|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Aetna Medicare |
$15.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.06
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$15.25
|
| Rate for Payer: BCBS Trust/PPO |
$47.43
|
| Rate for Payer: BCN Commercial |
$47.43
|
| Rate for Payer: BCN Medicare Advantage |
$15.25
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PACE Senior Care Partners |
$14.49
|
| Rate for Payer: PACE SWMI |
$15.25
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: PHP Medicare Advantage |
$15.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.07
|
| Rate for Payer: Priority Health Medicare |
$15.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.20
|
| Rate for Payer: Railroad Medicare Medicare |
$15.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.68
|
| Rate for Payer: UHC Core |
$50.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.25
|
| Rate for Payer: UHC Medicare Advantage |
$15.71
|
| Rate for Payer: VA VA |
$15.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: BCBS Trust/PPO |
$47.14
|
| Rate for Payer: BCN Commercial |
$47.14
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.68
|
| Rate for Payer: UHC Core |
$50.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.62
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$12.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.88
|
| Rate for Payer: BCN Commercial |
$38.88
|
| Rate for Payer: BCN Medicare Advantage |
$12.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PACE Senior Care Partners |
$11.88
|
| Rate for Payer: PACE SWMI |
$12.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.50
|
| Rate for Payer: Priority Health Medicare |
$12.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.00
|
| Rate for Payer: UHC Core |
$41.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.50
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: VA VA |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.64
|
| Rate for Payer: BCN Commercial |
$38.64
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.00
|
| Rate for Payer: UHC Core |
$41.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC NICU LEVEL 2 R&B
|
Facility
|
IP
|
$3,363.24
|
|
| Hospital Charge Code |
17200001
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,577.95 |
| Max. Negotiated Rate |
$166,100.00 |
| Rate for Payer: Aetna Commercial |
$2,858.75
|
| Rate for Payer: Aetna Medicare |
$1,727.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,076.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,076.25
|
| Rate for Payer: BCBS MAPPO |
$1,661.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,599.11
|
| Rate for Payer: BCN Commercial |
$2,599.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.00
|
| Rate for Payer: Cash Price |
$2,690.59
|
| Rate for Payer: Cash Price |
$2,690.59
|
| Rate for Payer: Cash Price |
$2,690.59
|
| Rate for Payer: Cofinity Commercial |
$2,892.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,690.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.00
|
| Rate for Payer: Healthscope Commercial |
$3,026.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,522.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,744.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,910.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,858.75
|
| Rate for Payer: PACE Senior Care Partners |
$1,577.95
|
| Rate for Payer: PACE SWMI |
$1,661.00
|
| Rate for Payer: PHP Commercial |
$2,858.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,354.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,926.02
|
| Rate for Payer: Priority Health Medicare |
$1,661.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,051.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1,661.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,959.65
|
| Rate for Payer: UHC Core |
$2,808.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$166,100.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.83
|
| Rate for Payer: VA VA |
$1,661.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,522.43
|
|
|
HC NICU LEVEL 3 R&B
|
Facility
|
IP
|
$4,986.03
|
|
| Hospital Charge Code |
17300001
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$1,577.95 |
| Max. Negotiated Rate |
$166,100.00 |
| Rate for Payer: Aetna Commercial |
$4,238.13
|
| Rate for Payer: Aetna Medicare |
$1,727.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,076.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,076.25
|
| Rate for Payer: BCBS MAPPO |
$1,661.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,853.20
|
| Rate for Payer: BCN Commercial |
$3,853.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.00
|
| Rate for Payer: Cash Price |
$3,988.82
|
| Rate for Payer: Cash Price |
$3,988.82
|
| Rate for Payer: Cash Price |
$3,988.82
|
| Rate for Payer: Cofinity Commercial |
$4,287.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,988.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.00
|
| Rate for Payer: Healthscope Commercial |
