer: PHP Commercial |
$371.99
|
| Rate for Payer: PHP Medicare Advantage |
$109.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$629.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO |
$380.74
|
| Rate for Payer: Priority Health Medicare |
$110.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.21
|
| Rate for Payer: Railroad Medicare Medicare |
$109.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.11
|
| Rate for Payer: UHC Core |
$365.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.41
|
| Rate for Payer: UHC Exchange |
$109.41
|
| Rate for Payer: UHC Medicare Advantage |
$109.41
|
| Rate for Payer: UHCCP Medicaid |
$629.55
|
| Rate for Payer: VA VA |
$109.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.22
|
|
|
HC AMNIOINFUSION
|
Facility
|
IP
|
$574.63
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.51 |
| Max. Negotiated Rate |
$517.17 |
| Rate for Payer: Aetna Commercial |
$488.44
|
| Rate for Payer: BCBS Trust/PPO |
$469.07
|
| Rate for Payer: BCN Commercial |
$444.07
|
| Rate for Payer: Cash Price |
$459.70
|
| Rate for Payer: Cofinity Commercial |
$494.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$459.70
|
| Rate for Payer: Healthscope Commercial |
$517.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$488.44
|
| Rate for Payer: Nomi Health Commercial |
$471.20
|
| Rate for Payer: PHP Commercial |
$488.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.51
|
| Rate for Payer: Priority Health HMO/PPO |
$499.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$385.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$505.67
|
| Rate for Payer: UHC Core |
$479.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.97
|
|
|
HC AMNIOINFUSION
|
Facility
|
OP
|
$574.63
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.47 |
| Max. Negotiated Rate |
$517.17 |
| Rate for Payer: Aetna Commercial |
$488.44
|
| Rate for Payer: Aetna Medicare |
$149.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.57
|
| Rate for Payer: BCBS Complete |
$230.94
|
| Rate for Payer: BCBS MAPPO |
$143.66
|
| Rate for Payer: BCBS Trust/PPO |
$472.40
|
| Rate for Payer: BCN Commercial |
$446.77
|
| Rate for Payer: BCN Medicare Advantage |
$143.66
|
| Rate for Payer: Cash Price |
$459.70
|
| Rate for Payer: Cash Price |
$459.70
|
| Rate for Payer: Cofinity Commercial |
$494.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$459.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.66
|
| Rate for Payer: Healthscope Commercial |
$517.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.97
|
| Rate for Payer: Mclaren Medicaid |
$219.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.84
|
| Rate for Payer: Meridian Medicaid |
$230.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$488.44
|
| Rate for Payer: Nomi Health Commercial |
$471.20
|
| Rate for Payer: PACE Senior Care Partners |
$136.47
|
| Rate for Payer: PACE SWMI |
$143.66
|
| Rate for Payer: PHP Commercial |
$488.44
|
| Rate for Payer: PHP Medicare Advantage |
$143.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.51
|
| Rate for Payer: Priority Health HMO/PPO |
$499.93
|
| Rate for Payer: Priority Health Medicare |
$145.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$385.00
|
| Rate for Payer: Railroad Medicare Medicare |
$143.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$505.67
|
| Rate for Payer: UHC Core |
$479.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$143.66
|
| Rate for Payer: UHC Exchange |
$143.66
|
| Rate for Payer: UHC Medicare Advantage |
$143.66
|
| Rate for Payer: UHCCP Medicaid |
$219.93
|
| Rate for Payer: VA VA |
$143.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.97
|
|
|
HC AMNIOTIC FLUID DELTA OD
|
Facility
|
IP
|
$70.48
|
|
|
Service Code
|
CPT 82143
|
| Hospital Charge Code |
30100095
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$63.43 |
| Rate for Payer: Aetna Commercial |
$59.91
|
| Rate for Payer: BCBS Trust/PPO |
$57.53
|
| Rate for Payer: BCN Commercial |
$54.47
|
| Rate for Payer: Cash Price |
$56.38
|
| Rate for Payer: Cofinity Commercial |
$60.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.38
|
| Rate for Payer: Healthscope Commercial |
$63.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.91
|
| Rate for Payer: Nomi Health Commercial |
$57.79
|
| Rate for Payer: PHP Commercial |
$59.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.81
|
| Rate for Payer: Priority Health HMO/PPO |
$61.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.02
|
| Rate for Payer: UHC Core |
$58.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.86
|
|
|
HC AMNIOTIC FLUID DELTA OD
|
Facility
|
OP
|
$70.48
|
|
|
Service Code
|
CPT 82143
|
| Hospital Charge Code |
30100095
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$63.43 |
| Rate for Payer: Aetna Commercial |
$59.91
|
| Rate for Payer: Aetna Medicare |
$18.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.02
|
| Rate for Payer: BCBS Complete |
$7.10
|
| Rate for Payer: BCBS MAPPO |
$17.62
