|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
OP
|
$365.26
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$328.73 |
| Rate for Payer: Aetna Commercial |
$310.47
|
| Rate for Payer: Aetna Medicare |
$94.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.14
|
| Rate for Payer: BCBS Complete |
$48.52
|
| Rate for Payer: BCBS MAPPO |
$91.32
|
| Rate for Payer: BCBS Trust/PPO |
$283.99
|
| Rate for Payer: BCN Commercial |
$283.99
|
| Rate for Payer: BCN Medicare Advantage |
$91.32
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cofinity Commercial |
$314.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.32
|
| Rate for Payer: Healthscope Commercial |
$328.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.94
|
| Rate for Payer: Mclaren Medicaid |
$46.21
|
| Rate for Payer: Meridian Medicaid |
$48.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$95.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.47
|
| Rate for Payer: PACE Senior Care Partners |
$86.75
|
| Rate for Payer: PACE SWMI |
$91.32
|
| Rate for Payer: PHP Commercial |
$310.47
|
| Rate for Payer: PHP Medicare Advantage |
$91.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.78
|
| Rate for Payer: Priority Health Medicare |
$91.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.77
|
| Rate for Payer: Railroad Medicare Medicare |
$91.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.43
|
| Rate for Payer: UHC Core |
$304.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.32
|
| Rate for Payer: UHC Medicare Advantage |
$94.05
|
| Rate for Payer: VA VA |
$91.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.94
|
|
|
HC IV PUSH CHEMO EACH ADDL DRUG
|
Facility
|
IP
|
$365.26
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
33100004
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$222.77 |
| Max. Negotiated Rate |
$328.73 |
| Rate for Payer: Aetna Commercial |
$310.47
|
| Rate for Payer: BCBS Trust/PPO |
$282.27
|
| Rate for Payer: BCN Commercial |
$282.27
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cofinity Commercial |
$314.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.21
|
| Rate for Payer: Healthscope Commercial |
$328.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.47
|
| Rate for Payer: PHP Commercial |
$310.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$222.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.43
|
| Rate for Payer: UHC Core |
$304.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.94
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
IP
|
$669.39
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$408.26 |
| Max. Negotiated Rate |
$602.45 |
| Rate for Payer: Aetna Commercial |
$568.98
|
| Rate for Payer: BCBS Trust/PPO |
$517.30
|
| Rate for Payer: BCN Commercial |
$517.30
|
| Rate for Payer: Cash Price |
$535.51
|
| Rate for Payer: Cofinity Commercial |
$575.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.51
|
| Rate for Payer: Healthscope Commercial |
$602.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.98
|
| Rate for Payer: PHP Commercial |
$568.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$582.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$408.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$589.06
|
| Rate for Payer: UHC Core |
$558.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.04
|
|
|
HC IV PUSH CHEMO INITIAL DRUG
|
Facility
|
OP
|
$669.39
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
33100003
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$158.98 |
| Max. Negotiated Rate |
$602.45 |
| Rate for Payer: Aetna Commercial |
$568.98
|
| Rate for Payer: Aetna Medicare |
$174.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$209.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$209.18
|
| Rate for Payer: BCBS Complete |
$233.27
|
| Rate for Payer: BCBS MAPPO |
$167.35
|
| Rate for Payer: BCBS Trust/PPO |
$520.45
|
| Rate for Payer: BCN Commercial |
$520.45
|
| Rate for Payer: BCN Medicare Advantage |
$167.35
|
| Rate for Payer: Cash Price |
$535.51
|
| Rate for Payer: Cash Price |
$535.51
|
| Rate for Payer: Cofinity Commercial |
$575.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.35
|
| Rate for Payer: Healthscope Commercial |
$602.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.04
|
| Rate for Payer: Mclaren Medicaid |
$222.16
|
| Rate for Payer: Meridian Medicaid |
$233.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$175.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$568.98
|
| Rate for Payer: PACE Senior Care Partners |
$158.98
|
| Rate for Payer: PACE SWMI |
$167.35
|
| Rate for Payer: PHP Commercial |
$568.98
|
| Rate for Payer: PHP Medicare Advantage |
$167.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$582.37
|
| Rate for Payer: Priority Health Medicare |
$167.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$408.26
|
| Rate for Payer: Railroad Medicare Medicare |
$167.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$589.06
|
| Rate for Payer: UHC Core |
$558.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.35
|
| Rate for Payer: UHC Medicare Advantage |
$172.37
|
| Rate for Payer: VA VA |
$167.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.04
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
IP
|
$277.09
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$249.38 |
| Rate for Payer: Aetna Commercial |
$235.53
|
