|
HC HEPATITS B VACCINE (HEPB), PEDIATRIC/ADOLESCENT, 3 DOSE IM
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.61
|
| Rate for Payer: BCBS Complete |
$6.87
|
| Rate for Payer: BCBS MAPPO |
$9.29
|
| Rate for Payer: BCBS Trust/PPO |
$30.53
|
| Rate for Payer: BCN Commercial |
$30.53
|
| Rate for Payer: BCN Medicare Advantage |
$9.29
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.75
|
| Rate for Payer: Meridian Medicaid |
$6.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.82
|
| Rate for Payer: PACE SWMI |
$9.29
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: PHP Medicare Advantage |
$9.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.31
|
| Rate for Payer: Priority Health Medicare |
$9.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.85
|
| Rate for Payer: Railroad Medicare Medicare |
$9.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.68
|
| Rate for Payer: UHC Core |
$31.01
|
| Rate for Payer: UHC Exchange |
$9.29
|
| Rate for Payer: UHC Medicaid |
$6.55
|
| Rate for Payer: UHC Medicare Advantage |
$9.29
|
| Rate for Payer: UHCCP Medicaid |
$6.55
|
| Rate for Payer: VA VA |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
OP
|
$34.85
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: Aetna Commercial |
$29.62
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.89
|
| Rate for Payer: BCBS Complete |
$6.45
|
| Rate for Payer: BCBS MAPPO |
$8.71
|
| Rate for Payer: BCBS Trust/PPO |
$28.65
|
| Rate for Payer: BCN Commercial |
$28.65
|
| Rate for Payer: BCN Medicare Advantage |
$8.71
|
| Rate for Payer: Cash Price |
$27.88
|
| Rate for Payer: Cofinity Commercial |
$29.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.71
|
| Rate for Payer: Healthscope Commercial |
$31.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.14
|
| Rate for Payer: Mclaren Medicaid |
$6.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.15
|
| Rate for Payer: Meridian Medicaid |
$6.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.62
|
| Rate for Payer: Nomi Health Commercial |
$28.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.14
|
| Rate for Payer: PACE Senior Care Partners |
$8.28
|
| Rate for Payer: PACE SWMI |
$8.71
|
| Rate for Payer: PHP Commercial |
$29.62
|
| Rate for Payer: PHP Medicare Advantage |
$8.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.32
|
| Rate for Payer: Priority Health Medicare |
$8.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.26
|
| Rate for Payer: Railroad Medicare Medicare |
$8.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.67
|
| Rate for Payer: UHC Core |
$29.10
|
| Rate for Payer: UHC Exchange |
$8.71
|
| Rate for Payer: UHC Medicaid |
$6.14
|
| Rate for Payer: UHC Medicare Advantage |
$8.71
|
| Rate for Payer: UHCCP Medicaid |
$6.14
|
| Rate for Payer: VA VA |
$8.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.14
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
IP
|
$34.85
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: Aetna Commercial |
$29.62
|
| Rate for Payer: BCBS Trust/PPO |
$28.78
|
| Rate for Payer: BCN Commercial |
$28.78
|
| Rate for Payer: Cash Price |
$27.88
|
| Rate for Payer: Cofinity Commercial |
$29.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.88
|
| Rate for Payer: Healthscope Commercial |
$31.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.62
|
| Rate for Payer: Nomi Health Commercial |
$28.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.14
|
| Rate for Payer: PHP Commercial |
$29.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.67
|
| Rate for Payer: UHC Core |
$29.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.14
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$26.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.86
|
| Rate for Payer: BCBS Complete |
$18.87
|
| Rate for Payer: BCBS MAPPO |
$25.49
|
| Rate for Payer: BCBS Trust/PPO |
$83.82
|
| Rate for Payer: BCN Commercial |
$83.82
|
| Rate for Payer: BCN Medicare Advantage |
$25.49
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.47
|
| Rate for Payer: Mclaren Medicaid |
$17.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.76
|
| Rate for Payer: Meridian Medicaid |
$18.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PACE Senior Care Partners |
$24.22
|
| Rate for Payer: PACE SWMI |
$25.49
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: PHP Medicare Advantage |