|
| Rate for Payer: BCBS Trust/PPO |
$57.94
|
| Rate for Payer: BCN Commercial |
$54.80
|
| Rate for Payer: BCN Medicare Advantage |
$17.62
|
| Rate for Payer: Cash Price |
$56.38
|
| Rate for Payer: Cash Price |
$56.38
|
| Rate for Payer: Cofinity Commercial |
$60.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$63.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.86
|
| Rate for Payer: Mclaren Medicaid |
$6.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.50
|
| Rate for Payer: Meridian Medicaid |
$7.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.91
|
| Rate for Payer: Nomi Health Commercial |
$57.79
|
| Rate for Payer: PACE Senior Care Partners |
$16.74
|
| Rate for Payer: PACE SWMI |
$17.62
|
| Rate for Payer: PHP Commercial |
$59.91
|
| Rate for Payer: PHP Medicare Advantage |
$17.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.81
|
| Rate for Payer: Priority Health HMO/PPO |
$61.32
|
| Rate for Payer: Priority Health Medicare |
$17.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.22
|
| Rate for Payer: Railroad Medicare Medicare |
$17.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.02
|
| Rate for Payer: UHC Core |
$58.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.62
|
| Rate for Payer: UHC Exchange |
$17.62
|
| Rate for Payer: UHC Medicare Advantage |
$17.62
|
| Rate for Payer: UHCCP Medicaid |
$6.76
|
| Rate for Payer: VA VA |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.86
|
|
|
HC AMNISURE ROM
|
Facility
|
OP
|
$207.56
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
30000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.30 |
| Max. Negotiated Rate |
$186.80 |
| Rate for Payer: Aetna Commercial |
$176.43
|
| Rate for Payer: Aetna Medicare |
$53.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.86
|
| Rate for Payer: BCBS Complete |
$74.49
|
| Rate for Payer: BCBS MAPPO |
$51.89
|
| Rate for Payer: BCBS Trust/PPO |
$170.64
|
| Rate for Payer: BCN Commercial |
$161.38
|
| Rate for Payer: BCN Medicare Advantage |
$51.89
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Cofinity Commercial |
$178.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.89
|
| Rate for Payer: Healthscope Commercial |
$186.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.67
|
| Rate for Payer: Mclaren Medicaid |
$70.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.48
|
| Rate for Payer: Meridian Medicaid |
$74.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.43
|
| Rate for Payer: Nomi Health Commercial |
$170.20
|
| Rate for Payer: PACE Senior Care Partners |
$49.30
|
| Rate for Payer: PACE SWMI |
$51.89
|
| Rate for Payer: PHP Commercial |
$176.43
|
| Rate for Payer: PHP Medicare Advantage |
$51.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.91
|
| Rate for Payer: Priority Health HMO/PPO |
$180.58
|
| Rate for Payer: Priority Health Medicare |
$52.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.07
|
| Rate for Payer: Railroad Medicare Medicare |
$51.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.65
|
| Rate for Payer: UHC Core |
$173.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.89
|
| Rate for Payer: UHC Exchange |
$51.89
|
| Rate for Payer: UHC Medicare Advantage |
$51.89
|
| Rate for Payer: UHCCP Medicaid |
$70.93
|
| Rate for Payer: VA VA |
$51.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.67
|
|
|
HC AMNISURE ROM
|
Facility
|
IP
|
$207.56
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
30000009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.91 |
| Max. Negotiated Rate |
$186.80 |
| Rate for Payer: Aetna Commercial |
$176.43
|
| Rate for Payer: BCBS Trust/PPO |
$169.43
|
| Rate for Payer: BCN Commercial |
$160.40
|
| Rate for Payer: Cash Price |
$166.05
|
| Rate for Payer: Cofinity Commercial |
$178.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.05
|
| Rate for Payer: Healthscope Commercial |
$186.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.43
|
| Rate for Payer: Nomi Health Commercial |
$170.20
|
| Rate for Payer: PHP Commercial |
$176.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.91
|
| Rate for Payer: Priority Health HMO/PPO |
$180.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.65
|
| Rate for Payer: UHC Core |
$173.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.67
|
|
|
HC AMPA-R AB CBA, SERUM
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: BCBS Trust/PPO |
$416.31
|
| Rate for Payer: BCN Commercial |
$394.13
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.50
|
| Rate for Payer: Nomi Health Commercial |
$418.20
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health HMO/PPO |
$443.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.80
|
| Rate for Payer: UHC Core |
$425.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.50
|
|
|
HC AMPA-R AB CBA, SERUM
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200416
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna Medicare |
$132.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.38
