|
HC HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$49.23
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
30200336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$44.31 |
| Rate for Payer: Aetna Commercial |
$41.85
|
| Rate for Payer: Aetna Medicare |
$12.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.38
|
| Rate for Payer: BCBS Complete |
$10.83
|
| Rate for Payer: BCBS MAPPO |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$40.47
|
| Rate for Payer: BCN Commercial |
$38.28
|
| Rate for Payer: BCN Medicare Advantage |
$12.31
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cofinity Commercial |
$42.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$44.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.92
|
| Rate for Payer: Mclaren Medicaid |
$10.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.92
|
| Rate for Payer: Meridian Medicaid |
$10.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.85
|
| Rate for Payer: Nomi Health Commercial |
$40.37
|
| Rate for Payer: PACE Senior Care Partners |
$11.69
|
| Rate for Payer: PACE SWMI |
$12.31
|
| Rate for Payer: PHP Commercial |
$41.85
|
| Rate for Payer: PHP Medicare Advantage |
$12.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.00
|
| Rate for Payer: Priority Health HMO/PPO |
$42.83
|
| Rate for Payer: Priority Health Medicare |
$12.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.98
|
| Rate for Payer: Railroad Medicare Medicare |
$12.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.32
|
| Rate for Payer: UHC Core |
$41.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.31
|
| Rate for Payer: UHC Exchange |
$12.31
|
| Rate for Payer: UHC Medicare Advantage |
$12.31
|
| Rate for Payer: UHCCP Medicaid |
$10.32
|
| Rate for Payer: VA VA |
$12.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.92
|
|
|
HC HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$49.23
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
30200336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$44.31 |
| Rate for Payer: Aetna Commercial |
$41.85
|
| Rate for Payer: BCBS Trust/PPO |
$40.19
|
| Rate for Payer: BCN Commercial |
$38.04
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cofinity Commercial |
$42.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.38
|
| Rate for Payer: Healthscope Commercial |
$44.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.85
|
| Rate for Payer: Nomi Health Commercial |
$40.37
|
| Rate for Payer: PHP Commercial |
$41.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.00
|
| Rate for Payer: Priority Health HMO/PPO |
$42.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.32
|
| Rate for Payer: UHC Core |
$41.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.92
|
|
|
HC HEPATITIS C ANTIBODY BY RIBA
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
30200337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: BCBS Trust/PPO |
$67.44
|
| Rate for Payer: BCN Commercial |
$63.85
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.23
|
| Rate for Payer: Nomi Health Commercial |
$67.75
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.70
|
| Rate for Payer: Priority Health HMO/PPO |
$71.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.71
|
| Rate for Payer: UHC Core |
$68.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.97
|
|
|
HC HEPATITIS C ANTIBODY BY RIBA
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
30200337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$21.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.82
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$20.66
|
| Rate for Payer: BCBS Trust/PPO |
$67.92
|
| Rate for Payer: BCN Commercial |
$64.24
|
| Rate for Payer: BCN Medicare Advantage |
$20.66
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.66
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.97
|
| Rate for Payer: Mclaren Medicaid |
$11.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.69
|
| Rate for Payer: Meridian Medicaid |
$11.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.23
|
| Rate for Payer: Nomi Health Commercial |
$67.75
|
| Rate for Payer: PACE Senior Care Partners |
$19.62
|
| Rate for Payer: PACE SWMI |
$20.66
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: PHP Medicare Advantage |
$20.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.70
|
| Rate for Payer: Priority Health HMO/PPO |
$71.88
|
| Rate for Payer: Priority Health Medicare |
$20.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.36
|
| Rate for Payer: Railroad Medicare Medicare |
$20.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.71
|
| Rate for Payer: UHC Core |
$68.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.66
|
| Rate for Payer: UHC Exchange |
$20.66
|
| Rate for Payer: UHC Medicare Advantage |
$20.66
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: VA VA |
$20.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.97
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANT
|
Facility
|
IP
|
$152.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$99.41 |
| Max. Negotiated Rate |
$137.65 |
| Rate for Payer: Aetna Commercial |
$130.00
|
| Rate for Payer: BCBS Trust/PPO |
$124.84
|
| Rate for Payer: BCN Commercial |
$118.19
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cofinity Commercial |
$131.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.35
|
| Rate for Payer: Healthscope Commercial |
$137.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.00
|
| Rate for Payer: Nomi Health Commercial |
$125.41
|
| Rate for Payer: PHP Commercial |
$130.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.41
|