$25.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.71
|
| Rate for Payer: Priority Health Medicare |
$25.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.96
|
| Rate for Payer: Railroad Medicare Medicare |
$25.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.72
|
| Rate for Payer: UHC Core |
$85.14
|
| Rate for Payer: UHC Exchange |
$25.49
|
| Rate for Payer: UHC Medicaid |
$17.98
|
| Rate for Payer: UHC Medicare Advantage |
$25.49
|
| Rate for Payer: UHCCP Medicaid |
$17.98
|
| Rate for Payer: VA VA |
$25.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.47
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.96 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: BCBS Trust/PPO |
$84.21
|
| Rate for Payer: BCN Commercial |
$84.21
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.72
|
| Rate for Payer: UHC Core |
$85.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.47
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
OP
|
$46.85
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Aetna Commercial |
$39.82
|
| Rate for Payer: Aetna Medicare |
$12.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.64
|
| Rate for Payer: BCBS Complete |
$8.67
|
| Rate for Payer: BCBS MAPPO |
$11.71
|
| Rate for Payer: BCBS Trust/PPO |
$38.52
|
| Rate for Payer: BCN Commercial |
$38.52
|
| Rate for Payer: BCN Medicare Advantage |
$11.71
|
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.71
|
| Rate for Payer: Healthscope Commercial |
$42.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.14
|
| Rate for Payer: Mclaren Medicaid |
$8.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.30
|
| Rate for Payer: Meridian Medicaid |
$8.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.82
|
| Rate for Payer: Nomi Health Commercial |
$38.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.14
|
| Rate for Payer: PACE Senior Care Partners |
$11.13
|
| Rate for Payer: PACE SWMI |
$11.71
|
| Rate for Payer: PHP Commercial |
$39.82
|
| Rate for Payer: PHP Medicare Advantage |
$11.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.76
|
| Rate for Payer: Priority Health Medicare |
$11.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.61
|
| Rate for Payer: Railroad Medicare Medicare |
$11.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.23
|
| Rate for Payer: UHC Core |
$39.12
|
| Rate for Payer: UHC Exchange |
$11.71
|
| Rate for Payer: UHC Medicaid |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$11.71
|
| Rate for Payer: UHCCP Medicaid |
$8.26
|
| Rate for Payer: VA VA |
$11.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.14
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
IP
|
$46.85
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Aetna Commercial |
$39.82
|
| Rate for Payer: BCBS Trust/PPO |
$38.69
|
| Rate for Payer: BCN Commercial |
$38.69
|
| Rate for Payer: Cash Price |
$37.48
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$42.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.82
|
| Rate for Payer: Nomi Health Commercial |
$38.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.14
|
| Rate for Payer: PHP Commercial |
$39.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.23
|
| Rate for Payer: UHC Core |
$39.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.14
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
OP
|
$339.59
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.87 |
| Max. Negotiated Rate |
$305.63 |
| Rate for Payer: Aetna Commercial |
$288.65
|
| Rate for Payer: Aetna Medicare |
$88.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.12
|
| Rate for Payer: BCBS Complete |
$62.86
|
| Rate for Payer: BCBS MAPPO |
$84.90
|
| Rate for Payer: BCBS Trust/PPO |
$279.18
|
| Rate for Payer: BCN Commercial |
$279.18
|
| Rate for Payer: BCN Medicare Advantage |
$84.90
|
| Rate for Payer: Cash Price |
$271.67
|
| Rate for Payer: Cofinity Commercial |
$292.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$305.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.69
|
| Rate for Payer: Mclaren Medicaid |
$59.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.14
|
| Rate for Payer: Meridian Medicaid |
$62.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.65
|
| Rate for Payer: Nomi Health Commercial |
$278.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.69
|
| Rate for Payer: PACE Senior Care Partners |
$80.65
|