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$127.50
|
| Rate for Payer: BCBS Trust/PPO |
$419.27
|
| Rate for Payer: BCN Commercial |
$396.52
|
| Rate for Payer: BCN Medicare Advantage |
$127.50
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.50
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.50
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.88
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.50
|
| Rate for Payer: Nomi Health Commercial |
$418.20
|
| Rate for Payer: PACE Senior Care Partners |
$121.12
|
| Rate for Payer: PACE SWMI |
$127.50
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: PHP Medicare Advantage |
$127.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health HMO/PPO |
$443.70
|
| Rate for Payer: Priority Health Medicare |
$128.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.70
|
| Rate for Payer: Railroad Medicare Medicare |
$127.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.80
|
| Rate for Payer: UHC Core |
$425.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.50
|
| Rate for Payer: UHC Exchange |
$127.50
|
| Rate for Payer: UHC Medicare Advantage |
$127.50
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$127.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.50
|
|
|
HC AMPA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200417
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.66
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$29.32
|
| Rate for Payer: BCBS Trust/PPO |
$96.43
|
| Rate for Payer: BCN Commercial |
$91.20
|
| Rate for Payer: BCN Medicare Advantage |
$29.32
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.32
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.97
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.79
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: PACE Senior Care Partners |
$27.86
|
| Rate for Payer: PACE SWMI |
$29.32
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: PHP Medicare Advantage |
$29.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.25
|
| Rate for Payer: Priority Health HMO/PPO |
$102.05
|
| Rate for Payer: Priority Health Medicare |
$29.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.59
|
| Rate for Payer: Railroad Medicare Medicare |
$29.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.22
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.32
|
| Rate for Payer: UHC Exchange |
$29.32
|
| Rate for Payer: UHC Medicare Advantage |
$29.32
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$29.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.97
|
|
|
HC AMPA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200417
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: BCBS Trust/PPO |
$95.75
|
| Rate for Payer: BCN Commercial |
$90.65
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.25
|
| Rate for Payer: Priority Health HMO/PPO |
$102.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.22
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.97
|
|
|
HC AMP FINGER/THUMB W DIRECT CLOSURE
|
Facility
|
OP
|
$4,860.61
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
45000090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,154.39 |
| Max. Negotiated Rate |
$4,374.55 |
| Rate for Payer: Aetna Commercial |
$4,131.52
|
| Rate for Payer: Aetna Medicare |
$1,263.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,518.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,518.94
|
| Rate for Payer: BCBS Complete |
$2,463.31
|
| Rate for Payer: BCBS MAPPO |
$1,215.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,995.91
|
| Rate for Payer: BCN Commercial |
$3,779.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,215.15
|
| Rate for Payer: Cash Price |
$3,888.49
|
| Rate for Payer: Cash Price |
$3,888.49
|
| Rate for Payer: Cofinity Commercial |
$4,180.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,215.15
|
| Rate for Payer: Healthscope Commercial |
$4,374.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,645.46
|
| Rate for Payer: Mclaren Medicaid |
$2,345.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,275.91
|
| Rate for Payer: Meridian Medicaid |
$2,463.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,397.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,131.52
|
| Rate for Payer: Nomi Health Commercial |
$3,985.70
|
| Rate for Payer: PACE Senior Care Partners |
$1,154.39
|
| Rate for Payer: PACE SWMI |
$1,215.15
|
| Rate for Payer: PHP Commercial |
$4,131.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,345.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,159.40
|
| Rate for Payer: Priority Health HMO/PPO |
$4,228.73
|
| Rate for Payer: Priority Health Medicare |
$1,227.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,256.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,277.34
|
| Rate for Payer: UHC Core |
$4,058.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,215.15
|
| Rate for Payer: UHC Exchange |
$1,215.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,215.15
