|
HC NM BONE SINGLE AREA
|
Facility
|
OP
|
$1,180.85
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.56 |
| Max. Negotiated Rate |
$1,062.76 |
| Rate for Payer: Aetna Commercial |
$1,003.72
|
| Rate for Payer: Aetna Medicare |
$307.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$369.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$369.02
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$295.21
|
| Rate for Payer: BCBS Trust/PPO |
$918.11
|
| Rate for Payer: BCN Commercial |
$918.11
|
| Rate for Payer: BCN Medicare Advantage |
$295.21
|
| Rate for Payer: Cash Price |
$944.68
|
| 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: Health Alliance Plan Medicare Advantage |
$295.21
|
| Rate for Payer: Healthscope Commercial |
$1,062.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$885.64
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$309.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.72
|
| Rate for Payer: PACE Senior Care Partners |
$280.45
|
| Rate for Payer: PACE SWMI |
$295.21
|
| Rate for Payer: PHP Commercial |
$1,003.72
|
| Rate for Payer: PHP Medicare Advantage |
$295.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| 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 Medicare |
$295.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$720.20
|
| Rate for Payer: Railroad Medicare Medicare |
$295.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.15
|
| Rate for Payer: UHC Core |
$986.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.21
|
| Rate for Payer: UHC Medicare Advantage |
$304.07
|
| Rate for Payer: VA VA |
$295.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$885.64
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
IP
|
$1,731.32
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,055.93 |
| Max. Negotiated Rate |
$1,558.19 |
| Rate for Payer: Aetna Commercial |
$1,471.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,337.96
|
| Rate for Payer: BCN Commercial |
$1,337.96
|
| Rate for Payer: Cash Price |
$1,385.06
|
| Rate for Payer: Cofinity Commercial |
$1,488.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,385.06
|
| Rate for Payer: Healthscope Commercial |
$1,558.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,298.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,471.62
|
| Rate for Payer: PHP Commercial |
$1,471.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,211.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,506.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,055.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,523.56
|
| Rate for Payer: UHC Core |
$1,445.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,298.49
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
OP
|
$1,731.32
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.56 |
| Max. Negotiated Rate |
$1,558.19 |
| Rate for Payer: Aetna Commercial |
$1,471.62
|
| Rate for Payer: Aetna Medicare |
$450.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$541.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$541.04
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$432.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,346.10
|
| Rate for Payer: BCN Commercial |
$1,346.10
|
| Rate for Payer: BCN Medicare Advantage |
$432.83
|
| Rate for Payer: Cash Price |
$1,385.06
|
| Rate for Payer: Cash Price |
$1,385.06
|
| Rate for Payer: Cofinity Commercial |
$1,488.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,385.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$432.83
|
| Rate for Payer: Healthscope Commercial |
$1,558.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,298.49
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$454.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$497.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,471.62
|
| Rate for Payer: PACE Senior Care Partners |
$411.19
|
| Rate for Payer: PACE SWMI |
$432.83
|
| Rate for Payer: PHP Commercial |
$1,471.62
|
| Rate for Payer: PHP Medicare Advantage |
$432.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,211.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,506.25
|
| Rate for Payer: Priority Health Medicare |
$432.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,055.93
|
| Rate for Payer: Railroad Medicare Medicare |
$432.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,523.56
|
| Rate for Payer: UHC Core |
$1,445.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$432.83
|
| Rate for Payer: UHC Medicare Advantage |
$445.81
|
| Rate for Payer: VA VA |
$432.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,298.49
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
IP
|
$1,701.22
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,037.57 |
| Max. Negotiated Rate |
$1,531.10 |
| Rate for Payer: Aetna Commercial |
$1,446.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,314.70
|
| Rate for Payer: BCN Commercial |
$1,314.70
|
| Rate for Payer: Cash Price |
$1,360.98
|
| Rate for Payer: Cofinity Commercial |
$1,463.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.98
|
| Rate for Payer: Healthscope Commercial |
$1,531.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,275.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,446.04
|
| Rate for Payer: PHP Commercial |
$1,446.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,480.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,037.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,497.07
|
| Rate for Payer: UHC Core |
$1,420.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,275.92
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
OP
|
$1,701.22
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.56 |
| Max. Negotiated Rate |
$1,531.10 |
| Rate for Payer: Aetna Commercial |
$1,446.04
|
| Rate for Payer: Aetna Medicare |
$442.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$531.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$531.63
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$425.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,322.70
|
| Rate for Payer: BCN Commercial |
