|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$97.58 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: BCBS Trust/PPO |
$123.65
|
| Rate for Payer: BCN Commercial |
$123.65
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$41.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.00
|
| Rate for Payer: BCBS Complete |
$13.93
|
| Rate for Payer: BCBS MAPPO |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$124.40
|
| Rate for Payer: BCN Commercial |
$124.40
|
| Rate for Payer: BCN Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Mclaren Medicaid |
$13.27
|
| Rate for Payer: Meridian Medicaid |
$13.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.00
|
| Rate for Payer: PACE Senior Care Partners |
$38.00
|
| Rate for Payer: PACE SWMI |
$40.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: PHP Medicare Advantage |
$40.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.20
|
| Rate for Payer: Priority Health Medicare |
$40.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.58
|
| Rate for Payer: Railroad Medicare Medicare |
$40.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.00
|
| Rate for Payer: UHC Medicare Advantage |
$41.20
|
| Rate for Payer: VA VA |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC LV4RP GROSS_MICRO (BILL ONLY)
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
31000087
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna Medicare |
$79.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.31
|
| Rate for Payer: BCBS Complete |
$37.33
|
| Rate for Payer: BCBS MAPPO |
$76.25
|
| Rate for Payer: BCBS Trust/PPO |
$237.14
|
| Rate for Payer: BCCCP Commercial |
$71.93
|
| Rate for Payer: BCN Commercial |
$237.14
|
| Rate for Payer: BCN Medicare Advantage |
$76.25
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.25
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.75
|
| Rate for Payer: Mclaren Medicaid |
$35.55
|
| Rate for Payer: Meridian Medicaid |
$37.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$80.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.25
|
| Rate for Payer: PACE Senior Care Partners |
$72.44
|
| Rate for Payer: PACE SWMI |
$76.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: PHP Medicare Advantage |
$76.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.35
|
| Rate for Payer: Priority Health Medicare |
$76.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.02
|
| Rate for Payer: Railroad Medicare Medicare |
$76.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.40
|
| Rate for Payer: UHC Core |
$254.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.25
|
| Rate for Payer: UHC Medicare Advantage |
$78.54
|
| Rate for Payer: VA VA |
$76.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.75
|
|
|
HC LV4RP GROSS_MICRO (BILL ONLY)
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
31000087
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$186.02 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: BCBS Trust/PPO |
$235.70
|
| Rate for Payer: BCN Commercial |
$235.70
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.40
|
| Rate for Payer: UHC Core |
$254.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.75
|
|
|
HC LVAD INSERTION
|
Facility
|
IP
|
$3,160.43
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,927.55 |
| Max. Negotiated Rate |
$2,844.39 |
| Rate for Payer: Aetna Commercial |
$2,686.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,442.38
|
| Rate for Payer: BCN Commercial |
$2,442.38
|
| Rate for Payer: Cash Price |
$2,528.34
|
| Rate for Payer: Cofinity Commercial |
$2,717.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,528.34
|
| Rate for Payer: Healthscope Commercial |
$2,844.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,370.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,686.37
|
| Rate for Payer: PHP Commercial |
$2,686.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,212.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,749.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,927.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,781.18
|
| Rate for Payer: UHC Core |
$2,638.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,370.32
|
|
|
HC LVAD INSERTION
|
Facility
|
OP
|
$3,160.43
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$750.60 |
| Max. Negotiated Rate |
$2,844.39 |
| Rate for Payer: Aetna Commercial |
$2,686.37
|
| Rate for Payer: Aetna Medicare |
$821.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$987.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$987.63
|
| Rate for Payer: BCBS Complete |
$1,264.17
|
| Rate for Payer: BCBS MAPPO |
$790.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,457.23
|
| Rate for Payer: BCN Commercial |
$2,457.23
|
| Rate for Payer: BCN Medicare Advantage |
$790.11
|
| Rate for Payer: Cash Price |
$2,528.34
|
| Rate for Payer: Cofinity Commercial |
$2,717.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,528.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$790.11
|
| Rate for Payer: Healthscope Commercial |
$2,844.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,370.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$829.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$908.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,686.37
|
| Rate for Payer: PACE Senior Care Partners |
$750.60
|
| Rate for Payer: PACE SWMI |
$790.11
|
| Rate for Payer: PHP Commercial |
$2,686.37
|
| Rate for Payer: PHP Medicare Advantage |
$790.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,212.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,749.57
|
| Rate for Payer: Priority Health Medicare |
$790.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,927.55
|
| Rate for Payer: Railroad Medicare Medicare |
$790.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,781.18
|
| Rate for Payer: UHC Core |