|
| Rate for Payer: UHCCP Medicaid |
$2,345.85
|
| Rate for Payer: VA VA |
$1,215.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,645.46
|
|
|
HC AMP FINGER/THUMB W DIRECT CLOSURE
|
Facility
|
IP
|
$4,860.61
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
45000090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,159.40 |
| Max. Negotiated Rate |
$4,374.55 |
| Rate for Payer: Aetna Commercial |
$4,131.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,967.72
|
| Rate for Payer: BCN Commercial |
$3,756.28
|
| Rate for Payer: Cash Price |
$3,888.49
|
| Rate for Payer: Cofinity Commercial |
$4,180.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,888.49
|
| Rate for Payer: Healthscope Commercial |
$4,374.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,645.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,131.52
|
| Rate for Payer: Nomi Health Commercial |
$3,985.70
|
| Rate for Payer: PHP Commercial |
$4,131.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,159.40
|
| Rate for Payer: Priority Health HMO/PPO |
$4,228.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,256.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,277.34
|
| Rate for Payer: UHC Core |
$4,058.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,645.46
|
|
|
HC AMP FINGER/THUMB W FLAP
|
Facility
|
OP
|
$4,658.14
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
45000091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,106.31 |
| Max. Negotiated Rate |
$4,192.33 |
| Rate for Payer: Aetna Commercial |
$3,959.42
|
| Rate for Payer: Aetna Medicare |
$1,211.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,455.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,455.67
|
| Rate for Payer: BCBS Complete |
$2,463.31
|
| Rate for Payer: BCBS MAPPO |
$1,164.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,829.46
|
| Rate for Payer: BCN Commercial |
$3,621.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,164.54
|
| Rate for Payer: Cash Price |
$3,726.51
|
| Rate for Payer: Cash Price |
$3,726.51
|
| Rate for Payer: Cofinity Commercial |
$4,006.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,726.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,164.54
|
| Rate for Payer: Healthscope Commercial |
$4,192.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,493.61
|
| Rate for Payer: Mclaren Medicaid |
$2,345.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,222.76
|
| Rate for Payer: Meridian Medicaid |
$2,463.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,339.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,959.42
|
| Rate for Payer: Nomi Health Commercial |
$3,819.67
|
| Rate for Payer: PACE Senior Care Partners |
$1,106.31
|
| Rate for Payer: PACE SWMI |
$1,164.54
|
| Rate for Payer: PHP Commercial |
$3,959.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,164.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,345.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,027.79
|
| Rate for Payer: Priority Health HMO/PPO |
$4,052.58
|
| Rate for Payer: Priority Health Medicare |
$1,176.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,120.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,164.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,099.16
|
| Rate for Payer: UHC Core |
$3,889.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,164.54
|
| Rate for Payer: UHC Exchange |
$1,164.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,164.54
|
| Rate for Payer: UHCCP Medicaid |
$2,345.85
|
| Rate for Payer: VA VA |
$1,164.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,493.61
|
|
|
HC AMP FINGER/THUMB W FLAP
|
Facility
|
IP
|
$4,658.14
|
|
|
Service Code
|
CPT 26952
|
| Hospital Charge Code |
45000091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,027.79 |
| Max. Negotiated Rate |
$4,192.33 |
| Rate for Payer: Aetna Commercial |
$3,959.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,802.44
|
| Rate for Payer: BCN Commercial |
$3,599.81
|
| Rate for Payer: Cash Price |
$3,726.51
|
| Rate for Payer: Cofinity Commercial |
$4,006.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,726.51
|
| Rate for Payer: Healthscope Commercial |
$4,192.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,493.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,959.42
|
| Rate for Payer: Nomi Health Commercial |
$3,819.67
|
| Rate for Payer: PHP Commercial |
$3,959.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,027.79
|
| Rate for Payer: Priority Health HMO/PPO |
$4,052.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,120.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,099.16
|
| Rate for Payer: UHC Core |
$3,889.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,493.61
|
|
|
HC AMPHETAMINES 3 OR 4
|
Facility
|
OP
|
$37.74
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
30000173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Aetna Medicare |
$9.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.79