| Rate for Payer: Priority Health HMO/PPO |
$133.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.59
|
| Rate for Payer: UHC Core |
$127.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.70
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANT
|
Facility
|
OP
|
$152.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$137.65 |
| Rate for Payer: Aetna Commercial |
$130.00
|
| Rate for Payer: Aetna Medicare |
$39.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.79
|
| Rate for Payer: BCBS Complete |
$32.52
|
| Rate for Payer: BCBS MAPPO |
$38.23
|
| Rate for Payer: BCBS Trust/PPO |
$125.73
|
| Rate for Payer: BCN Commercial |
$118.91
|
| Rate for Payer: BCN Medicare Advantage |
$38.23
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cofinity Commercial |
$131.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.23
|
| Rate for Payer: Healthscope Commercial |
$137.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.70
|
| Rate for Payer: Mclaren Medicaid |
$30.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.15
|
| Rate for Payer: Meridian Medicaid |
$32.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.00
|
| Rate for Payer: Nomi Health Commercial |
$125.41
|
| Rate for Payer: PACE Senior Care Partners |
$36.32
|
| Rate for Payer: PACE SWMI |
$38.23
|
| Rate for Payer: PHP Commercial |
$130.00
|
| Rate for Payer: PHP Medicare Advantage |
$38.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.41
|
| Rate for Payer: Priority Health HMO/PPO |
$133.06
|
| Rate for Payer: Priority Health Medicare |
$38.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.47
|
| Rate for Payer: Railroad Medicare Medicare |
$38.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.59
|
| Rate for Payer: UHC Core |
$127.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.23
|
| Rate for Payer: UHC Exchange |
$38.23
|
| Rate for Payer: UHC Medicare Advantage |
$38.23
|
| Rate for Payer: UHCCP Medicaid |
$30.97
|
| Rate for Payer: VA VA |
$38.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.70
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANTIFICATION
|
Facility
|
IP
|
$152.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600157
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$99.41 |
| Max. Negotiated Rate |
$137.65 |
| Rate for Payer: Aetna Commercial |
$130.00
|
| Rate for Payer: BCBS Trust/PPO |
$124.84
|
| Rate for Payer: BCN Commercial |
$118.19
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cofinity Commercial |
$131.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.35
|
| Rate for Payer: Healthscope Commercial |
$137.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.00
|
| Rate for Payer: Nomi Health Commercial |
$125.41
|
| Rate for Payer: PHP Commercial |
$130.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.41
|
| Rate for Payer: Priority Health HMO/PPO |
$133.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.59
|
| Rate for Payer: UHC Core |
$127.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.70
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANTIFICATION
|
Facility
|
OP
|
$152.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600157
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$137.65 |
| Rate for Payer: Aetna Commercial |
$130.00
|
| Rate for Payer: Aetna Medicare |
$39.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.79
|
| Rate for Payer: BCBS Complete |
$32.52
|
| Rate for Payer: BCBS MAPPO |
$38.23
|
| Rate for Payer: BCBS Trust/PPO |
$125.73
|
| Rate for Payer: BCN Commercial |
$118.91
|
| Rate for Payer: BCN Medicare Advantage |
$38.23
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cash Price |
$122.35
|
| Rate for Payer: Cofinity Commercial |
$131.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.23
|
| Rate for Payer: Healthscope Commercial |
$137.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.70
|
| Rate for Payer: Mclaren Medicaid |
$30.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.15
|
| Rate for Payer: Meridian Medicaid |
$32.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.00
|
| Rate for Payer: Nomi Health Commercial |
$125.41
|
| Rate for Payer: PACE Senior Care Partners |
$36.32
|
| Rate for Payer: PACE SWMI |
$38.23
|
| Rate for Payer: PHP Commercial |
$130.00
|
| Rate for Payer: PHP Medicare Advantage |
$38.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.41
|
| Rate for Payer: Priority Health HMO/PPO |
$133.06
|
| Rate for Payer: Priority Health Medicare |
$38.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.47
|
| Rate for Payer: Railroad Medicare Medicare |
$38.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.59
|
| Rate for Payer: UHC Core |
$127.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.23
|
| Rate for Payer: UHC Exchange |
$38.23
|
| Rate for Payer: UHC Medicare Advantage |
$38.23
|
| Rate for Payer: UHCCP Medicaid |
$30.97
|
| Rate for Payer: VA VA |
$38.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.70
|
|
|
HC HEPATITS B VACCINE (HEPB), PEDIATRIC/ADOLESCENT, 3 DOSE IM
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$28.14
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC HEPATITS B VACCINE (HEPB), PEDIATRIC/ADOLESCENT, 3 DOSE IM
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$9.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.38
|
| Rate for Payer: BCBS Complete |
$14.56
|
| Rate for Payer: BCBS MAPPO |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.93
|
| Rate for Payer: BCN Commercial |
$28.31
|
| Rate for Payer: BCN Medicare Advantage |
$9.10
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.10
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.65
|