$1,322.70
|
| Rate for Payer: BCN Medicare Advantage |
$425.30
|
| Rate for Payer: Cash Price |
$1,360.98
|
| Rate for Payer: Cash Price |
$1,360.98
|
| Rate for Payer: Cofinity Commercial |
$1,463.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.30
|
| Rate for Payer: Healthscope Commercial |
$1,531.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,275.92
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$446.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$489.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,446.04
|
| Rate for Payer: PACE Senior Care Partners |
$404.04
|
| Rate for Payer: PACE SWMI |
$425.30
|
| Rate for Payer: PHP Commercial |
$1,446.04
|
| Rate for Payer: PHP Medicare Advantage |
$425.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,480.06
|
| Rate for Payer: Priority Health Medicare |
$425.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,037.57
|
| Rate for Payer: Railroad Medicare Medicare |
$425.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,497.07
|
| Rate for Payer: UHC Core |
$1,420.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$425.30
|
| Rate for Payer: UHC Medicare Advantage |
$438.06
|
| Rate for Payer: VA VA |
$425.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,275.92
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
OP
|
$1,270.68
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
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 BRAIN <4 STATC VIEW W VAS F
|
Facility
|
IP
|
$1,270.68
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
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 BREAST IMAGING BILAT
|
Facility
|
IP
|
$1,160.25
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$707.64 |
| Max. Negotiated Rate |
$1,044.22 |
| Rate for Payer: Aetna Commercial |
$986.21
|
| Rate for Payer: BCBS Trust/PPO |
$896.64
|
| Rate for Payer: BCN Commercial |
$896.64
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cofinity Commercial |
$997.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.20
|
| Rate for Payer: Healthscope Commercial |
$1,044.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$870.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$986.21
|
| Rate for Payer: PHP Commercial |
$986.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,009.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$707.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,021.02
|
| Rate for Payer: UHC Core |
$968.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$870.19
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
OP
|
$1,160.25
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.56 |
| Max. Negotiated Rate |
$1,044.22 |
| Rate for Payer: Aetna Commercial |
$986.21
|
| Rate for Payer: Aetna Medicare |
$301.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$362.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$362.58
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$290.06
|
| Rate for Payer: BCBS Trust/PPO |
$902.09
|
| Rate for Payer: BCN Commercial |
$902.09
|
| Rate for Payer: BCN Medicare Advantage |
$290.06
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cash Price |
$928.20
|
| Rate for Payer: Cofinity Commercial |
$997.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.06
|
| Rate for Payer: Healthscope Commercial |
$1,044.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$870.19
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$304.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$986.21
|
| Rate for Payer: PACE Senior Care Partners |
$275.56
|
| Rate for Payer: PACE SWMI |
$290.06
|
| Rate for Payer: PHP Commercial |
$986.21
|
| Rate for Payer: PHP Medicare Advantage |
$290.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,009.42
|
| Rate for Payer: Priority Health Medicare |
$290.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$707.64
|
| Rate for Payer: Railroad Medicare Medicare |
$290.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,021.02
|
| Rate for Payer: UHC Core |
$968.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.06
|
| Rate for Payer: UHC Medicare Advantage |
$298.76
|
| Rate for Payer: VA VA |
$290.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$870.19
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
OP
|
$1,300.78
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.56 |
| Max. Negotiated Rate |
$1,170.70 |
| Rate for Payer: Aetna Commercial |
$1,105.66
|
| Rate for Payer: Aetna Medicare |
$338.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.49
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$325.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.36
|
| Rate for Payer: BCN Commercial |
$1,011.36
|
| Rate for Payer: BCN Medicare Advantage |
$325.20
|
| Rate for Payer: Cash Price |
$1,040.62
|
| Rate for Payer: Cash Price |
$1,040.62
|
| Rate for Payer: Cofinity Commercial |
$1,118.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.20
|
| Rate for Payer: Healthscope Commercial |
$1,170.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$975.58
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$341.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.66
|
| Rate for Payer: PACE Senior Care Partners |
$308.94
|
| Rate for Payer: PACE SWMI |
$325.20
|
| Rate for Payer: PHP Commercial |
$1,105.66
|
| Rate for Payer: PHP Medicare Advantage |
$325.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,131.68
|
| Rate for Payer: Priority Health Medicare |
$325.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$793.35
|
| Rate for Payer: Railroad Medicare Medicare |
$325.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.69
|
| Rate for Payer: UHC Core |
$1,086.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$325.20
|
| Rate for Payer: UHC Medicare Advantage |
$334.95
|
| Rate for Payer: VA VA |
$325.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$975.58
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
IP
|
$1,300.78
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$793.35 |
| Max. Negotiated Rate |
$1,170.70 |