$2,638.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$790.11
|
| Rate for Payer: UHC Medicare Advantage |
$813.81
|
| Rate for Payer: VA VA |
$790.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,370.32
|
|
|
HC LVDS PLT PER LEUKO RED IRRAD
|
Facility
|
IP
|
$2,777.25
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000088
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,693.84 |
| Max. Negotiated Rate |
$2,499.52 |
| Rate for Payer: Aetna Commercial |
$2,360.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,146.26
|
| Rate for Payer: BCN Commercial |
$2,146.26
|
| Rate for Payer: Cash Price |
$2,221.80
|
| Rate for Payer: Cofinity Commercial |
$2,388.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,221.80
|
| Rate for Payer: Healthscope Commercial |
$2,499.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,082.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,360.66
|
| Rate for Payer: PHP Commercial |
$2,360.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,944.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,416.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,693.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,443.98
|
| Rate for Payer: UHC Core |
$2,319.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,082.94
|
|
|
HC LVDS PLT PER LEUKO RED IRRAD
|
Facility
|
OP
|
$2,777.25
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000088
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$463.00 |
| Max. Negotiated Rate |
$2,499.52 |
| Rate for Payer: Aetna Commercial |
$2,360.66
|
| Rate for Payer: Aetna Medicare |
$722.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$867.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$867.89
|
| Rate for Payer: BCBS Complete |
$486.15
|
| Rate for Payer: BCBS MAPPO |
$694.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,159.31
|
| Rate for Payer: BCN Commercial |
$2,159.31
|
| Rate for Payer: BCN Medicare Advantage |
$694.31
|
| Rate for Payer: Cash Price |
$2,221.80
|
| Rate for Payer: Cash Price |
$2,221.80
|
| Rate for Payer: Cofinity Commercial |
$2,388.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,221.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.31
|
| Rate for Payer: Healthscope Commercial |
$2,499.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,082.94
|
| Rate for Payer: Mclaren Medicaid |
$463.00
|
| Rate for Payer: Meridian Medicaid |
$486.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$729.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$798.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,360.66
|
| Rate for Payer: PACE Senior Care Partners |
$659.60
|
| Rate for Payer: PACE SWMI |
$694.31
|
| Rate for Payer: PHP Commercial |
$2,360.66
|
| Rate for Payer: PHP Medicare Advantage |
$694.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$463.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,944.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,416.21
|
| Rate for Payer: Priority Health Medicare |
$694.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,693.84
|
| Rate for Payer: Railroad Medicare Medicare |
$694.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,443.98
|
| Rate for Payer: UHC Core |
$2,319.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$694.31
|
| Rate for Payer: UHC Medicare Advantage |
$715.14
|
| Rate for Payer: VA VA |
$694.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,082.94
|
|
|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
IP
|
$2,156.91
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,315.50 |
| Max. Negotiated Rate |
$1,941.22 |
| Rate for Payer: Aetna Commercial |
$1,833.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,666.86
|
| Rate for Payer: BCN Commercial |
$1,666.86
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cofinity Commercial |
$1,854.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.53
|
| Rate for Payer: Healthscope Commercial |
$1,941.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,617.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,833.37
|
| Rate for Payer: PHP Commercial |
$1,833.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,876.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,315.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,898.08
|
| Rate for Payer: UHC Core |
$1,801.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,617.68
|
|
|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
OP
|
$2,156.91
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$325.20 |
| Max. Negotiated Rate |
$1,941.22 |
| Rate for Payer: Aetna Commercial |
$1,833.37
|
| Rate for Payer: Aetna Medicare |
$560.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$674.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$674.03
|
| Rate for Payer: BCBS Complete |
$341.46
|
| Rate for Payer: BCBS MAPPO |
$539.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,677.00
|
| Rate for Payer: BCN Commercial |
$1,677.00
|
| Rate for Payer: BCN Medicare Advantage |
$539.23
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cofinity Commercial |
$1,854.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$539.23
|
| Rate for Payer: Healthscope Commercial |
$1,941.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,617.68
|
| Rate for Payer: Mclaren Medicaid |
$325.20
|
| Rate for Payer: Meridian Medicaid |
$341.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$566.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$620.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,833.37
|
| Rate for Payer: PACE Senior Care Partners |
$512.27
|
| Rate for Payer: PACE SWMI |
$539.23
|
| Rate for Payer: PHP Commercial |
$1,833.37
|
| Rate for Payer: PHP Medicare Advantage |
$539.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,509.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,876.51
|