| Rate for Payer: PACE SWMI |
$84.90
|
| Rate for Payer: PHP Commercial |
$288.65
|
| Rate for Payer: PHP Medicare Advantage |
$84.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$295.44
|
| Rate for Payer: Priority Health Medicare |
$85.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.35
|
| Rate for Payer: Railroad Medicare Medicare |
$84.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.84
|
| Rate for Payer: UHC Core |
$283.56
|
| Rate for Payer: UHC Exchange |
$84.90
|
| Rate for Payer: UHC Medicaid |
$59.87
|
| Rate for Payer: UHC Medicare Advantage |
$84.90
|
| Rate for Payer: UHCCP Medicaid |
$59.87
|
| Rate for Payer: VA VA |
$84.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.69
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
IP
|
$339.59
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$236.35 |
| Max. Negotiated Rate |
$305.63 |
| Rate for Payer: Aetna Commercial |
$288.65
|
| Rate for Payer: BCBS Trust/PPO |
$280.47
|
| Rate for Payer: BCN Commercial |
$280.47
|
| Rate for Payer: Cash Price |
$271.67
|
| Rate for Payer: Cofinity Commercial |
$292.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.67
|
| Rate for Payer: Healthscope Commercial |
$305.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.65
|
| Rate for Payer: Nomi Health Commercial |
$278.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.69
|
| Rate for Payer: PHP Commercial |
$288.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$295.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.84
|
| Rate for Payer: UHC Core |
$283.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.69
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
OP
|
$460.87
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$414.78 |
| Rate for Payer: Aetna Commercial |
$391.74
|
| Rate for Payer: Aetna Medicare |
$119.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$144.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$144.02
|
| Rate for Payer: BCBS Complete |
$85.31
|
| Rate for Payer: BCBS MAPPO |
$115.22
|
| Rate for Payer: BCBS Trust/PPO |
$378.88
|
| Rate for Payer: BCN Commercial |
$378.88
|
| Rate for Payer: BCN Medicare Advantage |
$115.22
|
| Rate for Payer: Cash Price |
$368.70
|
| Rate for Payer: Cofinity Commercial |
$396.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.22
|
| Rate for Payer: Healthscope Commercial |
$414.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.65
|
| Rate for Payer: Mclaren Medicaid |
$81.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.98
|
| Rate for Payer: Meridian Medicaid |
$85.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$126.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.74
|
| Rate for Payer: Nomi Health Commercial |
$377.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.65
|
| Rate for Payer: PACE Senior Care Partners |
$109.46
|
| Rate for Payer: PACE SWMI |
$115.22
|
| Rate for Payer: PHP Commercial |
$391.74
|
| Rate for Payer: PHP Medicare Advantage |
$115.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$400.96
|
| Rate for Payer: Priority Health Medicare |
$116.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.77
|
| Rate for Payer: Railroad Medicare Medicare |
$115.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.57
|
| Rate for Payer: UHC Core |
$384.83
|
| Rate for Payer: UHC Exchange |
$115.22
|
| Rate for Payer: UHC Medicaid |
$81.25
|
| Rate for Payer: UHC Medicare Advantage |
$115.22
|
| Rate for Payer: UHCCP Medicaid |
$81.25
|
| Rate for Payer: VA VA |
$115.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.65
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
IP
|
$460.87
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$320.77 |
| Max. Negotiated Rate |
$414.78 |
| Rate for Payer: Aetna Commercial |
$391.74
|
| Rate for Payer: BCBS Trust/PPO |
$380.63
|
| Rate for Payer: BCN Commercial |
$380.63
|
| Rate for Payer: Cash Price |
$368.70
|
| Rate for Payer: Cofinity Commercial |
$396.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.70
|
| Rate for Payer: Healthscope Commercial |
$414.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.74
|
| Rate for Payer: Nomi Health Commercial |
$377.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.65
|
| Rate for Payer: PHP Commercial |
$391.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$400.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.57