|
| Rate for Payer: BCBS Complete |
$15.10
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$31.03
|
| Rate for Payer: BCN Commercial |
$29.34
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.08
|
| Rate for Payer: Nomi Health Commercial |
$30.95
|
| Rate for Payer: PACE Senior Care Partners |
$8.96
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.53
|
| Rate for Payer: Priority Health HMO/PPO |
$32.83
|
| Rate for Payer: Priority Health Medicare |
$9.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.29
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.21
|
| Rate for Payer: UHC Core |
$31.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Medicare Advantage |
$9.44
|
| Rate for Payer: VA VA |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.30
|
|
|
HC AMPHETAMINES 3 OR 4
|
Facility
|
IP
|
$37.74
|
|
|
Service Code
|
CPT 80325
|
| Hospital Charge Code |
30000173
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: BCBS Trust/PPO |
$30.81
|
| Rate for Payer: BCN Commercial |
$29.17
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.08
|
| Rate for Payer: Nomi Health Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.53
|
| Rate for Payer: Priority Health HMO/PPO |
$32.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.21
|
| Rate for Payer: UHC Core |
$31.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.30
|
|
|
HC AMPHETAMINE URIN
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000139
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: BCBS Trust/PPO |
$82.99
|
| Rate for Payer: BCN Commercial |
$78.56
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO |
$88.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.46
|
| Rate for Payer: UHC Core |
$84.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.25
|
|
|
HC AMPHETAMINE URIN
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000139
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna Medicare |
$26.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.77
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$25.41
|
| Rate for Payer: BCBS Trust/PPO |
$83.57
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: BCN Medicare Advantage |
$25.41
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.41
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.25
|
| Rate for Payer: Mclaren Medicaid |
$44.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.69
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: PACE Senior Care Partners |
$24.14
|
| Rate for Payer: PACE SWMI |
$25.41
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: PHP Medicare Advantage |
$25.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO |
$88.44
|
| Rate for Payer: Priority Health Medicare |
$25.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.11
|
| Rate for Payer: Railroad Medicare Medicare |
$25.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.46
|
| Rate for Payer: UHC Core |
$84.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.41
|
| Rate for Payer: UHC Exchange |
$25.41
|
| Rate for Payer: UHC Medicare Advantage |
$25.41
|
| Rate for Payer: UHCCP Medicaid |
$44.93
|
| Rate for Payer: VA VA |
$25.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.25
|
|
|
HC AMPHETAMINE URN CMPT
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
30100570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna Medicare |
$8.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.88
|
| Rate for Payer: BCBS Complete |
$12.65
|
| Rate for Payer: BCBS MAPPO |
$7.91
|
| Rate for Payer: BCBS Trust/PPO |
$25.99
|
| Rate for Payer: BCN Commercial |
$24.58
|
| Rate for Payer: BCN Medicare Advantage |
$7.91
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.91
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: Nomi Health Commercial |
$25.93
|
| Rate for Payer: PACE Senior Care Partners |
$7.51
|
| Rate for Payer: PACE SWMI |
$7.91
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: PHP Medicare Advantage |
$7.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health HMO/PPO |
$27.51
|
| Rate for Payer: Priority Health Medicare |
$7.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.19
|
| Rate for Payer: Railroad Medicare Medicare |
$7.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC Core |
$26.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.91
|
| Rate for Payer: UHC Exchange |
$7.91
|
| Rate for Payer: UHC Medicare Advantage |
$7.91
|
| Rate for Payer: VA VA |
$7.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.71
|
|
|
HC AMPHETAMINE URN CMPT
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 80359
|
| Hospital Charge Code |
30100570
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$25.81
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: Nomi Health Commercial |
$25.93
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health HMO/PPO |
$27.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC Core |
$26.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.71
|
|
