|
HC OLIGOCLONAL BANDS
|
Facility
|
OP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: Aetna Medicare |
$11.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.00
|
| Rate for Payer: BCBS Complete |
$20.79
|
| Rate for Payer: BCBS MAPPO |
$11.20
|
| Rate for Payer: BCBS Trust/PPO |
$36.83
|
| Rate for Payer: BCN Commercial |
$34.83
|
| Rate for Payer: BCN Medicare Advantage |
$11.20
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$38.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.60
|
| Rate for Payer: Mclaren Medicaid |
$19.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.76
|
| Rate for Payer: Meridian Medicaid |
$20.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: PACE Senior Care Partners |
$10.64
|
| Rate for Payer: PACE SWMI |
$11.20
|
| Rate for Payer: PHP Commercial |
$38.08
|
| Rate for Payer: PHP Medicare Advantage |
$11.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health HMO/PPO |
$38.98
|
| Rate for Payer: Priority Health Medicare |
$11.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.02
|
| Rate for Payer: Railroad Medicare Medicare |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.42
|
| Rate for Payer: UHC Core |
$37.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.20
|
| Rate for Payer: UHC Exchange |
$11.20
|
| Rate for Payer: UHC Medicare Advantage |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$19.80
|
| Rate for Payer: VA VA |
$11.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.60
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
IP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: BCBS Trust/PPO |
$36.57
|
| Rate for Payer: BCN Commercial |
$34.62
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$38.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: PHP Commercial |
$38.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health HMO/PPO |
$38.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.42
|
| Rate for Payer: UHC Core |
$37.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.60
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
IP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: BCBS Trust/PPO |
$36.57
|
| Rate for Payer: BCN Commercial |
$34.62
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$38.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: PHP Commercial |
$38.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health HMO/PPO |
$38.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.42
|
| Rate for Payer: UHC Core |
$37.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.60
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
OP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: Aetna Medicare |
$11.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.00
|
| Rate for Payer: BCBS Complete |
$20.79
|
| Rate for Payer: BCBS MAPPO |
$11.20
|
| Rate for Payer: BCBS Trust/PPO |
$36.83
|
| Rate for Payer: BCN Commercial |
$34.83
|
| Rate for Payer: BCN Medicare Advantage |
$11.20
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$38.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.60
|
| Rate for Payer: Mclaren Medicaid |
$19.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.76
|
| Rate for Payer: Meridian Medicaid |
$20.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: PACE Senior Care Partners |
$10.64
|
| Rate for Payer: PACE SWMI |
$11.20
|
| Rate for Payer: PHP Commercial |
$38.08
|
| Rate for Payer: PHP Medicare Advantage |
$11.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health HMO/PPO |
$38.98
|
| Rate for Payer: Priority Health Medicare |
$11.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.02
|
| Rate for Payer: Railroad Medicare Medicare |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.42
|
| Rate for Payer: UHC Core |
$37.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.20
|
| Rate for Payer: UHC Exchange |
$11.20
|
| Rate for Payer: UHC Medicare Advantage |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$19.80
|
| Rate for Payer: VA VA |
$11.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.60
|
|
|
HC OMMAYA
|
Facility
|
OP
|
$384.73
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$91.37 |
| Max. Negotiated Rate |
$346.26 |
| Rate for Payer: Aetna Commercial |
$327.02
|
| Rate for Payer: Aetna Medicare |
$100.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.23
|
| Rate for Payer: BCBS Complete |
$246.72
|
| Rate for Payer: BCBS MAPPO |
$96.18
|
| Rate for Payer: BCBS Trust/PPO |
$316.29
|
| Rate for Payer: BCN Commercial |
$299.13
|
| Rate for Payer: BCN Medicare Advantage |
$96.18
|
| Rate for Payer: Cash Price |