|
| Rate for Payer: UHC Core |
$384.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.65
|
|
|
HC HER2 DUAL ISH
|
Facility
|
IP
|
$318.36
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000065
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$221.58 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$270.61
|
| Rate for Payer: BCBS Trust/PPO |
$262.93
|
| Rate for Payer: BCN Commercial |
$262.93
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cofinity Commercial |
$273.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.69
|
| Rate for Payer: Healthscope Commercial |
$286.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.61
|
| Rate for Payer: Nomi Health Commercial |
$261.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.77
|
| Rate for Payer: PHP Commercial |
$270.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.16
|
| Rate for Payer: UHC Core |
$265.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.77
|
|
|
HC HER2 DUAL ISH
|
Facility
|
OP
|
$318.36
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000065
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.13 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$270.61
|
| Rate for Payer: Aetna Medicare |
$82.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.49
|
| Rate for Payer: BCBS Complete |
$58.93
|
| Rate for Payer: BCBS MAPPO |
$79.59
|
| Rate for Payer: BCBS Trust/PPO |
$261.72
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$261.72
|
| Rate for Payer: BCN Medicare Advantage |
$79.59
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cofinity Commercial |
$273.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.59
|
| Rate for Payer: Healthscope Commercial |
$286.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.77
|
| Rate for Payer: Mclaren Medicaid |
$56.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.57
|
| Rate for Payer: Meridian Medicaid |
$58.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.61
|
| Rate for Payer: Nomi Health Commercial |
$261.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.77
|
| Rate for Payer: PACE Senior Care Partners |
$75.61
|
| Rate for Payer: PACE SWMI |
$79.59
|
| Rate for Payer: PHP Commercial |
$270.61
|
| Rate for Payer: PHP Medicare Advantage |
$79.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.97
|
| Rate for Payer: Priority Health Medicare |
$80.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.58
|
| Rate for Payer: Railroad Medicare Medicare |
$79.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.16
|
| Rate for Payer: UHC Core |
$265.83
|
| Rate for Payer: UHC Exchange |
$79.59
|
| Rate for Payer: UHC Medicaid |
$56.13
|
| Rate for Payer: UHC Medicare Advantage |
$79.59
|
| Rate for Payer: UHCCP Medicaid |
$56.13
|
| Rate for Payer: VA VA |
$79.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.77
|
|
|
HC HER2 DUAL ISH CMPT
|
Facility
|
IP
|
$318.36
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$221.58 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$270.61
|
| Rate for Payer: BCBS Trust/PPO |
$262.93
|
| Rate for Payer: BCN Commercial |
$262.93
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cofinity Commercial |
$273.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.69
|
| Rate for Payer: Healthscope Commercial |
$286.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.61
|
| Rate for Payer: Nomi Health Commercial |
$261.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.77
|
| Rate for Payer: PHP Commercial |
$270.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.16
|
| Rate for Payer: UHC Core |
$265.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.77
|
|
|
HC HER2 DUAL ISH CMPT
|
Facility
|
OP
|
$318.36
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.13 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$270.61
|
| Rate for Payer: Aetna Medicare |
$82.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.49
|
| Rate for Payer: BCBS Complete |
$58.93
|
| Rate for Payer: BCBS MAPPO |
$79.59
|
| Rate for Payer: BCBS Trust/PPO |
$261.72
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$261.72
|
| Rate for Payer: BCN Medicare Advantage |
$79.59
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cash Price |
$254.69
|
| Rate for Payer: Cofinity Commercial |
$273.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.59
|
| Rate for Payer: Healthscope Commercial |