| Rate for Payer: BCBS Trust/PPO |
$214.14
|
| Rate for Payer: BCN Commercial |
$214.14
|
| Rate for Payer: Cash Price |
$221.67
|
| Rate for Payer: Cofinity Commercial |
$238.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.67
|
| Rate for Payer: Healthscope Commercial |
$249.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.53
|
| Rate for Payer: PHP Commercial |
$235.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.84
|
| Rate for Payer: UHC Core |
$231.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.82
|
|
|
HC IV PUSH INITIAL DRUG
|
Facility
|
OP
|
$277.09
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
51000004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.81 |
| Max. Negotiated Rate |
$249.38 |
| Rate for Payer: Aetna Commercial |
$235.53
|
| Rate for Payer: Aetna Medicare |
$72.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.59
|
| Rate for Payer: BCBS Complete |
$147.63
|
| Rate for Payer: BCBS MAPPO |
$69.27
|
| Rate for Payer: BCBS Trust/PPO |
$215.44
|
| Rate for Payer: BCN Commercial |
$215.44
|
| Rate for Payer: BCN Medicare Advantage |
$69.27
|
| Rate for Payer: Cash Price |
$221.67
|
| Rate for Payer: Cash Price |
$221.67
|
| Rate for Payer: Cofinity Commercial |
$238.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.27
|
| Rate for Payer: Healthscope Commercial |
$249.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.82
|
| Rate for Payer: Mclaren Medicaid |
$140.60
|
| Rate for Payer: Meridian Medicaid |
$147.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$72.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.53
|
| Rate for Payer: PACE Senior Care Partners |
$65.81
|
| Rate for Payer: PACE SWMI |
$69.27
|
| Rate for Payer: PHP Commercial |
$235.53
|
| Rate for Payer: PHP Medicare Advantage |
$69.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.07
|
| Rate for Payer: Priority Health Medicare |
$69.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.00
|
| Rate for Payer: Railroad Medicare Medicare |
$69.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.84
|
| Rate for Payer: UHC Core |
$231.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.27
|
| Rate for Payer: UHC Medicare Advantage |
$71.35
|
| Rate for Payer: VA VA |
$69.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.82
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
OP
|
$217.88
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$196.09 |
| Rate for Payer: Aetna Commercial |
$185.20
|
| Rate for Payer: Aetna Medicare |
$56.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.09
|
| Rate for Payer: BCBS Complete |
$48.52
|
| Rate for Payer: BCBS MAPPO |
$54.47
|
| Rate for Payer: BCBS Trust/PPO |
$169.40
|
| Rate for Payer: BCN Commercial |
$169.40
|
| Rate for Payer: BCN Medicare Advantage |
$54.47
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$187.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.47
|
| Rate for Payer: Healthscope Commercial |
$196.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.41
|
| Rate for Payer: Mclaren Medicaid |
$46.21
|
| Rate for Payer: Meridian Medicaid |
$48.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.20
|
| Rate for Payer: PACE Senior Care Partners |
$51.75
|
| Rate for Payer: PACE SWMI |
$54.47
|
| Rate for Payer: PHP Commercial |
$185.20
|
| Rate for Payer: PHP Medicare Advantage |
$54.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.56
|
| Rate for Payer: Priority Health Medicare |
$54.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.89
|
| Rate for Payer: Railroad Medicare Medicare |
$54.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.73
|
| Rate for Payer: UHC Core |
$181.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.47
|
| Rate for Payer: UHC Medicare Advantage |
$56.10
|
| Rate for Payer: VA VA |
$54.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.41
|
|
|
HC IV SEQUENTIAL INFUSION UP TO 1 HR
|
Facility
|
IP
|
$217.88
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
26000006
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$132.89 |
| Max. Negotiated Rate |
$196.09 |
| Rate for Payer: Aetna Commercial |
$185.20
|
| Rate for Payer: BCBS Trust/PPO |
$168.38
|
| Rate for Payer: BCN Commercial |
$168.38
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$187.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$196.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.20
|
| Rate for Payer: PHP Commercial |
$185.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.73
|
| Rate for Payer: UHC Core |
$181.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.41
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$319.76 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: BCBS Trust/PPO |
$405.16
|
| Rate for Payer: BCN Commercial |
$405.16
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.37
|
| Rate for Payer: UHC Core |
$437.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.21
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
CPT M0243
|
| Hospital Charge Code |
77100029
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$124.52 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna Medicare |
$136.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$163.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$163.84
|
| Rate for Payer: BCBS Complete |
$325.67
|
| Rate for Payer: BCBS MAPPO |
$131.07
|
| Rate for Payer: BCBS Trust/PPO |
$407.63
|
