|
HC HEP C GENO SUBTYPES
|
Facility
|
IP
|
$406.67
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$248.03 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Aetna Commercial |
$345.67
|
| Rate for Payer: BCBS Trust/PPO |
$314.27
|
| Rate for Payer: BCN Commercial |
$314.27
|
| Rate for Payer: Cash Price |
$325.34
|
| Rate for Payer: Cofinity Commercial |
$349.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.34
|
| Rate for Payer: Healthscope Commercial |
$366.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.67
|
| Rate for Payer: PHP Commercial |
$345.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.87
|
| Rate for Payer: UHC Core |
$339.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.00
|
|
|
HC HER2 DUAL ISH
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000065
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Medicare |
$79.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.62
|
| Rate for Payer: BCBS Complete |
$247.59
|
| Rate for Payer: BCBS MAPPO |
$76.50
|
| Rate for Payer: BCBS Trust/PPO |
$237.92
|
| Rate for Payer: BCCCP Commercial |
$143.46
|
| Rate for Payer: BCN Commercial |
$237.92
|
| Rate for Payer: BCN Medicare Advantage |
$76.50
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.50
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.50
|
| Rate for Payer: Mclaren Medicaid |
$235.80
|
| Rate for Payer: Meridian Medicaid |
$247.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$80.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.10
|
| Rate for Payer: PACE Senior Care Partners |
$72.68
|
| Rate for Payer: PACE SWMI |
$76.50
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: PHP Medicare Advantage |
$76.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.22
|
| Rate for Payer: Priority Health Medicare |
$76.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.63
|
| Rate for Payer: Railroad Medicare Medicare |
$76.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.28
|
| Rate for Payer: UHC Core |
$255.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.50
|
| Rate for Payer: UHC Medicare Advantage |
$78.80
|
| Rate for Payer: VA VA |
$76.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.50
|
|
|
HC HER2 DUAL ISH
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000065
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$186.63 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: BCBS Trust/PPO |
$236.48
|
| Rate for Payer: BCN Commercial |
$236.48
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.10
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.28
|
| Rate for Payer: UHC Core |
$255.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.50
|
|
|
HC HER2 DUAL ISH CMPT
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Medicare |
$79.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.62
|
| Rate for Payer: BCBS Complete |
$247.59
|
| Rate for Payer: BCBS MAPPO |
$76.50
|
| Rate for Payer: BCBS Trust/PPO |
$237.92
|
| Rate for Payer: BCCCP Commercial |
$143.46
|
| Rate for Payer: BCN Commercial |
$237.92
|
| Rate for Payer: BCN Medicare Advantage |
$76.50
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.50
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.50
|
| Rate for Payer: Mclaren Medicaid |
$235.80
|
| Rate for Payer: Meridian Medicaid |
$247.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$80.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.10
|
| Rate for Payer: PACE Senior Care Partners |
$72.68
|
| Rate for Payer: PACE SWMI |
$76.50
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: PHP Medicare Advantage |
$76.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.22
|
| Rate for Payer: Priority Health Medicare |
$76.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.63
|
| Rate for Payer: Railroad Medicare Medicare |
$76.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.28
|
| Rate for Payer: UHC Core |
$255.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.50
|
| Rate for Payer: UHC Medicare Advantage |
$78.80
|
| Rate for Payer: VA VA |
$76.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.50
|
|
|
HC HER2 DUAL ISH CMPT
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$186.63 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: BCBS Trust/PPO |
$236.48
|
| Rate for Payer: BCN Commercial |
$236.48
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$263.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.80
|
| Rate for Payer: Healthscope Commercial |
$275.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.10
|
| Rate for Payer: PHP Commercial |
$260.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.28
|
| Rate for Payer: UHC Core |
$255.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.50
|
|
|
HC HER-2 NEU QUANTITATIVE
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 83950
|
| Hospital Charge Code |
30100382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna Commercial |
$207.40
|
| Rate for Payer: Aetna Medicare |
$63.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.25
|