$286.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.77
|
| Rate for Payer: Mclaren Medicaid |
$56.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.57
|
| Rate for Payer: Meridian Medicaid |
$58.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.61
|
| Rate for Payer: Nomi Health Commercial |
$261.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.77
|
| Rate for Payer: PACE Senior Care Partners |
$75.61
|
| Rate for Payer: PACE SWMI |
$79.59
|
| Rate for Payer: PHP Commercial |
$270.61
|
| Rate for Payer: PHP Medicare Advantage |
$79.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.97
|
| Rate for Payer: Priority Health Medicare |
$80.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.58
|
| Rate for Payer: Railroad Medicare Medicare |
$79.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.16
|
| Rate for Payer: UHC Core |
$265.83
|
| Rate for Payer: UHC Exchange |
$79.59
|
| Rate for Payer: UHC Medicaid |
$56.13
|
| Rate for Payer: UHC Medicare Advantage |
$79.59
|
| Rate for Payer: UHCCP Medicaid |
$56.13
|
| Rate for Payer: VA VA |
$79.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.77
|
|
|
HC HER-2 NEU QUANTITATIVE
|
Facility
|
OP
|
$253.86
|
|
|
Service Code
|
CPT 83950
|
| Hospital Charge Code |
30100382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.76 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.33
|
| Rate for Payer: BCBS Complete |
$46.99
|
| Rate for Payer: BCBS MAPPO |
$63.47
|
| Rate for Payer: BCBS Trust/PPO |
$208.70
|
| Rate for Payer: BCN Commercial |
$208.70
|
| Rate for Payer: BCN Medicare Advantage |
$63.47
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$218.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.47
|
| Rate for Payer: Healthscope Commercial |
$228.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.40
|
| Rate for Payer: Mclaren Medicaid |
$44.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.64
|
| Rate for Payer: Meridian Medicaid |
$46.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.78
|
| Rate for Payer: Nomi Health Commercial |
$208.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.40
|
| Rate for Payer: PACE Senior Care Partners |
$60.29
|
| Rate for Payer: PACE SWMI |
$63.47
|
| Rate for Payer: PHP Commercial |
$215.78
|
| Rate for Payer: PHP Medicare Advantage |
$63.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$220.86
|
| Rate for Payer: Priority Health Medicare |
$64.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.69
|
| Rate for Payer: Railroad Medicare Medicare |
$63.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.40
|
| Rate for Payer: UHC Core |
$211.97
|
| Rate for Payer: UHC Exchange |
$63.47
|
| Rate for Payer: UHC Medicaid |
$44.76
|
| Rate for Payer: UHC Medicare Advantage |
$63.47
|
| Rate for Payer: UHCCP Medicaid |
$44.76
|
| Rate for Payer: VA VA |
$63.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.40
|
|
|
HC HER-2 NEU QUANTITATIVE
|
Facility
|
IP
|
$253.86
|
|
|
Service Code
|
CPT 83950
|
| Hospital Charge Code |
30100382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$176.69 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna Commercial |
$215.78
|
| Rate for Payer: BCBS Trust/PPO |
$209.66
|
| Rate for Payer: BCN Commercial |
$209.66
|
| Rate for Payer: Cash Price |
$203.09
|
| Rate for Payer: Cofinity Commercial |
$218.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.09
|
| Rate for Payer: Healthscope Commercial |
$228.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.78
|
| Rate for Payer: Nomi Health Commercial |
$208.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.40
|
| Rate for Payer: PHP Commercial |
$215.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$220.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.40
|
| Rate for Payer: UHC Core |
$211.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.40
|
|
|
HC HERPES PCR
|
Facility
|
IP
|
$74.29
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600211
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.71 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: BCBS Trust/PPO |
$61.36
|
| Rate for Payer: BCN Commercial |
$61.36
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$60.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.38
|
| Rate for Payer: UHC Core |
$62.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.72
|
|
|
HC HERPES PCR
|
Facility
|