| Rate for Payer: BCN Commercial |
$407.63
|
| Rate for Payer: BCN Medicare Advantage |
$131.07
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.07
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.21
|
| Rate for Payer: Mclaren Medicaid |
$310.17
|
| Rate for Payer: Meridian Medicaid |
$325.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Senior Care Partners |
$124.52
|
| Rate for Payer: PACE SWMI |
$131.07
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: PHP Medicare Advantage |
$131.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.12
|
| Rate for Payer: Priority Health Medicare |
$131.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.76
|
| Rate for Payer: Railroad Medicare Medicare |
$131.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.37
|
| Rate for Payer: UHC Core |
$437.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.07
|
| Rate for Payer: UHC Medicare Advantage |
$135.00
|
| Rate for Payer: VA VA |
$131.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.21
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
IP
|
$524.28
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$319.76 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: BCBS Trust/PPO |
$405.16
|
| Rate for Payer: BCN Commercial |
$405.16
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.37
|
| Rate for Payer: UHC Core |
$437.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.21
|
|
|
HC IV/SQ INJ CASIRIVIMAB/IMDEVIMAB SUBSEQ
|
Facility
|
OP
|
$524.28
|
|
|
Service Code
|
CPT M0240
|
| Hospital Charge Code |
77100030
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$124.52 |
| Max. Negotiated Rate |
$471.85 |
| Rate for Payer: Aetna Commercial |
$445.64
|
| Rate for Payer: Aetna Medicare |
$136.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$163.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$163.84
|
| Rate for Payer: BCBS Complete |
$325.67
|
| Rate for Payer: BCBS MAPPO |
$131.07
|
| Rate for Payer: BCBS Trust/PPO |
$407.63
|
| Rate for Payer: BCN Commercial |
$407.63
|
| Rate for Payer: BCN Medicare Advantage |
$131.07
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cash Price |
$419.42
|
| Rate for Payer: Cofinity Commercial |
$450.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.07
|
| Rate for Payer: Healthscope Commercial |
$471.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.21
|
| Rate for Payer: Mclaren Medicaid |
$310.17
|
| Rate for Payer: Meridian Medicaid |
$325.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.64
|
| Rate for Payer: PACE Senior Care Partners |
$124.52
|
| Rate for Payer: PACE SWMI |
$131.07
|
| Rate for Payer: PHP Commercial |
$445.64
|
| Rate for Payer: PHP Medicare Advantage |
$131.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.12
|
| Rate for Payer: Priority Health Medicare |
$131.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.76
|
| Rate for Payer: Railroad Medicare Medicare |
$131.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$461.37
|
| Rate for Payer: UHC Core |
$437.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.07
|
| Rate for Payer: UHC Medicare Advantage |
$135.00
|
| Rate for Payer: VA VA |
$131.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.21
|
|
|
HC IVUS CATHETER
|
Facility
|
IP
|
$2,685.65
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,637.98 |
| Max. Negotiated Rate |
$2,417.08 |
| Rate for Payer: Aetna Commercial |
$2,282.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,075.47
|
| Rate for Payer: BCN Commercial |
$2,075.47
|
| Rate for Payer: Cash Price |
$2,148.52
|
| Rate for Payer: Cofinity Commercial |
$2,309.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,148.52
|
| Rate for Payer: Healthscope Commercial |
$2,417.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,014.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,282.80
|
| Rate for Payer: PHP Commercial |
$2,282.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,336.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,637.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,363.37
|
| Rate for Payer: UHC Core |
$2,242.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,014.24
|
|
|
HC IVUS CATHETER
|
Facility
|
OP
|
$2,685.65
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$637.84 |
| Max. Negotiated Rate |
$2,417.08 |
| Rate for Payer: Aetna Commercial |
$2,282.80
|
| Rate for Payer: Aetna Medicare |
$698.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$839.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$839.27
|
| Rate for Payer: BCBS Complete |
$1,074.26
|
| Rate for Payer: BCBS MAPPO |
$671.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,088.09
|
| Rate for Payer: BCN Commercial |
$2,088.09
|
| Rate for Payer: BCN Medicare Advantage |
$671.41
|
| Rate for Payer: Cash Price |
$2,148.52
|
| Rate for Payer: Cofinity Commercial |
$2,309.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,148.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$671.41
|
| Rate for Payer: Healthscope Commercial |
$2,417.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,014.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$704.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$772.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,282.80
|
| Rate for Payer: PACE Senior Care Partners |
$637.84
|
| Rate for Payer: PACE SWMI |
$671.41
|
| Rate for Payer: PHP Commercial |
$2,282.80
|