$307.78
|
| Rate for Payer: Cash Price |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$330.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.18
|
| Rate for Payer: Healthscope Commercial |
$346.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.55
|
| Rate for Payer: Mclaren Medicaid |
$234.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.99
|
| Rate for Payer: Meridian Medicaid |
$246.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.02
|
| Rate for Payer: Nomi Health Commercial |
$315.48
|
| Rate for Payer: PACE Senior Care Partners |
$91.37
|
| Rate for Payer: PACE SWMI |
$96.18
|
| Rate for Payer: PHP Commercial |
$327.02
|
| Rate for Payer: PHP Medicare Advantage |
$96.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.07
|
| Rate for Payer: Priority Health HMO/PPO |
$334.72
|
| Rate for Payer: Priority Health Medicare |
$97.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.77
|
| Rate for Payer: Railroad Medicare Medicare |
$96.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.56
|
| Rate for Payer: UHC Core |
$321.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.18
|
| Rate for Payer: UHC Exchange |
$96.18
|
| Rate for Payer: UHC Medicare Advantage |
$96.18
|
| Rate for Payer: UHCCP Medicaid |
$234.96
|
| Rate for Payer: VA VA |
$96.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.55
|
|
|
HC OMMAYA
|
Facility
|
IP
|
$384.73
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$250.07 |
| Max. Negotiated Rate |
$346.26 |
| Rate for Payer: Aetna Commercial |
$327.02
|
| Rate for Payer: BCBS Trust/PPO |
$314.06
|
| Rate for Payer: BCN Commercial |
$297.32
|
| Rate for Payer: Cash Price |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$330.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.78
|
| Rate for Payer: Healthscope Commercial |
$346.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.02
|
| Rate for Payer: Nomi Health Commercial |
$315.48
|
| Rate for Payer: PHP Commercial |
$327.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.07
|
| Rate for Payer: Priority Health HMO/PPO |
$334.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.56
|
| Rate for Payer: UHC Core |
$321.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.55
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Aetna Commercial |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.54
|
| Rate for Payer: Nomi Health Commercial |
$1.48
|
| Rate for Payer: PHP Commercial |
$1.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.18
|
| Rate for Payer: Priority Health HMO/PPO |
$1.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.59
|
| Rate for Payer: UHC Core |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.36
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
OP
|
$1.81
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Aetna Commercial |
$1.54
|
| Rate for Payer: Aetna Medicare |
$0.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.57
|
| Rate for Payer: BCBS Complete |
$0.72
|
| Rate for Payer: BCBS MAPPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$1.49
|
| Rate for Payer: BCN Commercial |
$1.41
|
| Rate for Payer: BCN Medicare Advantage |
$0.45
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.45
|
| Rate for Payer: Healthscope Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.54
|
| Rate for Payer: Nomi Health Commercial |
$1.48
|
| Rate for Payer: PACE Senior Care Partners |
$0.43
|
| Rate for Payer: PACE SWMI |
$0.45
|
| Rate for Payer: PHP Commercial |
$1.54
|
| Rate for Payer: PHP Medicare Advantage |
$0.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.18
|
| Rate for Payer: Priority Health HMO/PPO |
$1.57
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.21
|
| Rate for Payer: Railroad Medicare Medicare |
$0.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.59
|
| Rate for Payer: UHC Core |
$1.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.45
|
| Rate for Payer: UHC Exchange |
$0.45
|
| Rate for Payer: UHC Medicare Advantage |
$0.45
|
| Rate for Payer: VA VA |
$0.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.36
|
|
|
HC OPEN HEART OFF BYPASS
|
Facility
|
OP
|
$5,803.80
|
|
| Hospital Charge Code |
27000702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,378.40 |
| Max. Negotiated Rate |
$5,223.42 |
| Rate for Payer: Aetna Commercial |
$4,933.23
|
| Rate for Payer: Aetna Medicare |
$1,508.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,813.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,813.69
|
| Rate for Payer: BCBS Complete |
$2,321.52
|
| Rate for Payer: BCBS MAPPO |