OP
|
$74.29
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600211
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.22
|
| Rate for Payer: BCBS Complete |
$13.75
|
| Rate for Payer: BCBS MAPPO |
$18.57
|
| Rate for Payer: BCBS Trust/PPO |
$61.07
|
| Rate for Payer: BCN Commercial |
$61.07
|
| Rate for Payer: BCN Medicare Advantage |
$18.57
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.57
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.72
|
| Rate for Payer: Mclaren Medicaid |
$13.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.50
|
| Rate for Payer: Meridian Medicaid |
$13.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$60.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PACE Senior Care Partners |
$17.64
|
| Rate for Payer: PACE SWMI |
$18.57
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: PHP Medicare Advantage |
$18.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.63
|
| Rate for Payer: Priority Health Medicare |
$18.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.71
|
| Rate for Payer: Railroad Medicare Medicare |
$18.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.38
|
| Rate for Payer: UHC Core |
$62.03
|
| Rate for Payer: UHC Exchange |
$18.57
|
| Rate for Payer: UHC Medicaid |
$13.10
|
| Rate for Payer: UHC Medicare Advantage |
$18.57
|
| Rate for Payer: UHCCP Medicaid |
$13.10
|
| Rate for Payer: VA VA |
$18.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.72
|
|
|
HC HERPES PCR COMPONENT
|
Facility
|
IP
|
$74.29
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.71 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: BCBS Trust/PPO |
$61.36
|
| Rate for Payer: BCN Commercial |
$61.36
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$60.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.38
|
| Rate for Payer: UHC Core |
$62.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.72
|
|
|
HC HERPES PCR COMPONENT
|
Facility
|
OP
|
$74.29
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600212
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.22
|
| Rate for Payer: BCBS Complete |
$13.75
|
| Rate for Payer: BCBS MAPPO |
$18.57
|
| Rate for Payer: BCBS Trust/PPO |
$61.07
|
| Rate for Payer: BCN Commercial |
$61.07
|
| Rate for Payer: BCN Medicare Advantage |
$18.57
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.57
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.72
|
| Rate for Payer: Mclaren Medicaid |
$13.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.50
|
| Rate for Payer: Meridian Medicaid |
$13.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$60.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PACE Senior Care Partners |
$17.64
|
| Rate for Payer: PACE SWMI |
$18.57
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: PHP Medicare Advantage |
$18.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.63
|
| Rate for Payer: Priority Health Medicare |
$18.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.71
|
| Rate for Payer: Railroad Medicare Medicare |
$18.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.38
|
| Rate for Payer: UHC Core |
$62.03
|
| Rate for Payer: UHC Exchange |
$18.57
|
| Rate for Payer: UHC Medicaid |
$13.10
|
| Rate for Payer: UHC Medicare Advantage |
$18.57
|
| Rate for Payer: UHCCP Medicaid |
$13.10
|
| Rate for Payer: VA VA |
$18.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.72
|
|
|
HC HERPES SIMPLEX IGG TYPE 1
|
Facility
|
IP
|
$50.95
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200281
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.46 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna Commercial |
$43.31
|
| Rate for Payer: BCBS Trust/PPO |
$42.08
|
| Rate for Payer: BCN Commercial |
$42.08
|
| Rate for Payer: Cash Price |
$40.76
|
| Rate for Payer: Cofinity Commercial |
$43.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.76
|
| Rate for Payer: Healthscope Commercial |
$45.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.31
|
| Rate for Payer: Nomi Health Commercial |
$41.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.21
|
| Rate for Payer: PHP Commercial |
$43.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.84
|
| Rate for Payer: UHC Core |
$42.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.21
|
|
|
HC HERPES SIMPLEX IGG TYPE 1
|
Facility
|
OP
|
$50.95
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200281