| Rate for Payer: PHP Medicare Advantage |
$671.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,879.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,336.52
|
| Rate for Payer: Priority Health Medicare |
$671.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,637.98
|
| Rate for Payer: Railroad Medicare Medicare |
$671.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,363.37
|
| Rate for Payer: UHC Core |
$2,242.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$671.41
|
| Rate for Payer: UHC Medicare Advantage |
$691.55
|
| Rate for Payer: VA VA |
$671.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,014.24
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
IP
|
$1,298.86
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$792.17 |
| Max. Negotiated Rate |
$1,168.97 |
| Rate for Payer: Aetna Commercial |
$1,104.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,003.76
|
| Rate for Payer: BCN Commercial |
$1,003.76
|
| Rate for Payer: Cash Price |
$1,039.09
|
| Rate for Payer: Cofinity Commercial |
$1,117.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,039.09
|
| Rate for Payer: Healthscope Commercial |
$1,168.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$974.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,104.03
|
| Rate for Payer: PHP Commercial |
$1,104.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,130.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$792.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,143.00
|
| Rate for Payer: UHC Core |
$1,084.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$974.14
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
OP
|
$1,298.86
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.48 |
| Max. Negotiated Rate |
$1,168.97 |
| Rate for Payer: Aetna Commercial |
$1,104.03
|
| Rate for Payer: Aetna Medicare |
$337.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$405.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$405.89
|
| Rate for Payer: BCBS Complete |
$519.54
|
| Rate for Payer: BCBS MAPPO |
$324.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.86
|
| Rate for Payer: BCN Commercial |
$1,009.86
|
| Rate for Payer: BCN Medicare Advantage |
$324.72
|
| Rate for Payer: Cash Price |
$1,039.09
|
| Rate for Payer: Cofinity Commercial |
$1,117.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,039.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.72
|
| Rate for Payer: Healthscope Commercial |
$1,168.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$974.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$340.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,104.03
|
| Rate for Payer: PACE Senior Care Partners |
$308.48
|
| Rate for Payer: PACE SWMI |
$324.72
|
| Rate for Payer: PHP Commercial |
$1,104.03
|
| Rate for Payer: PHP Medicare Advantage |
$324.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,130.01
|
| Rate for Payer: Priority Health Medicare |
$324.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$792.17
|
| Rate for Payer: Railroad Medicare Medicare |
$324.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,143.00
|
| Rate for Payer: UHC Core |
$1,084.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.72
|
| Rate for Payer: UHC Medicare Advantage |
$334.46
|
| Rate for Payer: VA VA |
$324.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$974.14
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
IP
|
$7,678.97
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,683.40 |
| Max. Negotiated Rate |
$6,911.07 |
| Rate for Payer: Aetna Commercial |
$6,527.12
|
| Rate for Payer: BCBS Trust/PPO |
$5,934.31
|
| Rate for Payer: BCN Commercial |
$5,934.31
|
| Rate for Payer: Cash Price |
$6,143.18
|
| Rate for Payer: Cofinity Commercial |
$6,603.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,143.18
|
| Rate for Payer: Healthscope Commercial |
$6,911.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,759.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,527.12
|
| Rate for Payer: PHP Commercial |
$6,527.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,375.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,680.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,683.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,757.49
|
| Rate for Payer: UHC Core |
$6,411.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,759.23
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
OP
|
$7,678.97
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,823.76 |
| Max. Negotiated Rate |
$6,911.07 |
| Rate for Payer: Aetna Commercial |
$6,527.12
|
| Rate for Payer: Aetna Medicare |
$1,996.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,399.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,399.68
|
| Rate for Payer: BCBS Complete |
$3,071.59
|
| Rate for Payer: BCBS MAPPO |
$1,919.74
|
| Rate for Payer: BCBS Trust/PPO |
$5,970.40
|
| Rate for Payer: BCN Commercial |
$5,970.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,919.74
|
| Rate for Payer: Cash Price |
$6,143.18
|
| Rate for Payer: Cofinity Commercial |
$6,603.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,143.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,919.74
|
| Rate for Payer: Healthscope Commercial |
$6,911.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,759.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,015.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,207.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,527.12