$1,450.95
|
| Rate for Payer: BCBS Trust/PPO |
$4,771.30
|
| Rate for Payer: BCN Commercial |
$4,512.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,450.95
|
| Rate for Payer: Cash Price |
$4,643.04
|
| Rate for Payer: Cofinity Commercial |
$4,991.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,643.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,450.95
|
| Rate for Payer: Healthscope Commercial |
$5,223.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,352.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,668.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,933.23
|
| Rate for Payer: Nomi Health Commercial |
$4,759.12
|
| Rate for Payer: PACE Senior Care Partners |
$1,378.40
|
| Rate for Payer: PACE SWMI |
$1,450.95
|
| Rate for Payer: PHP Commercial |
$4,933.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,450.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,772.47
|
| Rate for Payer: Priority Health HMO/PPO |
$5,049.31
|
| Rate for Payer: Priority Health Medicare |
$1,465.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,888.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,450.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,107.34
|
| Rate for Payer: UHC Core |
$4,846.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,450.95
|
| Rate for Payer: UHC Exchange |
$1,450.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,450.95
|
| Rate for Payer: VA VA |
$1,450.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,352.85
|
|
|
HC OPEN HEART OFF BYPASS
|
Facility
|
IP
|
$5,803.80
|
|
| Hospital Charge Code |
27000702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,772.47 |
| Max. Negotiated Rate |
$5,223.42 |
| Rate for Payer: Aetna Commercial |
$4,933.23
|
| Rate for Payer: BCBS Trust/PPO |
$4,737.64
|
| Rate for Payer: BCN Commercial |
$4,485.18
|
| Rate for Payer: Cash Price |
$4,643.04
|
| Rate for Payer: Cofinity Commercial |
$4,991.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,643.04
|
| Rate for Payer: Healthscope Commercial |
$5,223.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,352.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,933.23
|
| Rate for Payer: Nomi Health Commercial |
$4,759.12
|
| Rate for Payer: PHP Commercial |
$4,933.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,772.47
|
| Rate for Payer: Priority Health HMO/PPO |
$5,049.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,888.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,107.34
|
| Rate for Payer: UHC Core |
$4,846.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,352.85
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$944.00
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Aetna Commercial |
$802.40
|
| Rate for Payer: BCBS Trust/PPO |
$770.59
|
| Rate for Payer: BCN Commercial |
$729.52
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cofinity Commercial |
$811.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.20
|
| Rate for Payer: Healthscope Commercial |
$849.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$708.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.40
|
| Rate for Payer: Nomi Health Commercial |
$774.08
|
| Rate for Payer: PHP Commercial |
$802.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.60
|
| Rate for Payer: Priority Health HMO/PPO |
$821.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$632.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.72
|
| Rate for Payer: UHC Core |
$788.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$708.00
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$944.00
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$224.20 |
| Max. Negotiated Rate |
$849.60 |
| Rate for Payer: Aetna Commercial |
$802.40
|
| Rate for Payer: Aetna Medicare |
$245.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.00
|
| Rate for Payer: BCBS Complete |
$377.60
|
| Rate for Payer: BCBS MAPPO |
$236.00
|
| Rate for Payer: BCBS Trust/PPO |
$776.06
|
| Rate for Payer: BCN Commercial |
$733.96
|
| Rate for Payer: BCN Medicare Advantage |
$236.00
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cofinity Commercial |
$811.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$755.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$849.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$708.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$802.40
|
| Rate for Payer: Nomi Health Commercial |
$774.08
|
| Rate for Payer: PACE Senior Care Partners |
$224.20
|
| Rate for Payer: PACE SWMI |
$236.00
|
| Rate for Payer: PHP Commercial |
$802.40
|