$4,487.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,739.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,744.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,910.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,238.13
|
| Rate for Payer: PACE Senior Care Partners |
$1,577.95
|
| Rate for Payer: PACE SWMI |
$1,661.00
|
| Rate for Payer: PHP Commercial |
$4,238.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,490.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,337.85
|
| Rate for Payer: Priority Health Medicare |
$1,661.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,040.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,661.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,387.71
|
| Rate for Payer: UHC Core |
$4,163.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$166,100.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.83
|
| Rate for Payer: VA VA |
$1,661.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,739.52
|
|
|
HC NICU LEVEL 4 R&B
|
Facility
|
IP
|
$5,221.18
|
|
| Hospital Charge Code |
17400001
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$1,577.95 |
| Max. Negotiated Rate |
$166,100.00 |
| Rate for Payer: Aetna Commercial |
$4,438.00
|
| Rate for Payer: Aetna Medicare |
$1,727.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,076.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,076.25
|
| Rate for Payer: BCBS MAPPO |
$1,661.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,034.93
|
| Rate for Payer: BCN Commercial |
$4,034.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.00
|
| Rate for Payer: Cash Price |
$4,176.94
|
| Rate for Payer: Cash Price |
$4,176.94
|
| Rate for Payer: Cash Price |
$4,176.94
|
| Rate for Payer: Cofinity Commercial |
$4,490.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,176.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.00
|
| Rate for Payer: Healthscope Commercial |
$4,699.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,915.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,744.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,910.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,438.00
|
| Rate for Payer: PACE Senior Care Partners |
$1,577.95
|
| Rate for Payer: PACE SWMI |
$1,661.00
|
| Rate for Payer: PHP Commercial |
$4,438.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,654.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,542.43
|
| Rate for Payer: Priority Health Medicare |
$1,661.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,184.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,661.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,594.64
|
| Rate for Payer: UHC Core |
$4,359.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$166,100.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.83
|
| Rate for Payer: VA VA |
$1,661.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,915.88
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$186.06
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$113.48 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Aetna Commercial |
$158.15
|
| Rate for Payer: BCBS Trust/PPO |
$143.79
|
| Rate for Payer: BCN Commercial |
$143.79
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Healthscope Commercial |
$167.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: PHP Commercial |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.73
|
| Rate for Payer: UHC Core |
$155.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.54
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$186.06
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$44.19 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Aetna Commercial |
$158.15
|
| Rate for Payer: Aetna Medicare |
$48.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.14
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: BCBS MAPPO |
$46.52
|
| Rate for Payer: BCBS Trust/PPO |
$144.66
|
| Rate for Payer: BCN Commercial |
$144.66
|
| Rate for Payer: BCN Medicare Advantage |
$46.52
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.52
|
| Rate for Payer: Healthscope Commercial |
$167.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: PACE Senior Care Partners |
$44.19
|
| Rate for Payer: PACE SWMI |
$46.52
|
| Rate for Payer: PHP Commercial |
$158.15
|
| Rate for Payer: PHP Medicare Advantage |
$46.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.87
|
| Rate for Payer: Priority Health Medicare |
$46.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.48
|
| Rate for Payer: Railroad Medicare Medicare |
$46.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.73
|
| Rate for Payer: UHC Core |
$155.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.52
|
| Rate for Payer: UHC Medicare Advantage |
$47.91
|
| Rate for Payer: VA VA |
$46.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.54
|
|
|
HC NICU OR OB NURSERY R&B
|
Facility
|
IP
|
$2,250.16
|
|
| Hospital Charge Code |
17000001
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$1,372.37 |
| Max. Negotiated Rate |
$166,100.00 |
| Rate for Payer: Aetna Commercial |
$1,912.64
|