| Rate for Payer: Aetna Commercial |
$1,105.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,005.24
|
| Rate for Payer: BCN Commercial |
$1,005.24
|
| Rate for Payer: Cash Price |
$1,040.62
|
| Rate for Payer: Cofinity Commercial |
$1,118.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.62
|
| Rate for Payer: Healthscope Commercial |
$1,170.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$975.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.66
|
| Rate for Payer: PHP Commercial |
$1,105.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,131.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$793.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.69
|
| Rate for Payer: UHC Core |
$1,086.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$975.58
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
OP
|
$857.70
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$203.70 |
| Max. Negotiated Rate |
$771.93 |
| Rate for Payer: Aetna Commercial |
$729.04
|
| Rate for Payer: Aetna Medicare |
$223.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.03
|
| Rate for Payer: BCBS Complete |
$372.29
|
| Rate for Payer: BCBS MAPPO |
$214.42
|
| Rate for Payer: BCBS Trust/PPO |
$666.86
|
| Rate for Payer: BCN Commercial |
$666.86
|
| Rate for Payer: BCN Medicare Advantage |
$214.42
|
| Rate for Payer: Cash Price |
$686.16
|
| Rate for Payer: Cash Price |
$686.16
|
| Rate for Payer: Cofinity Commercial |
$737.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.42
|
| Rate for Payer: Healthscope Commercial |
$771.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$643.28
|
| Rate for Payer: Mclaren Medicaid |
$354.56
|
| Rate for Payer: Meridian Medicaid |
$372.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$225.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$729.04
|
| Rate for Payer: PACE Senior Care Partners |
$203.70
|
| Rate for Payer: PACE SWMI |
$214.42
|
| Rate for Payer: PHP Commercial |
$729.04
|
| Rate for Payer: PHP Medicare Advantage |
$214.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$746.20
|
| Rate for Payer: Priority Health Medicare |
$214.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.11
|
| Rate for Payer: Railroad Medicare Medicare |
$214.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$754.78
|
| Rate for Payer: UHC Core |
$716.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.42
|
| Rate for Payer: UHC Medicare Advantage |
$220.86
|
| Rate for Payer: VA VA |
$214.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$643.28
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
IP
|
$857.70
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$523.11 |
| Max. Negotiated Rate |
$771.93 |
| Rate for Payer: Aetna Commercial |
$729.04
|
| Rate for Payer: BCBS Trust/PPO |
$662.83
|
| Rate for Payer: BCN Commercial |
$662.83
|
| Rate for Payer: Cash Price |
$686.16
|
| Rate for Payer: Cofinity Commercial |
$737.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.16
|
| Rate for Payer: Healthscope Commercial |
$771.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$643.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$729.04
|
| Rate for Payer: PHP Commercial |
$729.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$746.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$754.78
|
| Rate for Payer: UHC Core |
$716.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$643.28
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$610.36 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: BCBS Trust/PPO |
$773.39
|
| Rate for Payer: BCN Commercial |
$773.39
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.67
|
| Rate for Payer: UHC Core |
$835.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.57
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$237.68 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna Medicare |
$260.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$312.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$312.74
|
| Rate for Payer: BCBS Complete |
$372.29
|
| Rate for Payer: BCBS MAPPO |
$250.19
|
| Rate for Payer: BCBS Trust/PPO |
$778.09
|
| Rate for Payer: BCN Commercial |
$778.09
|
| Rate for Payer: BCN Medicare Advantage |
$250.19
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.19
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.57
|
| Rate for Payer: Mclaren Medicaid |
$354.56
|
| Rate for Payer: Meridian Medicaid |
$372.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$262.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PACE Senior Care Partners |
$237.68
|
| Rate for Payer: PACE SWMI |
$250.19
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: PHP Medicare Advantage |
$250.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.66
|
| Rate for Payer: Priority Health Medicare |
$250.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.36
|
| Rate for Payer: Railroad Medicare Medicare |
$250.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.67
|
| Rate for Payer: UHC Core |
$835.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.19
|
| Rate for Payer: UHC Medicare Advantage |
$257.70
|
| Rate for Payer: VA VA |
$250.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.57
|
|
|
HC NM CSF LEAK
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$237.68 |
| Max. Negotiated Rate |
$978.06 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna Medicare |
$260.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$312.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$312.74
|
| Rate for Payer: BCBS Complete |
$978.06
|
| Rate for Payer: BCBS MAPPO |
$250.19
|
| Rate for Payer: BCBS Trust/PPO |
$778.09
|
| Rate for Payer: BCN Commercial |
$778.09
|
| Rate for Payer: BCN Medicare Advantage |
$250.19
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.19
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.57
|
| Rate for Payer: Mclaren Medicaid |
$931.49
|
| Rate for Payer: Meridian Medicaid |
$978.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$262.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PACE Senior Care Partners |