| Rate for Payer: PHP Medicare Advantage |
$236.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.60
|
| Rate for Payer: Priority Health HMO/PPO |
$821.28
|
| Rate for Payer: Priority Health Medicare |
$238.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$632.48
|
| Rate for Payer: Railroad Medicare Medicare |
$236.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.72
|
| Rate for Payer: UHC Core |
$788.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.00
|
| Rate for Payer: UHC Exchange |
$236.00
|
| Rate for Payer: UHC Medicare Advantage |
$236.00
|
| Rate for Payer: VA VA |
$236.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$708.00
|
|
|
HC OPEN HEART TEG
|
Facility
|
IP
|
$552.37
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$359.04 |
| Max. Negotiated Rate |
$497.13 |
| Rate for Payer: Aetna Commercial |
$469.51
|
| Rate for Payer: BCBS Trust/PPO |
$450.90
|
| Rate for Payer: BCN Commercial |
$426.87
|
| Rate for Payer: Cash Price |
$441.90
|
| Rate for Payer: Cofinity Commercial |
$475.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.90
|
| Rate for Payer: Healthscope Commercial |
$497.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.51
|
| Rate for Payer: Nomi Health Commercial |
$452.94
|
| Rate for Payer: PHP Commercial |
$469.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.04
|
| Rate for Payer: Priority Health HMO/PPO |
$480.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.09
|
| Rate for Payer: UHC Core |
$461.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.28
|
|
|
HC OPEN HEART TEG
|
Facility
|
OP
|
$552.37
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$131.19 |
| Max. Negotiated Rate |
$497.13 |
| Rate for Payer: Aetna Commercial |
$469.51
|
| Rate for Payer: Aetna Medicare |
$143.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$172.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$172.62
|
| Rate for Payer: BCBS Complete |
$220.95
|
| Rate for Payer: BCBS MAPPO |
$138.09
|
| Rate for Payer: BCBS Trust/PPO |
$454.10
|
| Rate for Payer: BCN Commercial |
$429.47
|
| Rate for Payer: BCN Medicare Advantage |
$138.09
|
| Rate for Payer: Cash Price |
$441.90
|
| Rate for Payer: Cofinity Commercial |
$475.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.09
|
| Rate for Payer: Healthscope Commercial |
$497.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.51
|
| Rate for Payer: Nomi Health Commercial |
$452.94
|
| Rate for Payer: PACE Senior Care Partners |
$131.19
|
| Rate for Payer: PACE SWMI |
$138.09
|
| Rate for Payer: PHP Commercial |
$469.51
|
| Rate for Payer: PHP Medicare Advantage |
$138.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.04
|
| Rate for Payer: Priority Health HMO/PPO |
$480.56
|
| Rate for Payer: Priority Health Medicare |
$139.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.09
|
| Rate for Payer: Railroad Medicare Medicare |
$138.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.09
|
| Rate for Payer: UHC Core |
$461.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.09
|
| Rate for Payer: UHC Exchange |
$138.09
|
| Rate for Payer: UHC Medicare Advantage |
$138.09
|
| Rate for Payer: VA VA |
$138.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.28
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
OP
|
$349.23
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$82.94 |
| Max. Negotiated Rate |
$314.31 |
| Rate for Payer: Aetna Commercial |
$296.85
|
| Rate for Payer: Aetna Medicare |
$90.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.13
|
| Rate for Payer: BCBS Complete |
$139.69
|
| Rate for Payer: BCBS MAPPO |
$87.31
|
| Rate for Payer: BCBS Trust/PPO |
$287.10
|
| Rate for Payer: BCN Commercial |
$271.53
|
| Rate for Payer: BCN Medicare Advantage |
$87.31
|
| Rate for Payer: Cash Price |
$279.38
|
| Rate for Payer: Cofinity Commercial |
$300.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.31
|
| Rate for Payer: Healthscope Commercial |
$314.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.85
|
| Rate for Payer: Nomi Health Commercial |
$286.37
|
| Rate for Payer: PACE Senior Care Partners |
$82.94
|
| Rate for Payer: PACE SWMI |
$87.31
|
| Rate for Payer: PHP Commercial |
$296.85
|
| Rate for Payer: PHP Medicare Advantage |
$87.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.00
|
| Rate for Payer: Priority Health HMO/PPO |
$303.83
|
| Rate for Payer: Priority Health Medicare |
$88.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.98
|
| Rate for Payer: Railroad Medicare Medicare |
$87.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.32
|
| Rate for Payer: UHC Core |