| Rate for Payer: Aetna Medicare |
$1,727.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,076.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,076.25
|
| Rate for Payer: BCBS MAPPO |
$1,661.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,738.92
|
| Rate for Payer: BCN Commercial |
$1,738.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.00
|
| Rate for Payer: Cash Price |
$1,800.13
|
| Rate for Payer: Cash Price |
$1,800.13
|
| Rate for Payer: Cash Price |
$1,800.13
|
| Rate for Payer: Cofinity Commercial |
$1,935.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.00
|
| Rate for Payer: Healthscope Commercial |
$2,025.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,687.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,744.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,910.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,912.64
|
| Rate for Payer: PACE Senior Care Partners |
$1,577.95
|
| Rate for Payer: PACE SWMI |
$1,661.00
|
| Rate for Payer: PHP Commercial |
$1,912.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,575.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,957.64
|
| Rate for Payer: Priority Health Medicare |
$1,661.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,372.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,661.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,980.14
|
| Rate for Payer: UHC Core |
$1,878.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$166,100.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.83
|
| Rate for Payer: VA VA |
$1,661.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,687.62
|
|
|
HC NIFOMETER
|
Facility
|
IP
|
$82.48
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.30 |
| Max. Negotiated Rate |
$74.23 |
| Rate for Payer: Aetna Commercial |
$70.11
|
| Rate for Payer: BCBS Trust/PPO |
$63.74
|
| Rate for Payer: BCN Commercial |
$63.74
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$70.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$74.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.11
|
| Rate for Payer: PHP Commercial |
$70.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.58
|
| Rate for Payer: UHC Core |
$68.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.86
|
|
|
HC NIFOMETER
|
Facility
|
OP
|
$82.48
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.59 |
| Max. Negotiated Rate |
$74.23 |
| Rate for Payer: Aetna Commercial |
$70.11
|
| Rate for Payer: Aetna Medicare |
$21.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.78
|
| Rate for Payer: BCBS Complete |
$32.99
|
| Rate for Payer: BCBS MAPPO |
$20.62
|
| Rate for Payer: BCBS Trust/PPO |
$64.13
|
| Rate for Payer: BCN Commercial |
$64.13
|
| Rate for Payer: BCN Medicare Advantage |
$20.62
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$70.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.62
|
| Rate for Payer: Healthscope Commercial |
$74.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.11
|
| Rate for Payer: PACE Senior Care Partners |
$19.59
|
| Rate for Payer: PACE SWMI |
$20.62
|
| Rate for Payer: PHP Commercial |
$70.11
|
| Rate for Payer: PHP Medicare Advantage |
$20.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.76
|
| Rate for Payer: Priority Health Medicare |
$20.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.30
|
| Rate for Payer: Railroad Medicare Medicare |
$20.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.58
|
| Rate for Payer: UHC Core |
$68.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.62
|
| Rate for Payer: UHC Medicare Advantage |
$21.24
|
| Rate for Payer: VA VA |
$20.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.86
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
IP
|
$49.14
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$29.97 |
| Max. Negotiated Rate |
$44.23 |
| Rate for Payer: Aetna Commercial |
$41.77
|
| Rate for Payer: BCBS Trust/PPO |
$37.98
|
| Rate for Payer: BCN Commercial |
$37.98
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cofinity Commercial |
$42.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.31
|
| Rate for Payer: Healthscope Commercial |
$44.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.77
|
| Rate for Payer: PHP Commercial |
$41.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.24
|
| Rate for Payer: UHC Core |
$41.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.86
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
OP
|
$49.14
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$44.23 |
| Rate for Payer: Aetna Commercial |
$41.77
|
| Rate for Payer: Aetna Medicare |
$12.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.36
|
| Rate for Payer: BCBS Complete |
$27.63
|
| Rate for Payer: BCBS MAPPO |
$12.28
|
| Rate for Payer: BCBS Trust/PPO |
$38.21
|
| Rate for Payer: BCN Commercial |
$38.21
|
| Rate for Payer: BCN Medicare Advantage |
$12.28
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cofinity Commercial |
$42.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.28
|
| Rate for Payer: Healthscope Commercial |