| Rate for Payer: BCBS Complete |
$49.91
|
| Rate for Payer: BCBS MAPPO |
$61.00
|
| Rate for Payer: BCBS Trust/PPO |
$189.71
|
| Rate for Payer: BCN Commercial |
$189.71
|
| Rate for Payer: BCN Medicare Advantage |
$61.00
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$209.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.00
|
| Rate for Payer: Healthscope Commercial |
$219.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.00
|
| Rate for Payer: Mclaren Medicaid |
$47.53
|
| Rate for Payer: Meridian Medicaid |
$49.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.40
|
| Rate for Payer: PACE Senior Care Partners |
$57.95
|
| Rate for Payer: PACE SWMI |
$61.00
|
| Rate for Payer: PHP Commercial |
$207.40
|
| Rate for Payer: PHP Medicare Advantage |
$61.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.28
|
| Rate for Payer: Priority Health Medicare |
$61.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.82
|
| Rate for Payer: Railroad Medicare Medicare |
$61.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.72
|
| Rate for Payer: UHC Core |
$203.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.00
|
| Rate for Payer: UHC Medicare Advantage |
$62.83
|
| Rate for Payer: VA VA |
$61.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.00
|
|
|
HC HER-2 NEU QUANTITATIVE
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 83950
|
| Hospital Charge Code |
30100382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$148.82 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Aetna Commercial |
$207.40
|
| Rate for Payer: BCBS Trust/PPO |
$188.56
|
| Rate for Payer: BCN Commercial |
$188.56
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$209.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.20
|
| Rate for Payer: Healthscope Commercial |
$219.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.40
|
| Rate for Payer: PHP Commercial |
$207.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.72
|
| Rate for Payer: UHC Core |
$203.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.00
|
|
|
HC HERPES PCR
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600211
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: BCBS Trust/PPO |
$55.18
|
| Rate for Payer: BCN Commercial |
$55.18
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC HERPES PCR
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600211
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.31
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$55.51
|
| Rate for Payer: BCN Commercial |
$55.51
|
| Rate for Payer: BCN Medicare Advantage |
$17.85
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PACE Senior Care Partners |
$16.96
|
| Rate for Payer: PACE SWMI |
$17.85
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$17.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.12
|
| Rate for Payer: Priority Health Medicare |
$17.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.55
|
| Rate for Payer: Railroad Medicare Medicare |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.85
|
| Rate for Payer: UHC Medicare Advantage |
$18.39
|
| Rate for Payer: VA VA |
$17.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC HERPES PCR COMPONENT
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.31
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$55.51
|
| Rate for Payer: BCN Commercial |
$55.51
|
| Rate for Payer: BCN Medicare Advantage |
$17.85
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PACE Senior Care Partners |
$16.96
|
| Rate for Payer: PACE SWMI |
$17.85
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$17.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.12
|
| Rate for Payer: Priority Health Medicare |
$17.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.55
|
| Rate for Payer: Railroad Medicare Medicare |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.85
|
| Rate for Payer: UHC Medicare Advantage |
$18.39
|
| Rate for Payer: VA VA |
$17.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC HERPES PCR COMPONENT
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: BCBS Trust/PPO |
$55.18
|
| Rate for Payer: BCN Commercial |
$55.18
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC HERPES SIMPLEX IGG TYPE 1
|
Facility
|
IP
|
$48.97
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200281
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.87 |
| Max. Negotiated Rate |
$44.07 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$37.84
|
| Rate for Payer: BCN Commercial |
$37.84
|
| Rate for Payer: Cash Price |
$39.18
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.18
|
| Rate for Payer: Healthscope Commercial |
$44.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.09
|
| Rate for Payer: UHC Core |
$40.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.73
|
|
|
HC HERPES SIMPLEX IGG TYPE 1
|
Facility
|
OP
|
$48.97
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200281
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$44.07 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$12.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.30
