|
HC HOSP OUTPT VISIT NEW LVL 4
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000123
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.33 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$213.29
|
| Rate for Payer: BCN Commercial |
$213.29
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT VISIT NEW LVL 5
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000124
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$71.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.25
|
| Rate for Payer: BCBS Complete |
$91.05
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$214.59
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.00
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Mclaren Medicaid |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PACE Senior Care Partners |
$65.55
|
| Rate for Payer: PACE SWMI |
$69.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.33
|
| Rate for Payer: Railroad Medicare Medicare |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$71.07
|
| Rate for Payer: VA VA |
$69.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT VISIT NEW LVL 5
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000124
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.33 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$213.29
|
| Rate for Payer: BCN Commercial |
$213.29
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.60
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOT BIOPSY
|
Facility
|
OP
|
$479.16
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$431.24 |
| Rate for Payer: Aetna Commercial |
$407.29
|
| Rate for Payer: Aetna Medicare |
$124.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$149.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$149.74
|
| Rate for Payer: BCBS Complete |
$191.66
|
| Rate for Payer: BCBS MAPPO |
$119.79
|
| Rate for Payer: BCBS Trust/PPO |
$372.55
|
| Rate for Payer: BCN Commercial |
$372.55
|
| Rate for Payer: BCN Medicare Advantage |
$119.79
|
| Rate for Payer: Cash Price |
$383.33
|
| Rate for Payer: Cofinity Commercial |
$412.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.79
|
| Rate for Payer: Healthscope Commercial |
$431.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$125.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.29
|
| Rate for Payer: PACE Senior Care Partners |
$113.80
|
| Rate for Payer: PACE SWMI |
$119.79
|
| Rate for Payer: PHP Commercial |
$407.29
|
| Rate for Payer: PHP Medicare Advantage |
$119.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.87
|
| Rate for Payer: Priority Health Medicare |
$119.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.24
|
| Rate for Payer: Railroad Medicare Medicare |
$119.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.66
|
| Rate for Payer: UHC Core |
$400.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.79
|
| Rate for Payer: UHC Medicare Advantage |
$123.38
|
| Rate for Payer: VA VA |
$119.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.37
|
|
|
HC HOT BIOPSY
|
Facility
|
IP
|
$479.16
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.24 |
| Max. Negotiated Rate |
$431.24 |
| Rate for Payer: Aetna Commercial |
$407.29
|
| Rate for Payer: BCBS Trust/PPO |
$370.29
|
| Rate for Payer: BCN Commercial |
$370.29
|
| Rate for Payer: Cash Price |
$383.33
|
| Rate for Payer: Cofinity Commercial |
$412.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.33
|
| Rate for Payer: Healthscope Commercial |
$431.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.29
|
| Rate for Payer: PHP Commercial |
$407.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.66
|
| Rate for Payer: UHC Core |
$400.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.37
|
|
|
HC HPV TYPES 6,11,16,18,31,33,45,53,58, NONVALENT (9VHPV), 3 DOSE IM
|
Facility
|
OP
|
$189.72
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
63600071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.06 |
| Max. Negotiated Rate |
$170.75 |
| Rate for Payer: Aetna Commercial |
$161.26
|
| Rate for Payer: Aetna Medicare |
$49.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.29
|
| Rate for Payer: BCBS Complete |
$75.89
|
| Rate for Payer: BCBS MAPPO |
$47.43
|
| Rate for Payer: BCBS Trust/PPO |
$147.51
|
| Rate for Payer: BCN Commercial |
$147.51
|
| Rate for Payer: BCN Medicare Advantage |
$47.43
|
| Rate for Payer: Cash Price |
$151.78
|
| Rate for Payer: Cofinity Commercial |
$163.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.43
|
| Rate for Payer: Healthscope Commercial |
$170.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.26
|
| Rate for Payer: PACE Senior Care Partners |
$45.06
|
| Rate for Payer: PACE SWMI |
$47.43
|
| Rate for Payer: PHP Commercial |
$161.26
|
| Rate for Payer: PHP Medicare Advantage |
$47.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.06
|
| Rate for Payer: Priority Health Medicare |
$47.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.71
|
| Rate for Payer: Railroad Medicare Medicare |
$47.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.95
|
| Rate for Payer: UHC Core |
$158.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.43
|
| Rate for Payer: UHC Medicare Advantage |
$48.85