$44.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.86
|
| Rate for Payer: Mclaren Medicaid |
$26.31
|
| Rate for Payer: Meridian Medicaid |
$27.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.77
|
| Rate for Payer: PACE Senior Care Partners |
$11.67
|
| Rate for Payer: PACE SWMI |
$12.28
|
| Rate for Payer: PHP Commercial |
$41.77
|
| Rate for Payer: PHP Medicare Advantage |
$12.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.75
|
| Rate for Payer: Priority Health Medicare |
$12.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.97
|
| Rate for Payer: Railroad Medicare Medicare |
$12.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.24
|
| Rate for Payer: UHC Core |
$41.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.28
|
| Rate for Payer: UHC Medicare Advantage |
$12.65
|
| Rate for Payer: VA VA |
$12.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.86
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$4,800.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,927.52 |
| Max. Negotiated Rate |
$4,320.00 |
| Rate for Payer: Aetna Commercial |
$4,080.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,709.44
|
| Rate for Payer: BCN Commercial |
$3,709.44
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Cofinity Commercial |
$4,128.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,840.00
|
| Rate for Payer: Healthscope Commercial |
$4,320.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,600.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,080.00
|
| Rate for Payer: PHP Commercial |
$4,080.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,176.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,927.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,224.00
|
| Rate for Payer: UHC Core |
$4,008.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,600.00
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$4,800.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,140.00 |
| Max. Negotiated Rate |
$4,320.00 |
| Rate for Payer: Aetna Commercial |
$4,080.00
|
| Rate for Payer: Aetna Medicare |
$1,248.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,500.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,500.00
|
| Rate for Payer: BCBS Complete |
$1,256.10
|
| Rate for Payer: BCBS MAPPO |
$1,200.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,732.00
|
| Rate for Payer: BCN Commercial |
$3,732.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Cofinity Commercial |
$4,128.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,840.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,200.00
|
| Rate for Payer: Healthscope Commercial |
$4,320.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,600.00
|
| Rate for Payer: Mclaren Medicaid |
$1,196.28
|
| Rate for Payer: Meridian Medicaid |
$1,256.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,260.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,380.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,080.00
|
| Rate for Payer: PACE Senior Care Partners |
$1,140.00
|
| Rate for Payer: PACE SWMI |
$1,200.00
|
| Rate for Payer: PHP Commercial |
$4,080.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,200.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,176.00
|
| Rate for Payer: Priority Health Medicare |
$1,200.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,927.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,200.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,224.00
|
| Rate for Payer: UHC Core |
$4,008.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,200.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,236.00
|
| Rate for Payer: VA VA |
$1,200.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,600.00
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
OP
|
$883.99
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$209.95 |
| Max. Negotiated Rate |
$795.59 |
| Rate for Payer: Aetna Commercial |
$751.39
|
| Rate for Payer: Aetna Medicare |
$229.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$276.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$276.25
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$221.00
|
| Rate for Payer: BCBS Trust/PPO |
$687.30
|
| Rate for Payer: BCN Commercial |
$687.30
|
| Rate for Payer: BCN Medicare Advantage |
$221.00
|
| Rate for Payer: Cash Price |
$707.19
|
| Rate for Payer: Cash Price |
$707.19
|
| Rate for Payer: Cofinity Commercial |
$760.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.00
|
| Rate for Payer: Healthscope Commercial |
$795.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$662.99
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$751.39
|
| Rate for Payer: PACE Senior Care Partners |
$209.95
|
| Rate for Payer: PACE SWMI |
$221.00
|
| Rate for Payer: PHP Commercial |
$751.39
|
| Rate for Payer: PHP Medicare Advantage |
$221.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$769.07
|
| Rate for Payer: Priority Health Medicare |
$221.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$539.15
|
| Rate for Payer: Railroad Medicare Medicare |