|
| Rate for Payer: BCBS Complete |
$10.22
|
| Rate for Payer: BCBS MAPPO |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$38.07
|
| Rate for Payer: BCN Commercial |
$38.07
|
| Rate for Payer: BCN Medicare Advantage |
$12.24
|
| Rate for Payer: Cash Price |
$39.18
|
| Rate for Payer: Cash Price |
$39.18
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$44.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.73
|
| Rate for Payer: Mclaren Medicaid |
$9.73
|
| Rate for Payer: Meridian Medicaid |
$10.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Senior Care Partners |
$11.63
|
| Rate for Payer: PACE SWMI |
$12.24
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$12.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.60
|
| Rate for Payer: Priority Health Medicare |
$12.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.87
|
| Rate for Payer: Railroad Medicare Medicare |
$12.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.09
|
| Rate for Payer: UHC Core |
$40.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.24
|
| Rate for Payer: UHC Medicare Advantage |
$12.61
|
| Rate for Payer: VA VA |
$12.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.73
|
|
|
HC HERPES SIMPLEX IGG TYPE 2
|
Facility
|
IP
|
$71.85
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200283
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.82 |
| Max. Negotiated Rate |
$64.66 |
| Rate for Payer: Aetna Commercial |
$61.07
|
| Rate for Payer: BCBS Trust/PPO |
$55.53
|
| Rate for Payer: BCN Commercial |
$55.53
|
| Rate for Payer: Cash Price |
$57.48
|
| Rate for Payer: Cofinity Commercial |
$61.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.48
|
| Rate for Payer: Healthscope Commercial |
$64.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.07
|
| Rate for Payer: PHP Commercial |
$61.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.23
|
| Rate for Payer: UHC Core |
$59.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.89
|
|
|
HC HERPES SIMPLEX IGG TYPE 2
|
Facility
|
OP
|
$71.85
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200283
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$64.66 |
| Rate for Payer: Aetna Commercial |
$61.07
|
| Rate for Payer: Aetna Medicare |
$18.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.45
|
| Rate for Payer: BCBS Complete |
$14.99
|
| Rate for Payer: BCBS MAPPO |
$17.96
|
| Rate for Payer: BCBS Trust/PPO |
$55.86
|
| Rate for Payer: BCN Commercial |
$55.86
|
| Rate for Payer: BCN Medicare Advantage |
$17.96
|
| Rate for Payer: Cash Price |
$57.48
|
| Rate for Payer: Cash Price |
$57.48
|
| Rate for Payer: Cofinity Commercial |
$61.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$64.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.89
|
| Rate for Payer: Mclaren Medicaid |
$14.28
|
| Rate for Payer: Meridian Medicaid |
$14.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.07
|
| Rate for Payer: PACE Senior Care Partners |
$17.06
|
| Rate for Payer: PACE SWMI |
$17.96
|
| Rate for Payer: PHP Commercial |
$61.07
|
| Rate for Payer: PHP Medicare Advantage |
$17.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.51
|
| Rate for Payer: Priority Health Medicare |
$17.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.23
|
| Rate for Payer: UHC Core |
$59.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.96
|
| Rate for Payer: UHC Medicare Advantage |
$18.50
|
| Rate for Payer: VA VA |
$17.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.89
|
|
|
HC HERPES SIMPLEX IGM TYPE 1&2
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200278
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$37.27
|
| Rate for Payer: BCN Commercial |
$37.27
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.96
|
| Rate for Payer: Mclaren Medicaid |
$10.62
|
| Rate for Payer: Meridian Medicaid |
$11.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.75
|
| Rate for Payer: PACE Senior Care Partners |
$11.39
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.71
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.24
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.19
|
| Rate for Payer: UHC Core |
$40.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
| Rate for Payer: VA VA |
$11.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.96
|
|
|
HC HERPES SIMPLEX IGM TYPE 1&2
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200278
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.24 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: BCBS Trust/PPO |
$37.05
|
| Rate for Payer: BCN Commercial |
$37.05
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.75
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.19
|
| Rate for Payer: UHC Core |
$40.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.96
|
|
|
HC HERPES SIMPLEX NON-SPECIFIC
|
Facility
|
OP
|
$38.76
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200277
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.11