|
| Rate for Payer: VA VA |
$47.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.29
|
|
|
HC HPV TYPES 6,11,16,18,31,33,45,53,58, NONVALENT (9VHPV), 3 DOSE IM
|
Facility
|
IP
|
$189.72
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
63600071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.71 |
| Max. Negotiated Rate |
$170.75 |
| Rate for Payer: Aetna Commercial |
$161.26
|
| Rate for Payer: BCBS Trust/PPO |
$146.62
|
| Rate for Payer: BCN Commercial |
$146.62
|
| Rate for Payer: Cash Price |
$151.78
|
| Rate for Payer: Cofinity Commercial |
$163.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.78
|
| Rate for Payer: Healthscope Commercial |
$170.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.26
|
| Rate for Payer: PHP Commercial |
$161.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.95
|
| Rate for Payer: UHC Core |
$158.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.29
|
|
|
HC HPV TYPES 6, 11, 16, 18 QUADRIVALENT (4VHPV), 3 DOSE IM
|
Facility
|
OP
|
$208.69
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$187.82 |
| Rate for Payer: Aetna Commercial |
$177.39
|
| Rate for Payer: Aetna Medicare |
$54.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.22
|
| Rate for Payer: BCBS Complete |
$83.48
|
| Rate for Payer: BCBS MAPPO |
$52.17
|
| Rate for Payer: BCBS Trust/PPO |
$162.26
|
| Rate for Payer: BCN Commercial |
$162.26
|
| Rate for Payer: BCN Medicare Advantage |
$52.17
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cofinity Commercial |
$179.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.17
|
| Rate for Payer: Healthscope Commercial |
$187.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.39
|
| Rate for Payer: PACE Senior Care Partners |
$49.56
|
| Rate for Payer: PACE SWMI |
$52.17
|
| Rate for Payer: PHP Commercial |
$177.39
|
| Rate for Payer: PHP Medicare Advantage |
$52.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.56
|
| Rate for Payer: Priority Health Medicare |
$52.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.28
|
| Rate for Payer: Railroad Medicare Medicare |
$52.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.65
|
| Rate for Payer: UHC Core |
$174.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.17
|
| Rate for Payer: UHC Medicare Advantage |
$53.74
|
| Rate for Payer: VA VA |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.52
|
|
|
HC HPV TYPES 6, 11, 16, 18 QUADRIVALENT (4VHPV), 3 DOSE IM
|
Facility
|
IP
|
$208.69
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.28 |
| Max. Negotiated Rate |
$187.82 |
| Rate for Payer: Aetna Commercial |
$177.39
|
| Rate for Payer: BCBS Trust/PPO |
$161.28
|
| Rate for Payer: BCN Commercial |
$161.28
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cofinity Commercial |
$179.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.95
|
| Rate for Payer: Healthscope Commercial |
$187.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.39
|
| Rate for Payer: PHP Commercial |
$177.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.65
|
| Rate for Payer: UHC Core |
$174.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.52
|
|
|
HC H PYLORI AG STOOL
|
Facility
|
IP
|
$117.90
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
30600138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$71.91 |
| Max. Negotiated Rate |
$106.11 |
| Rate for Payer: Aetna Commercial |
$100.22
|
| Rate for Payer: BCBS Trust/PPO |
$91.11
|
| Rate for Payer: BCN Commercial |
$91.11
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cofinity Commercial |
$101.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.32
|
| Rate for Payer: Healthscope Commercial |
$106.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.22
|
| Rate for Payer: PHP Commercial |
$100.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.75
|
| Rate for Payer: UHC Core |
$98.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.42
|
|
|
HC H PYLORI AG STOOL
|
Facility
|
OP
|
$117.90
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
30600138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$106.11 |
| Rate for Payer: Aetna Commercial |
$100.22
|
| Rate for Payer: Aetna Medicare |
$30.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.84
|
| Rate for Payer: BCBS Complete |
$11.14
|
| Rate for Payer: BCBS MAPPO |
$29.48
|
| Rate for Payer: BCBS Trust/PPO |
$91.67
|
| Rate for Payer: BCN Commercial |
$91.67
|
| Rate for Payer: BCN Medicare Advantage |
$29.48
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cash Price |
$94.32
|
| Rate for Payer: Cofinity Commercial |
$101.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.48
|
| Rate for Payer: Healthscope Commercial |
$106.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.42
|
| Rate for Payer: Mclaren Medicaid |
$10.61
|
| Rate for Payer: Meridian Medicaid |
$11.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.22
|
| Rate for Payer: PACE Senior Care Partners |
$28.00
|
| Rate for Payer: PACE SWMI |
$29.48
|
| Rate for Payer: PHP Commercial |
$100.22
|
| Rate for Payer: PHP Medicare Advantage |
$29.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.57
|
| Rate for Payer: Priority Health Medicare |