$291.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.31
|
| Rate for Payer: UHC Exchange |
$87.31
|
| Rate for Payer: UHC Medicare Advantage |
$87.31
|
| Rate for Payer: VA VA |
$87.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.92
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
IP
|
$349.23
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$227.00 |
| Max. Negotiated Rate |
$314.31 |
| Rate for Payer: Aetna Commercial |
$296.85
|
| Rate for Payer: BCBS Trust/PPO |
$285.08
|
| Rate for Payer: BCN Commercial |
$269.88
|
| Rate for Payer: Cash Price |
$279.38
|
| Rate for Payer: Cofinity Commercial |
$300.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.38
|
| Rate for Payer: Healthscope Commercial |
$314.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.85
|
| Rate for Payer: Nomi Health Commercial |
$286.37
|
| Rate for Payer: PHP Commercial |
$296.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.00
|
| Rate for Payer: Priority Health HMO/PPO |
$303.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.32
|
| Rate for Payer: UHC Core |
$291.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.92
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
OP
|
$193.26
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$173.93 |
| Rate for Payer: Aetna Commercial |
$164.27
|
| Rate for Payer: Aetna Medicare |
$50.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.39
|
| Rate for Payer: BCBS Complete |
$77.30
|
| Rate for Payer: BCBS MAPPO |
$48.32
|
| Rate for Payer: BCBS Trust/PPO |
$158.88
|
| Rate for Payer: BCN Commercial |
$150.26
|
| Rate for Payer: BCN Medicare Advantage |
$48.32
|
| Rate for Payer: Cash Price |
$154.61
|
| Rate for Payer: Cofinity Commercial |
$166.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.32
|
| Rate for Payer: Healthscope Commercial |
$173.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.27
|
| Rate for Payer: Nomi Health Commercial |
$158.47
|
| Rate for Payer: PACE Senior Care Partners |
$45.90
|
| Rate for Payer: PACE SWMI |
$48.32
|
| Rate for Payer: PHP Commercial |
$164.27
|
| Rate for Payer: PHP Medicare Advantage |
$48.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.62
|
| Rate for Payer: Priority Health HMO/PPO |
$168.14
|
| Rate for Payer: Priority Health Medicare |
$48.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.48
|
| Rate for Payer: Railroad Medicare Medicare |
$48.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.07
|
| Rate for Payer: UHC Core |
$161.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.32
|
| Rate for Payer: UHC Exchange |
$48.32
|
| Rate for Payer: UHC Medicare Advantage |
$48.32
|
| Rate for Payer: VA VA |
$48.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.94
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
IP
|
$193.26
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$125.62 |
| Max. Negotiated Rate |
$173.93 |
| Rate for Payer: Aetna Commercial |
$164.27
|
| Rate for Payer: BCBS Trust/PPO |
$157.76
|
| Rate for Payer: BCN Commercial |
$149.35
|
| Rate for Payer: Cash Price |
$154.61
|
| Rate for Payer: Cofinity Commercial |
$166.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.61
|
| Rate for Payer: Healthscope Commercial |
$173.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.27
|
| Rate for Payer: Nomi Health Commercial |
$158.47
|
| Rate for Payer: PHP Commercial |
$164.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.62
|
| Rate for Payer: Priority Health HMO/PPO |
$168.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.07
|
| Rate for Payer: UHC Core |
$161.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.94
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$629.85 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: BCBS Trust/PPO |
$790.99
|
| Rate for Payer: BCN Commercial |
$748.84
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$726.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO |
$843.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$649.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$852.72
|
| Rate for Payer: UHC Core |
$809.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$726.75
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna Medicare |
$251.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$302.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$302.81
|
| Rate for Payer: BCBS Complete |
$520.48
|
| Rate for Payer: BCBS MAPPO |
$242.25
|
| Rate for Payer: BCBS Trust/PPO |
$796.61
|
| Rate for Payer: BCN Commercial |
$753.40
|
| Rate for Payer: BCN Medicare Advantage |