|
| Rate for Payer: PACE Senior Care Partners |
$1,823.76
|
| Rate for Payer: PACE SWMI |
$1,919.74
|
| Rate for Payer: PHP Commercial |
$6,527.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,919.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,375.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,680.70
|
| Rate for Payer: Priority Health Medicare |
$1,919.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,683.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,919.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,757.49
|
| Rate for Payer: UHC Core |
$6,411.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,919.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,977.33
|
| Rate for Payer: VA VA |
$1,919.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,759.23
|
|
|
HC IVUS OR OCT EACH ADDL VESSEL
|
Facility
|
IP
|
$1,502.16
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
48100107
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$916.17 |
| Max. Negotiated Rate |
$1,351.94 |
| Rate for Payer: Aetna Commercial |
$1,276.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.87
|
| Rate for Payer: BCN Commercial |
$1,160.87
|
| Rate for Payer: Cash Price |
$1,201.73
|
| Rate for Payer: Cofinity Commercial |
$1,291.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.73
|
| Rate for Payer: Healthscope Commercial |
$1,351.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,126.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,276.84
|
| Rate for Payer: PHP Commercial |
$1,276.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,306.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$916.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,321.90
|
| Rate for Payer: UHC Core |
$1,254.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,126.62
|
|
|
HC IVUS OR OCT EACH ADDL VESSEL
|
Facility
|
OP
|
$1,502.16
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
48100107
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$356.76 |
| Max. Negotiated Rate |
$1,351.94 |
| Rate for Payer: Aetna Commercial |
$1,276.84
|
| Rate for Payer: Aetna Medicare |
$390.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$469.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$469.42
|
| Rate for Payer: BCBS Complete |
$600.86
|
| Rate for Payer: BCBS MAPPO |
$375.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,167.93
|
| Rate for Payer: BCN Commercial |
$1,167.93
|
| Rate for Payer: BCN Medicare Advantage |
$375.54
|
| Rate for Payer: Cash Price |
$1,201.73
|
| Rate for Payer: Cofinity Commercial |
$1,291.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,201.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.54
|
| Rate for Payer: Healthscope Commercial |
$1,351.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,126.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$394.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$431.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,276.84
|
| Rate for Payer: PACE Senior Care Partners |
$356.76
|
| Rate for Payer: PACE SWMI |
$375.54
|
| Rate for Payer: PHP Commercial |
$1,276.84
|
| Rate for Payer: PHP Medicare Advantage |
$375.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,306.88
|
| Rate for Payer: Priority Health Medicare |
$375.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$916.17
|
| Rate for Payer: Railroad Medicare Medicare |
$375.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,321.90
|
| Rate for Payer: UHC Core |
$1,254.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$375.54
|
| Rate for Payer: UHC Medicare Advantage |
$386.81
|
| Rate for Payer: VA VA |
$375.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,126.62
|
|
|
HC IVUS OR OCT INITIAL VESSEL
|
Facility
|
OP
|
$3,621.45
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
48100106
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$860.09 |
| Max. Negotiated Rate |
$3,259.30 |
| Rate for Payer: Aetna Commercial |
$3,078.23
|
| Rate for Payer: Aetna Medicare |
$941.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,131.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,131.70
|
| Rate for Payer: BCBS Complete |
$1,448.58
|
| Rate for Payer: BCBS MAPPO |
$905.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,815.68
|
| Rate for Payer: BCN Commercial |
$2,815.68
|
| Rate for Payer: BCN Medicare Advantage |
$905.36
|
| Rate for Payer: Cash Price |
$2,897.16
|
| Rate for Payer: Cofinity Commercial |
$3,114.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,897.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$905.36
|
| Rate for Payer: Healthscope Commercial |
$3,259.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,716.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$950.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,041.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,078.23
|
| Rate for Payer: PACE Senior Care Partners |
$860.09
|
| Rate for Payer: PACE SWMI |
$905.36
|
| Rate for Payer: PHP Commercial |
$3,078.23
|
| Rate for Payer: PHP Medicare Advantage |
$905.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,535.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,150.66
|
| Rate for Payer: Priority Health Medicare |
$905.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,208.72
|