$29.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.91
|
| Rate for Payer: Railroad Medicare Medicare |
$29.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.75
|
| Rate for Payer: UHC Core |
$98.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.48
|
| Rate for Payer: UHC Medicare Advantage |
$30.36
|
| Rate for Payer: VA VA |
$29.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.42
|
|
|
HC H PYLORI CLARITHRO RESIST PCR CMPT
|
Facility
|
IP
|
$64.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: BCBS Trust/PPO |
$49.58
|
| Rate for Payer: BCN Commercial |
$49.58
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Commercial |
$55.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.33
|
| Rate for Payer: Healthscope Commercial |
$57.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.54
|
| Rate for Payer: PHP Commercial |
$54.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.46
|
| Rate for Payer: UHC Core |
$53.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.12
|
|
|
HC H PYLORI CLARITHRO RESIST PCR CMPT
|
Facility
|
OP
|
$64.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare |
$16.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.05
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$16.04
|
| Rate for Payer: BCBS Trust/PPO |
$49.88
|
| Rate for Payer: BCN Commercial |
$49.88
|
| Rate for Payer: BCN Medicare Advantage |
$16.04
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Commercial |
$55.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.04
|
| Rate for Payer: Healthscope Commercial |
$57.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.12
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.54
|
| Rate for Payer: PACE Senior Care Partners |
$15.24
|
| Rate for Payer: PACE SWMI |
$16.04
|
| Rate for Payer: PHP Commercial |
$54.54
|
| Rate for Payer: PHP Medicare Advantage |
$16.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.82
|
| Rate for Payer: Priority Health Medicare |
$16.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.13
|
| Rate for Payer: Railroad Medicare Medicare |
$16.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.46
|
| Rate for Payer: UHC Core |
$53.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.04
|
| Rate for Payer: UHC Medicare Advantage |
$16.52
|
| Rate for Payer: VA VA |
$16.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.12
|
|
|
HC H PYLORI CLARITHRO RESIST PCR, FECES
|
Facility
|
OP
|
$64.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600325
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare |
$16.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.05
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$16.04
|
| Rate for Payer: BCBS Trust/PPO |
$49.88
|
| Rate for Payer: BCN Commercial |
$49.88
|
| Rate for Payer: BCN Medicare Advantage |
$16.04
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Commercial |
$55.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.04
|
| Rate for Payer: Healthscope Commercial |
$57.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.12
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.54
|
| Rate for Payer: PACE Senior Care Partners |
$15.24
|
| Rate for Payer: PACE SWMI |
$16.04
|
| Rate for Payer: PHP Commercial |
$54.54
|
| Rate for Payer: PHP Medicare Advantage |
$16.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.82
|
| Rate for Payer: Priority Health Medicare |
$16.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.13
|
| Rate for Payer: Railroad Medicare Medicare |
$16.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.46
|
| Rate for Payer: UHC Core |
$53.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.04
|
| Rate for Payer: UHC Medicare Advantage |
$16.52
|
| Rate for Payer: VA VA |
$16.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.12
|
|
|
HC H PYLORI CLARITHRO RESIST PCR, FECES
|
Facility
|
IP
|
$64.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600325
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: BCBS Trust/PPO |
$49.58
|
| Rate for Payer: BCN Commercial |
$49.58
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Cofinity Commercial |
$55.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.33
|
| Rate for Payer: Healthscope Commercial |
$57.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.54
|
| Rate for Payer: PHP Commercial |
$54.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.46
|
| Rate for Payer: UHC Core |
$53.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.12
|
|
|
HC H PYLORI W SUSCEPTIBILITIES
|
Facility
|
OP
|
$90.40
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
30600333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Aetna Commercial |
$76.84
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.25
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS MAPPO |
$22.60
|
| Rate for Payer: BCBS Trust/PPO |
$70.29
|
| Rate for Payer: BCN Commercial |
$70.29
|
| Rate for Payer: BCN Medicare Advantage |
$22.60
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$77.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$81.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.80
|
| Rate for Payer: Mclaren Medicaid |
$4.89