$221.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$777.91
|
| Rate for Payer: UHC Core |
$738.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.00
|
| Rate for Payer: UHC Medicare Advantage |
$227.63
|
| Rate for Payer: VA VA |
$221.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$662.99
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
IP
|
$883.99
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$539.15 |
| Max. Negotiated Rate |
$795.59 |
| Rate for Payer: Aetna Commercial |
$751.39
|
| Rate for Payer: BCBS Trust/PPO |
$683.15
|
| Rate for Payer: BCN Commercial |
$683.15
|
| Rate for Payer: Cash Price |
$707.19
|
| Rate for Payer: Cofinity Commercial |
$760.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.19
|
| Rate for Payer: Healthscope Commercial |
$795.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$662.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$751.39
|
| Rate for Payer: PHP Commercial |
$751.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$769.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$539.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$777.91
|
| Rate for Payer: UHC Core |
$738.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$662.99
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
IP
|
$1,126.87
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$687.28 |
| Max. Negotiated Rate |
$1,014.18 |
| Rate for Payer: Aetna Commercial |
$957.84
|
| Rate for Payer: BCBS Trust/PPO |
$870.85
|
| Rate for Payer: BCN Commercial |
$870.85
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cofinity Commercial |
$969.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$901.50
|
| Rate for Payer: Healthscope Commercial |
$1,014.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$845.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$957.84
|
| Rate for Payer: PHP Commercial |
$957.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$980.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$687.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$991.65
|
| Rate for Payer: UHC Core |
$940.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$845.15
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
OP
|
$1,126.87
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$267.63 |
| Max. Negotiated Rate |
$1,014.18 |
| Rate for Payer: Aetna Commercial |
$957.84
|
| Rate for Payer: Aetna Medicare |
$292.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$352.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$352.15
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$281.72
|
| Rate for Payer: BCBS Trust/PPO |
$876.14
|
| Rate for Payer: BCN Commercial |
$876.14
|
| Rate for Payer: BCN Medicare Advantage |
$281.72
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cofinity Commercial |
$969.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$901.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.72
|
| Rate for Payer: Healthscope Commercial |
$1,014.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$845.15
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$295.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$957.84
|
| Rate for Payer: PACE Senior Care Partners |
$267.63
|
| Rate for Payer: PACE SWMI |
$281.72
|
| Rate for Payer: PHP Commercial |
$957.84
|
| Rate for Payer: PHP Medicare Advantage |
$281.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$980.38
|
| Rate for Payer: Priority Health Medicare |
$281.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$687.28
|
| Rate for Payer: Railroad Medicare Medicare |
$281.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$991.65
|
| Rate for Payer: UHC Core |
$940.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.72
|
| Rate for Payer: UHC Medicare Advantage |
$290.17
|
| Rate for Payer: VA VA |
$281.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$845.15
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
IP
|
$1,045.41
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$637.60 |
| Max. Negotiated Rate |
$940.87 |
| Rate for Payer: Aetna Commercial |
$888.60
|
| Rate for Payer: BCBS Trust/PPO |
$807.89
|
| Rate for Payer: BCN Commercial |
$807.89
|
| Rate for Payer: Cash Price |
$836.33
|
| Rate for Payer: Cofinity Commercial |
$899.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.33
|
| Rate for Payer: Healthscope Commercial |
$940.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$784.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$888.60
|
| Rate for Payer: PHP Commercial |
$888.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$637.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$919.96
|
| Rate for Payer: UHC Core |
$872.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$784.06
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
OP
|
$1,045.41
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$248.28 |
| Max. Negotiated Rate |
$940.87 |
| Rate for Payer: Aetna Commercial |
$888.60
|
| Rate for Payer: Aetna Medicare |