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna Commercial |
$43.31
|
| Rate for Payer: Aetna Medicare |
$13.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.92
|
| Rate for Payer: BCBS Complete |
$9.43
|
| Rate for Payer: BCBS MAPPO |
$12.74
|
| Rate for Payer: BCBS Trust/PPO |
$41.89
|
| Rate for Payer: BCN Commercial |
$41.89
|
| Rate for Payer: BCN Medicare Advantage |
$12.74
|
| Rate for Payer: Cash Price |
$40.76
|
| Rate for Payer: Cofinity Commercial |
$43.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$45.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.21
|
| Rate for Payer: Mclaren Medicaid |
$8.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.37
|
| Rate for Payer: Meridian Medicaid |
$9.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.31
|
| Rate for Payer: Nomi Health Commercial |
$41.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.21
|
| Rate for Payer: PACE Senior Care Partners |
$12.10
|
| Rate for Payer: PACE SWMI |
$12.74
|
| Rate for Payer: PHP Commercial |
$43.31
|
| Rate for Payer: PHP Medicare Advantage |
$12.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.33
|
| Rate for Payer: Priority Health Medicare |
$12.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.46
|
| Rate for Payer: Railroad Medicare Medicare |
$12.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.84
|
| Rate for Payer: UHC Core |
$42.54
|
| Rate for Payer: UHC Exchange |
$12.74
|
| Rate for Payer: UHC Medicaid |
$8.98
|
| Rate for Payer: UHC Medicare Advantage |
$12.74
|
| Rate for Payer: UHCCP Medicaid |
$8.98
|
| Rate for Payer: VA VA |
$12.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.21
|
|
|
HC HERPES SIMPLEX IGG TYPE 2
|
Facility
|
OP
|
$74.76
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200283
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$67.28 |
| Rate for Payer: Aetna Commercial |
$63.55
|
| Rate for Payer: Aetna Medicare |
$19.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.36
|
| Rate for Payer: BCBS Complete |
$13.84
|
| Rate for Payer: BCBS MAPPO |
$18.69
|
| Rate for Payer: BCBS Trust/PPO |
$61.46
|
| Rate for Payer: BCN Commercial |
$61.46
|
| Rate for Payer: BCN Medicare Advantage |
$18.69
|
| Rate for Payer: Cash Price |
$59.81
|
| Rate for Payer: Cofinity Commercial |
$64.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$67.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.07
|
| Rate for Payer: Mclaren Medicaid |
$13.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.62
|
| Rate for Payer: Meridian Medicaid |
$13.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.55
|
| Rate for Payer: Nomi Health Commercial |
$61.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.07
|
| Rate for Payer: PACE Senior Care Partners |
$17.76
|
| Rate for Payer: PACE SWMI |
$18.69
|
| Rate for Payer: PHP Commercial |
$63.55
|
| Rate for Payer: PHP Medicare Advantage |
$18.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.04
|
| Rate for Payer: Priority Health Medicare |
$18.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.03
|
| Rate for Payer: Railroad Medicare Medicare |
$18.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.79
|
| Rate for Payer: UHC Core |
$62.42
|
| Rate for Payer: UHC Exchange |
$18.69
|
| Rate for Payer: UHC Medicaid |
$13.18
|
| Rate for Payer: UHC Medicare Advantage |
$18.69
|
| Rate for Payer: UHCCP Medicaid |
$13.18
|
| Rate for Payer: VA VA |
$18.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.07
|
|
|
HC HERPES SIMPLEX IGG TYPE 2
|
Facility
|
IP
|
$74.76
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200283
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.03 |
| Max. Negotiated Rate |
$67.28 |
| Rate for Payer: Aetna Commercial |
$63.55
|
| Rate for Payer: BCBS Trust/PPO |
$61.74
|
| Rate for Payer: BCN Commercial |
$61.74
|
| Rate for Payer: Cash Price |
$59.81
|
| Rate for Payer: Cofinity Commercial |
$64.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.81
|
| Rate for Payer: Healthscope Commercial |
$67.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.55
|
| Rate for Payer: Nomi Health Commercial |
$61.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.07
|
| Rate for Payer: PHP Commercial |
$63.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.79
|
| Rate for Payer: UHC Core |
$62.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.07
|
|