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PACE Senior Care Partners |
$21.47
|
| Rate for Payer: PACE SWMI |
$22.60
|
| Rate for Payer: PHP Commercial |
$76.84
|
| Rate for Payer: PHP Medicare Advantage |
$22.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.65
|
| Rate for Payer: Priority Health Medicare |
$22.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.13
|
| Rate for Payer: Railroad Medicare Medicare |
$22.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.55
|
| Rate for Payer: UHC Core |
$75.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.60
|
| Rate for Payer: UHC Medicare Advantage |
$23.28
|
| Rate for Payer: VA VA |
$22.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.80
|
|
|
HC H PYLORI W SUSCEPTIBILITIES
|
Facility
|
IP
|
$90.40
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
30600333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$55.13 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Aetna Commercial |
$76.84
|
| Rate for Payer: BCBS Trust/PPO |
$69.86
|
| Rate for Payer: BCN Commercial |
$69.86
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$77.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.32
|
| Rate for Payer: Healthscope Commercial |
$81.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PHP Commercial |
$76.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.55
|
| Rate for Payer: UHC Core |
$75.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.80
|
|
|
HC HSV 1 IGM TITER
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.72
|
| Rate for Payer: BCBS Complete |
$10.22
|
| Rate for Payer: BCBS MAPPO |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$51.55
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: BCN Medicare Advantage |
$16.58
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Mclaren Medicaid |
$9.73
|
| Rate for Payer: Meridian Medicaid |
$10.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PACE Senior Care Partners |
$15.75
|
| Rate for Payer: PACE SWMI |
$16.58
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Medicare |
$16.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: Railroad Medicare Medicare |
$16.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.58
|
| Rate for Payer: UHC Medicare Advantage |
$17.07
|
| Rate for Payer: VA VA |
$16.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC HSV 1 IGM TITER
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$51.24
|
| Rate for Payer: BCN Commercial |
$51.24
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC HSV 2 IGM TITER
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200385
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$51.24
|
| Rate for Payer: BCN Commercial |
$51.24
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC HSV 2 IGM TITER
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200385
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.72
|
| Rate for Payer: BCBS Complete |
$14.99
|
| Rate for Payer: BCBS MAPPO |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$51.55
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: BCN Medicare Advantage |
$16.58
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Mclaren Medicaid |
$14.28
|
| Rate for Payer: Meridian Medicaid |
$14.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PACE Senior Care Partners |
$15.75
|
| Rate for Payer: PACE SWMI |
$16.58
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Medicare |
$16.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: Railroad Medicare Medicare |
$16.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.58
|
| Rate for Payer: UHC Medicare Advantage |
$17.07
|
| Rate for Payer: VA VA |
$16.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC HSV AB IGM BY IFA
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200279
|
|
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 HSV AB IGM BY IFA
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200279
|
|
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 HSV CULTURE, NEONATE
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
30600296
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$51.24
|
| Rate for Payer: BCN Commercial |
$51.24
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC HSV CULTURE, NEONATE
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
30600296
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.72
|
| Rate for Payer: BCBS Complete |
$15.16
|
| Rate for Payer: BCBS MAPPO |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$51.55
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: BCN Medicare Advantage |
$16.58
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Mclaren Medicaid |
$14.44
|
| Rate for Payer: Meridian Medicaid |
$15.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.36
|
| Rate for Payer: PACE Senior Care Partners |
$15.75
|
| Rate for Payer: PACE SWMI |
$16.58
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Medicare |
$16.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: Railroad Medicare Medicare |
$16.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.58
|
| Rate for Payer: UHC Medicare Advantage |
$17.07
|
| Rate for Payer: VA VA |
$16.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