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS MAPPO |
$9.69
|
| Rate for Payer: BCBS Trust/PPO |
$30.14
|
| Rate for Payer: BCN Commercial |
$30.14
|
| Rate for Payer: BCN Medicare Advantage |
$9.69
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.69
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Mclaren Medicaid |
$10.62
|
| Rate for Payer: Meridian Medicaid |
$11.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PACE Senior Care Partners |
$9.21
|
| Rate for Payer: PACE SWMI |
$9.69
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.72
|
| Rate for Payer: Priority Health Medicare |
$9.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: Railroad Medicare Medicare |
$9.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.11
|
| Rate for Payer: UHC Core |
$32.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.69
|
| Rate for Payer: UHC Medicare Advantage |
$9.98
|
| Rate for Payer: VA VA |
$9.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
|
HC HERPES SIMPLEX NON-SPECIFIC
|
Facility
|
IP
|
$38.76
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200277
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.95
|
| Rate for Payer: BCN Commercial |
$29.95
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.11
|
| Rate for Payer: UHC Core |
$32.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
|
HC HERPES SIMPLEX PCR
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600158
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: BCBS Trust/PPO |
$42.50
|
| Rate for Payer: BCN Commercial |
$42.50
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$47.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.00
|
| Rate for Payer: Healthscope Commercial |
$49.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
| Rate for Payer: PHP Commercial |
$46.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.40
|
| Rate for Payer: UHC Core |
$45.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.25
|
|
|
HC HERPES SIMPLEX PCR
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600158
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Aetna Medicare |
$14.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.19
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$13.75
|
| Rate for Payer: BCBS Trust/PPO |
$42.76
|
| Rate for Payer: BCN Commercial |
$42.76
|
| Rate for Payer: BCN Medicare Advantage |
$13.75
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$47.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.75
|
| Rate for Payer: Healthscope Commercial |
$49.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.25
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
| Rate for Payer: PACE Senior Care Partners |
$13.06
|
| Rate for Payer: PACE SWMI |
$13.75
|
| Rate for Payer: PHP Commercial |
$46.75
|
| Rate for Payer: PHP Medicare Advantage |
$13.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.85
|
| Rate for Payer: Priority Health Medicare |
$13.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.54
|
| Rate for Payer: Railroad Medicare Medicare |
$13.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.40
|
| Rate for Payer: UHC Core |
$45.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.75
|
| Rate for Payer: UHC Medicare Advantage |
$14.16
|
| Rate for Payer: VA VA |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.25
|
|
|
HC HERPES SIMPLEX VIRUS 1 (HSV-1)
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600270
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HERPES SIMPLEX VIRUS 1 (HSV-1)
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600270
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HERPES SIMPLEX VIRUS CULTURE
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
30600116
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: BCBS Trust/PPO |
$78.83
|
| Rate for Payer: BCN Commercial |
$78.83
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC HERPES SIMPLEX VIRUS CULTURE
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
30600116
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.88
|
| Rate for Payer: BCBS Complete |
$26.24
|
| Rate for Payer: BCBS MAPPO |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$79.30
|
| Rate for Payer: BCN Commercial |
$79.30
|
| Rate for Payer: BCN Medicare Advantage |
$25.50
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.50
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Mclaren Medicaid |
$24.99
|
| Rate for Payer: Meridian Medicaid |
$26.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PACE Senior Care Partners |
$24.22
|
| Rate for Payer: PACE SWMI |
$25.50
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$25.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.74
|
| Rate for Payer: Priority Health Medicare |
$25.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.21
|
| Rate for Payer: Railroad Medicare Medicare |
$25.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.50
|
| Rate for Payer: UHC Medicare Advantage |
$26.26
|
| Rate for Payer: VA VA |
$25.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