$242.25
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.25
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$726.75
|
| Rate for Payer: Mclaren Medicaid |
$495.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.36
|
| Rate for Payer: Meridian Medicaid |
$520.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: PACE Senior Care Partners |
$230.14
|
| Rate for Payer: PACE SWMI |
$242.25
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: PHP Medicare Advantage |
$242.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$495.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO |
$843.03
|
| Rate for Payer: Priority Health Medicare |
$244.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$649.23
|
| Rate for Payer: Railroad Medicare Medicare |
$242.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$852.72
|
| Rate for Payer: UHC Core |
$809.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.25
|
| Rate for Payer: UHC Exchange |
$242.25
|
| Rate for Payer: UHC Medicare Advantage |
$242.25
|
| Rate for Payer: UHCCP Medicaid |
$495.67
|
| Rate for Payer: VA VA |
$242.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$726.75
|
|
|
HC OPIATE URIN
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
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 |
$25.42
|
| Rate for Payer: BCBS Trust/PPO |
$83.57
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: BCN Medicare Advantage |
$25.42
|
| 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 |
$25.42
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.24
|
| 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 |
$25.42
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: PHP Medicare Advantage |
$25.42
|
| 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 |
$25.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.46
|
| Rate for Payer: UHC Core |
$84.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.42
|
| Rate for Payer: UHC Exchange |
$25.42
|
| Rate for Payer: UHC Medicare Advantage |
$25.42
|
| Rate for Payer: UHCCP Medicaid |
$44.93
|
| Rate for Payer: VA VA |
$25.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.24
|
|
|
HC OPIATE URIN
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
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 |
$76.24
|
| 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 |
$76.24
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: BCBS Trust/PPO |
$51.62
|
| Rate for Payer: BCN Commercial |
$48.87
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO |
$55.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.65
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Medicare |
$16.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.76
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS MAPPO |
$15.81
|
| Rate for Payer: BCBS Trust/PPO |
$51.99
|
| Rate for Payer: BCN Commercial |
$49.17
|
| Rate for Payer: BCN Medicare Advantage |
$15.81
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.81
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: PACE Senior Care Partners |
$15.02
|
| Rate for Payer: PACE SWMI |
$15.81
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: PHP Medicare Advantage |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO |
$55.02
|
| Rate for Payer: Priority Health Medicare |
$15.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.37
|
| Rate for Payer: Railroad Medicare Medicare |
$15.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.65
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.81
|
| Rate for Payer: UHC Exchange |
$15.81
|
| Rate for Payer: UHC Medicare Advantage |
$15.81
|
| Rate for Payer: VA VA |
$15.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.75
|
| Rate for Payer: BCBS Complete |
$9.57
|
| Rate for Payer: BCBS MAPPO |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$24.27
|
| Rate for Payer: BCN Medicare Advantage |
$7.80
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.80
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$9.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.19
|
| Rate for Payer: Meridian Medicaid |
$9.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PACE Senior Care Partners |
$7.41
|
| Rate for Payer: PACE SWMI |
$7.80
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: Railroad Medicare Medicare |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.80
|
| Rate for Payer: UHC Exchange |
$7.80
|
| Rate for Payer: UHC Medicare Advantage |
$7.80
|
| Rate for Payer: UHCCP Medicaid |
$9.11
|
| Rate for Payer: VA VA |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