| Rate for Payer: Railroad Medicare Medicare |
$905.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,186.88
|
| Rate for Payer: UHC Core |
$3,023.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$905.36
|
| Rate for Payer: UHC Medicare Advantage |
$932.52
|
| Rate for Payer: VA VA |
$905.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,716.09
|
|
|
HC IVUS OR OCT INITIAL VESSEL
|
Facility
|
IP
|
$3,621.45
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
48100106
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,208.72 |
| Max. Negotiated Rate |
$3,259.30 |
| Rate for Payer: Aetna Commercial |
$3,078.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,798.66
|
| Rate for Payer: BCN Commercial |
$2,798.66
|
| Rate for Payer: Cash Price |
$2,897.16
|
| Rate for Payer: Cofinity Commercial |
$3,114.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,897.16
|
| Rate for Payer: Healthscope Commercial |
$3,259.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,716.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,078.23
|
| Rate for Payer: PHP Commercial |
$3,078.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,535.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,150.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,208.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,186.88
|
| Rate for Payer: UHC Core |
$3,023.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,716.09
|
|
|
HC JAK2 EXON 12 MUTATION DETECTION
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 0027U
|
| Hospital Charge Code |
31000148
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$223.22 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Aetna Commercial |
$311.10
|
| Rate for Payer: BCBS Trust/PPO |
$282.84
|
| Rate for Payer: BCN Commercial |
$282.84
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$314.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.80
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.10
|
| Rate for Payer: PHP Commercial |
$311.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.08
|
| Rate for Payer: UHC Core |
$305.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.50
|
|
|
HC JAK2 EXON 12 MUTATION DETECTION
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 0027U
|
| Hospital Charge Code |
31000148
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$86.92 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Aetna Commercial |
$311.10
|
| Rate for Payer: Aetna Medicare |
$95.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.38
|
| Rate for Payer: BCBS Complete |
$94.47
|
| Rate for Payer: BCBS MAPPO |
$91.50
|
| Rate for Payer: BCBS Trust/PPO |
$284.56
|
| Rate for Payer: BCN Commercial |
$284.56
|
| Rate for Payer: BCN Medicare Advantage |
$91.50
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$314.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.50
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.50
|
| Rate for Payer: Mclaren Medicaid |
$89.97
|
| Rate for Payer: Meridian Medicaid |
$94.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.10
|
| Rate for Payer: PACE Senior Care Partners |
$86.92
|
| Rate for Payer: PACE SWMI |
$91.50
|
| Rate for Payer: PHP Commercial |
$311.10
|
| Rate for Payer: PHP Medicare Advantage |
$91.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.42
|
| Rate for Payer: Priority Health Medicare |
$91.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.22
|
| Rate for Payer: Railroad Medicare Medicare |
$91.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.08
|
| Rate for Payer: UHC Core |
$305.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.50
|
| Rate for Payer: UHC Medicare Advantage |
$94.24
|
| Rate for Payer: VA VA |
$91.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.50
|
|
|
HC JAK2 V617F MUTATION
|
Facility
|
OP
|
$380.46
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.65 |
| Max. Negotiated Rate |
$342.41 |
| Rate for Payer: Aetna Commercial |
$323.39
|
| Rate for Payer: Aetna Medicare |
$98.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.89
|
| Rate for Payer: BCBS Complete |
$71.03
|
| Rate for Payer: BCBS MAPPO |
$95.12
|
| Rate for Payer: BCBS Trust/PPO |
$295.81
|
| Rate for Payer: BCN Commercial |
$295.81
|
| Rate for Payer: BCN Medicare Advantage |
$95.12
|
| Rate for Payer: Cash Price |
$304.37
|
| Rate for Payer: Cash Price |
$304.37
|
| Rate for Payer: Cofinity Commercial |
$327.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.12
|
| Rate for Payer: Healthscope Commercial |
$342.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.34
|
| Rate for Payer: Mclaren Medicaid |
$67.65
|
| Rate for Payer: Meridian Medicaid |
$71.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.39
|
| Rate for Payer: PACE Senior Care Partners |
$90.36
|
| Rate for Payer: PACE SWMI |
$95.12
|
| Rate for Payer: PHP Commercial |
$323.39
|
| Rate for Payer: PHP Medicare Advantage |
$95.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.00
|
| Rate for Payer: Priority Health Medicare |
$95.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.04
|
| Rate for Payer: Railroad Medicare Medicare |
$95.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.80
|
| Rate for Payer: UHC Core |
$317.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.12
|
| Rate for Payer: UHC Medicare Advantage |
$97.97
|
| Rate for Payer: VA VA |
$95.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.34
|
|