| Rate for Payer: Priority Health Medicare |
$539.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,315.50
|
| Rate for Payer: Railroad Medicare Medicare |
$539.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,898.08
|
| Rate for Payer: UHC Core |
$1,801.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$539.23
|
| Rate for Payer: UHC Medicare Advantage |
$555.40
|
| Rate for Payer: VA VA |
$539.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,617.68
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
OP
|
$8,832.18
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,097.64 |
| Max. Negotiated Rate |
$7,948.96 |
| Rate for Payer: Aetna Commercial |
$7,507.35
|
| Rate for Payer: Aetna Medicare |
$2,296.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,760.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,760.06
|
| Rate for Payer: BCBS Complete |
$3,532.87
|
| Rate for Payer: BCBS MAPPO |
$2,208.04
|
| Rate for Payer: BCBS Trust/PPO |
$6,867.02
|
| Rate for Payer: BCN Commercial |
$6,867.02
|
| Rate for Payer: BCN Medicare Advantage |
$2,208.04
|
| Rate for Payer: Cash Price |
$7,065.74
|
| Rate for Payer: Cofinity Commercial |
$7,595.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,065.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,208.04
|
| Rate for Payer: Healthscope Commercial |
$7,948.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,624.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,318.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,539.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,507.35
|
| Rate for Payer: PACE Senior Care Partners |
$2,097.64
|
| Rate for Payer: PACE SWMI |
$2,208.04
|
| Rate for Payer: PHP Commercial |
$7,507.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,208.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,182.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,684.00
|
| Rate for Payer: Priority Health Medicare |
$2,208.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,386.75
|
| Rate for Payer: Railroad Medicare Medicare |
$2,208.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,772.32
|
| Rate for Payer: UHC Core |
$7,374.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,208.04
|
| Rate for Payer: UHC Medicare Advantage |
$2,274.29
|
| Rate for Payer: VA VA |
$2,208.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,624.14
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
IP
|
$8,832.18
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,386.75 |
| Max. Negotiated Rate |
$7,948.96 |
| Rate for Payer: Aetna Commercial |
$7,507.35
|
| Rate for Payer: BCBS Trust/PPO |
$6,825.51
|
| Rate for Payer: BCN Commercial |
$6,825.51
|
| Rate for Payer: Cash Price |
$7,065.74
|
| Rate for Payer: Cofinity Commercial |
$7,595.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,065.74
|
| Rate for Payer: Healthscope Commercial |
$7,948.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,624.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,507.35
|
| Rate for Payer: PHP Commercial |
$7,507.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,182.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,684.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,386.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,772.32
|
| Rate for Payer: UHC Core |
$7,374.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,624.14
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
OP
|
$3,518.07
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$835.54 |
| Max. Negotiated Rate |
$3,166.26 |
| Rate for Payer: Aetna Commercial |
$2,990.36
|
| Rate for Payer: Aetna Medicare |
$914.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,099.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,099.40
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$879.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.30
|
| Rate for Payer: BCN Commercial |
$2,735.30
|
| Rate for Payer: BCN Medicare Advantage |
$879.52
|
| Rate for Payer: Cash Price |
$2,814.46
|
| Rate for Payer: Cash Price |
$2,814.46
|
| Rate for Payer: Cofinity Commercial |
$3,025.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,814.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$879.52
|
| Rate for Payer: Healthscope Commercial |
$3,166.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,638.55
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$923.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,011.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,990.36
|
| Rate for Payer: PACE Senior Care Partners |
$835.54
|
| Rate for Payer: PACE SWMI |
$879.52
|
| Rate for Payer: PHP Commercial |
$2,990.36
|
| Rate for Payer: PHP Medicare Advantage |
$879.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,462.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,060.72
|
| Rate for Payer: Priority Health Medicare |
$879.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,145.67
|
| Rate for Payer: Railroad Medicare Medicare |
$879.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,095.90
|
| Rate for Payer: UHC Core |
$2,937.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$879.52
|
| Rate for Payer: UHC Medicare Advantage |
$905.90
|
| Rate for Payer: VA VA |
$879.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,638.55
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
IP
|
$3,518.07
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,145.67 |
| Max. Negotiated Rate |
$3,166.26 |
| Rate for Payer: Aetna Commercial |
$2,990.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,718.76
|
| Rate for Payer: BCN Commercial |
$2,718.76
|
| Rate for Payer: Cash Price |
$2,814.46
|
| Rate for Payer: Cofinity Commercial |
$3,025.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,814.46
|
| Rate for Payer: Healthscope Commercial |