$271.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$326.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$326.69
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$261.35
|
| Rate for Payer: BCBS Trust/PPO |
$812.81
|
| Rate for Payer: BCN Commercial |
$812.81
|
| Rate for Payer: BCN Medicare Advantage |
$261.35
|
| Rate for Payer: Cash Price |
$836.33
|
| Rate for Payer: Cash Price |
$836.33
|
| Rate for Payer: Cofinity Commercial |
$899.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$261.35
|
| Rate for Payer: Healthscope Commercial |
$940.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$784.06
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$274.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$888.60
|
| Rate for Payer: PACE Senior Care Partners |
$248.28
|
| Rate for Payer: PACE SWMI |
$261.35
|
| Rate for Payer: PHP Commercial |
$888.60
|
| Rate for Payer: PHP Medicare Advantage |
$261.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.51
|
| Rate for Payer: Priority Health Medicare |
$261.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$637.60
|
| Rate for Payer: Railroad Medicare Medicare |
$261.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$919.96
|
| Rate for Payer: UHC Core |
$872.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$261.35
|
| Rate for Payer: UHC Medicare Advantage |
$269.19
|
| Rate for Payer: VA VA |
$261.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$784.06
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
OP
|
$1,270.68
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.56 |
| Max. Negotiated Rate |
$1,143.61 |
| Rate for Payer: Aetna Commercial |
$1,080.08
|
| Rate for Payer: Aetna Medicare |
$330.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$397.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$397.09
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$317.67
|
| Rate for Payer: BCBS Trust/PPO |
$987.95
|
| Rate for Payer: BCN Commercial |
$987.95
|
| Rate for Payer: BCN Medicare Advantage |
$317.67
|
| Rate for Payer: Cash Price |
$1,016.54
|
| Rate for Payer: Cash Price |
$1,016.54
|
| Rate for Payer: Cofinity Commercial |
$1,092.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.67
|
| Rate for Payer: Healthscope Commercial |
$1,143.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$953.01
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$333.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$365.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,080.08
|
| Rate for Payer: PACE Senior Care Partners |
$301.79
|
| Rate for Payer: PACE SWMI |
$317.67
|
| Rate for Payer: PHP Commercial |
$1,080.08
|
| Rate for Payer: PHP Medicare Advantage |
$317.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,105.49
|
| Rate for Payer: Priority Health Medicare |
$317.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$774.99
|
| Rate for Payer: Railroad Medicare Medicare |
$317.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,118.20
|
| Rate for Payer: UHC Core |
$1,061.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.67
|
| Rate for Payer: UHC Medicare Advantage |
$327.20
|
| Rate for Payer: VA VA |
$317.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$953.01
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
IP
|
$1,270.68
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$774.99 |
| Max. Negotiated Rate |
$1,143.61 |
| Rate for Payer: Aetna Commercial |
$1,080.08
|
| Rate for Payer: BCBS Trust/PPO |
$981.98
|
| Rate for Payer: BCN Commercial |
$981.98
|
| Rate for Payer: Cash Price |
$1,016.54
|
| Rate for Payer: Cofinity Commercial |
$1,092.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.54
|
| Rate for Payer: Healthscope Commercial |
$1,143.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$953.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,080.08
|
| Rate for Payer: PHP Commercial |
$1,080.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,105.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$774.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,118.20
|
| Rate for Payer: UHC Core |
$1,061.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$953.01
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
IP
|
$1,180.85
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$720.20 |
| Max. Negotiated Rate |
$1,062.76 |
| Rate for Payer: Aetna Commercial |
$1,003.72
|
| Rate for Payer: BCBS Trust/PPO |
$912.56
|
| Rate for Payer: BCN Commercial |
$912.56
|
| Rate for Payer: Cash Price |
$944.68
|
| Rate for Payer: Cofinity Commercial |
$1,015.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.68
|
| Rate for Payer: Healthscope Commercial |
$1,062.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$885.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.72
|
| Rate for Payer: PHP Commercial |
$1,003.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,027.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$720.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.15
|
| Rate for Payer: UHC Core |
$986.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$885.64
|
|