$237.68
|
| Rate for Payer: PACE SWMI |
$250.19
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: PHP Medicare Advantage |
$250.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$931.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.66
|
| Rate for Payer: Priority Health Medicare |
$250.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.36
|
| Rate for Payer: Railroad Medicare Medicare |
$250.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.67
|
| Rate for Payer: UHC Core |
$835.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.19
|
| Rate for Payer: UHC Medicare Advantage |
$257.70
|
| Rate for Payer: VA VA |
$250.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.57
|
|
|
HC NM CSF LEAK
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$610.36 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: BCBS Trust/PPO |
$773.39
|
| Rate for Payer: BCN Commercial |
$773.39
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.67
|
| Rate for Payer: UHC Core |
$835.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.57
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$274.46 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: BCBS Trust/PPO |
$347.76
|
| Rate for Payer: BCN Commercial |
$347.76
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.62
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$349.88
|
| Rate for Payer: BCN Commercial |
$349.88
|
| Rate for Payer: BCN Medicare Advantage |
$112.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.50
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$118.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PACE Senior Care Partners |
$106.88
|
| Rate for Payer: PACE SWMI |
$112.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$112.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.50
|
| Rate for Payer: Priority Health Medicare |
$112.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.46
|
| Rate for Payer: Railroad Medicare Medicare |
$112.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.50
|
| Rate for Payer: UHC Medicare Advantage |
$115.88
|
| Rate for Payer: VA VA |
$112.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.62
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$349.88
|
| Rate for Payer: BCN Commercial |
$349.88
|
| Rate for Payer: BCN Medicare Advantage |
$112.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.50
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$118.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PACE Senior Care Partners |
$106.88
|
| Rate for Payer: PACE SWMI |
$112.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$112.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.50
|
| Rate for Payer: Priority Health Medicare |
$112.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.46
|
| Rate for Payer: Railroad Medicare Medicare |
$112.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.50
|
| Rate for Payer: UHC Medicare Advantage |
$115.88
|
| Rate for Payer: VA VA |
$112.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$274.46 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: BCBS Trust/PPO |
$347.76
|
| Rate for Payer: BCN Commercial |
$347.76
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.14 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: BCBS Trust/PPO |
$88.87
|
| Rate for Payer: BCN Commercial |
$88.87
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.20
|
| Rate for Payer: UHC Core |
$96.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.25
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna Medicare |
$29.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.94
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$28.75
|
| Rate for Payer: BCBS Trust/PPO |
$89.41
|
| Rate for Payer: BCN Commercial |
$89.41
|
| Rate for Payer: BCN Medicare Advantage |
$28.75
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.75
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.25
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PACE Senior Care Partners |
$27.31
|
| Rate for Payer: PACE SWMI |
$28.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: PHP Medicare Advantage |
$28.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.05
|
| Rate for Payer: Priority Health Medicare |
$28.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.14
|
| Rate for Payer: Railroad Medicare Medicare |
$28.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.20
|
| Rate for Payer: UHC Core |
$96.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.75
|
| Rate for Payer: UHC Medicare Advantage |
$29.61
|
| Rate for Payer: VA VA |
$28.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.25
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: BCBS Trust/PPO |
$63.06
|
| Rate for Payer: BCN Commercial |
$63.06
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.81
|
| Rate for Payer: UHC Core |
$68.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$21.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.50
|
| Rate for Payer: BCBS Complete |
$18.67
|
| Rate for Payer: BCBS MAPPO |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$63.44
|
| Rate for Payer: BCN Commercial |
$63.44
|
| Rate for Payer: BCN Medicare Advantage |
$20.40
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Mclaren Medicaid |
$17.78
|
| Rate for Payer: Meridian Medicaid |
$18.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.36
|
| Rate for Payer: PACE Senior Care Partners |
$19.38
|
| Rate for Payer: PACE SWMI |
$20.40
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: PHP Medicare Advantage |
$20.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.99
|
| Rate for Payer: Priority Health Medicare |
$20.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.77
|
| Rate for Payer: Railroad Medicare Medicare |
$20.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.81
|
| Rate for Payer: UHC Core |
$68.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.40
|
| Rate for Payer: UHC Medicare Advantage |
$21.01
|
| Rate for Payer: VA VA |
$20.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