$3,166.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,638.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,990.36
|
| Rate for Payer: PHP Commercial |
$2,990.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,462.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,060.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,145.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,095.90
|
| Rate for Payer: UHC Core |
$2,937.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,638.55
|
|
|
HC LW / LASSO / ORBITER CATHETER
|
Facility
|
OP
|
$4,698.41
|
|
|
Service Code
|
HCPCS C1731
|
| Hospital Charge Code |
27200056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,115.87 |
| Max. Negotiated Rate |
$4,228.57 |
| Rate for Payer: Aetna Commercial |
$3,993.65
|
| Rate for Payer: Aetna Medicare |
$1,221.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,468.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,468.25
|
| Rate for Payer: BCBS Complete |
$1,879.36
|
| Rate for Payer: BCBS MAPPO |
$1,174.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,653.01
|
| Rate for Payer: BCN Commercial |
$3,653.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,174.60
|
| Rate for Payer: Cash Price |
$3,758.73
|
| Rate for Payer: Cofinity Commercial |
$4,040.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,758.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,174.60
|
| Rate for Payer: Healthscope Commercial |
$4,228.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,523.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,233.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,350.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,993.65
|
| Rate for Payer: PACE Senior Care Partners |
$1,115.87
|
| Rate for Payer: PACE SWMI |
$1,174.60
|
| Rate for Payer: PHP Commercial |
$3,993.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,174.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,288.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,087.62
|
| Rate for Payer: Priority Health Medicare |
$1,174.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,865.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,174.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,134.60
|
| Rate for Payer: UHC Core |
$3,923.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,174.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,209.84
|
| Rate for Payer: VA VA |
$1,174.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,523.81
|
|
|
HC LW / LASSO / ORBITER CATHETER
|
Facility
|
IP
|
$4,698.41
|
|
|
Service Code
|
HCPCS C1731
|
| Hospital Charge Code |
27200056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,865.56 |
| Max. Negotiated Rate |
$4,228.57 |
| Rate for Payer: Aetna Commercial |
$3,993.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,630.93
|
| Rate for Payer: BCN Commercial |
$3,630.93
|
| Rate for Payer: Cash Price |
$3,758.73
|
| Rate for Payer: Cofinity Commercial |
$4,040.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,758.73
|
| Rate for Payer: Healthscope Commercial |
$4,228.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,523.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,993.65
|
| Rate for Payer: PHP Commercial |
$3,993.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,288.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,087.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,865.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,134.60
|
| Rate for Payer: UHC Core |
$3,923.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,523.81
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
IP
|
$33.66
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.53 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: BCBS Trust/PPO |
$26.01
|
| Rate for Payer: BCN Commercial |
$26.01
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.61
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.62
|
| Rate for Payer: UHC Core |
$28.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.24
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
OP
|
$33.66
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna Medicare |
$8.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.52
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$8.42
|
| Rate for Payer: BCBS Trust/PPO |
$26.17
|
| Rate for Payer: BCN Commercial |
$26.17
|
| Rate for Payer: BCN Medicare Advantage |
$8.42
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.24
|
| Rate for Payer: Mclaren Medicaid |
$11.43
|
| Rate for Payer: Meridian Medicaid |
$12.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.61
|
| Rate for Payer: PACE Senior Care Partners |
$7.99
|
| Rate for Payer: PACE SWMI |
$8.42
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: PHP Medicare Advantage |
$8.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.28
|
| Rate for Payer: Priority Health Medicare |
$8.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.53
|
| Rate for Payer: Railroad Medicare Medicare |
$8.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.62
|
| Rate for Payer: UHC Core |
$28.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.42
|
| Rate for Payer: UHC Medicare Advantage |
$8.67
|
| Rate for Payer: VA VA |
$8.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.24
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna Commercial |
$50.15
|
| Rate for Payer: Aetna Medicare |
$15.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.44
|
| Rate for Payer: BCBS Complete |
$6.03
|
| Rate for Payer: BCBS MAPPO |
$14.75
|
| Rate for Payer: BCBS Trust/PPO |
$45.87
|
| Rate for Payer: BCN Commercial |
$45.87
|
| Rate for Payer: BCN Medicare Advantage |
$14.75
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$50.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.75
|
| Rate for Payer: Healthscope Commercial |
$53.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.25
|
| Rate for Payer: Mclaren Medicaid |
$5.74
|
| Rate for Payer: Meridian Medicaid |
$6.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.15
|
| Rate for Payer: PACE Senior Care Partners |
$14.01
|
| Rate for Payer: PACE SWMI |
$14.75
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: PHP Medicare Advantage |
$14.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.33
|
| Rate for Payer: Priority Health Medicare |
$14.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.98
|
| Rate for Payer: Railroad Medicare Medicare |
$14.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.92
|
| Rate for Payer: UHC Core |
$49.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.75
|
| Rate for Payer: UHC Medicare Advantage |
$15.19
|
| Rate for Payer: VA VA |
$14.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.25
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna Commercial |
$50.15
|
| Rate for Payer: BCBS Trust/PPO |
$45.60
|
| Rate for Payer: BCN Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$50.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Healthscope Commercial |
$53.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.15
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.92
|
| Rate for Payer: UHC Core |
$49.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.25
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna Commercial |
$135.15
|
| Rate for Payer: Aetna Medicare |
$41.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.69
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$39.75
|
| Rate for Payer: BCBS Trust/PPO |
$123.62
|
| Rate for Payer: BCN Commercial |
$123.62
|
| Rate for Payer: BCN Medicare Advantage |
$39.75
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$136.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.75
|
| Rate for Payer: Healthscope Commercial |
$143.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.25
|
| Rate for Payer: Mclaren Medicaid |
$12.57
|
| Rate for Payer: Meridian Medicaid |
$13.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.15
|
| Rate for Payer: PACE Senior Care Partners |
$37.76
|
| Rate for Payer: PACE SWMI |
$39.75
|
| Rate for Payer: PHP Commercial |
$135.15
|
| Rate for Payer: PHP Medicare Advantage |
$39.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.33
|
| Rate for Payer: Priority Health Medicare |
$39.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.97
|
| Rate for Payer: Railroad Medicare Medicare |
$39.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.92
|
| Rate for Payer: UHC Core |
$132.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.75
|
| Rate for Payer: UHC Medicare Advantage |
$40.94
|
| Rate for Payer: VA VA |
$39.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.25
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.97 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna Commercial |
$135.15
|
| Rate for Payer: BCBS Trust/PPO |
$122.88
|
| Rate for Payer: BCN Commercial |
$122.88
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$136.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.20
|
| Rate for Payer: Healthscope Commercial |
$143.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.15
|
| Rate for Payer: PHP Commercial |
$135.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.92
|
| Rate for Payer: UHC Core |
$132.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.25
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna Commercial |
$73.95
|
| Rate for Payer: Aetna Medicare |
$22.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.19
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: BCBS MAPPO |
$21.75
|
| Rate for Payer: BCBS Trust/PPO |
$67.64
|
| Rate for Payer: BCN Commercial |
$67.64
|
| Rate for Payer: BCN Medicare Advantage |
$21.75
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.75
|
| Rate for Payer: Healthscope Commercial |
$78.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.25
|
| Rate for Payer: Mclaren Medicaid |
$6.86
|
| Rate for Payer: Meridian Medicaid |
$7.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.95
|
| Rate for Payer: PACE Senior Care Partners |
$20.66
|
| Rate for Payer: PACE SWMI |
$21.75
|
| Rate for Payer: PHP Commercial |
$73.95
|
| Rate for Payer: PHP Medicare Advantage |
$21.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.69
|
| Rate for Payer: Priority Health Medicare |
$21.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.06
|
| Rate for Payer: Railroad Medicare Medicare |
$21.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.56
|
| Rate for Payer: UHC Core |
$72.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.75
|
| Rate for Payer: UHC Medicare Advantage |
$22.40
|
| Rate for Payer: VA VA |
$21.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.25
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna Commercial |
$73.95
|
| Rate for Payer: BCBS Trust/PPO |
$67.23
|
| Rate for Payer: BCN Commercial |
$67.23
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.60
|
| Rate for Payer: Healthscope Commercial |
$78.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.95
|
| Rate for Payer: PHP Commercial |
$73.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.56
|
| Rate for Payer: UHC Core |
$72.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.25
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna Commercial |
$60.35
|
| Rate for Payer: BCBS Trust/PPO |
$54.87
|
| Rate for Payer: BCN Commercial |
$54.87
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$61.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.80
|
| Rate for Payer: Healthscope Commercial |
$63.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.35
|
| Rate for Payer: PHP Commercial |
$60.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.48
|
| Rate for Payer: UHC Core |
$59.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.25
|
|