| Rate for Payer: PACE SWMI |
$9.10
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Medicare |
$9.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: Railroad Medicare Medicare |
$9.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.10
|
| Rate for Payer: UHC Exchange |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$9.10
|
| Rate for Payer: VA VA |
$9.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
OP
|
$34.17
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$35.03 |
| Rate for Payer: Aetna Commercial |
$29.04
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.68
|
| Rate for Payer: BCBS Complete |
$35.03
|
| Rate for Payer: BCBS MAPPO |
$8.54
|
| Rate for Payer: BCBS Trust/PPO |
$28.09
|
| Rate for Payer: BCN Commercial |
$26.57
|
| Rate for Payer: BCN Medicare Advantage |
$8.54
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$29.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.54
|
| Rate for Payer: Healthscope Commercial |
$30.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.63
|
| Rate for Payer: Mclaren Medicaid |
$33.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.97
|
| Rate for Payer: Meridian Medicaid |
$35.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.04
|
| Rate for Payer: Nomi Health Commercial |
$28.02
|
| Rate for Payer: PACE Senior Care Partners |
$8.12
|
| Rate for Payer: PACE SWMI |
$8.54
|
| Rate for Payer: PHP Commercial |
$29.04
|
| Rate for Payer: PHP Medicare Advantage |
$8.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.21
|
| Rate for Payer: Priority Health HMO/PPO |
$29.73
|
| Rate for Payer: Priority Health Medicare |
$8.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.89
|
| Rate for Payer: Railroad Medicare Medicare |
$8.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.07
|
| Rate for Payer: UHC Core |
$28.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.54
|
| Rate for Payer: UHC Exchange |
$8.54
|
| Rate for Payer: UHC Medicare Advantage |
$8.54
|
| Rate for Payer: UHCCP Medicaid |
$33.36
|
| Rate for Payer: VA VA |
$8.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.63
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
IP
|
$34.17
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.21 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: Aetna Commercial |
$29.04
|
| Rate for Payer: BCBS Trust/PPO |
$27.89
|
| Rate for Payer: BCN Commercial |
$26.41
|
| Rate for Payer: Cash Price |
$27.34
|
| Rate for Payer: Cofinity Commercial |
$29.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.34
|
| Rate for Payer: Healthscope Commercial |
$30.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.04
|
| Rate for Payer: Nomi Health Commercial |
$28.02
|
| Rate for Payer: PHP Commercial |
$29.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.21
|
| Rate for Payer: Priority Health HMO/PPO |
$29.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.07
|
| Rate for Payer: UHC Core |
$28.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.63
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: BCBS Trust/PPO |
$81.60
|
| Rate for Payer: BCN Commercial |
$77.25
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health HMO/PPO |
$86.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.96
|
| Rate for Payer: UHC Core |
$83.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.97
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Medicare |
$25.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.24
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$24.99
|
| Rate for Payer: BCBS Trust/PPO |
$82.18
|
| Rate for Payer: BCN Commercial |
$77.72
|
| Rate for Payer: BCN Medicare Advantage |
$24.99
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.97
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.24
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.97
|
| Rate for Payer: Nomi Health Commercial |
$81.97
|
| Rate for Payer: PACE Senior Care Partners |
$23.74
|
| Rate for Payer: PACE SWMI |
$24.99
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: PHP Medicare Advantage |
$24.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.97
|
| Rate for Payer: Priority Health HMO/PPO |
$86.97
|
| Rate for Payer: Priority Health Medicare |
$25.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.97
|
| Rate for Payer: Railroad Medicare Medicare |
$24.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.96
|
| Rate for Payer: UHC Core |
$83.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.99
|
| Rate for Payer: UHC Exchange |
$24.99
|
| Rate for Payer: UHC Medicare Advantage |
$24.99
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$24.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.97
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
IP
|
$45.93
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.85 |
| Max. Negotiated Rate |
$41.34 |
| Rate for Payer: Aetna Commercial |
$39.04
|
| Rate for Payer: BCBS Trust/PPO |
$37.49
|
| Rate for Payer: BCN Commercial |
$35.49
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$39.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.74
|
| Rate for Payer: Healthscope Commercial |
$41.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.04
|
| Rate for Payer: Nomi Health Commercial |
$37.66
|
| Rate for Payer: PHP Commercial |
$39.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: Priority Health HMO/PPO |
$39.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.42
|
| Rate for Payer: UHC Core |
$38.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.45
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
OP
|
$45.93
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$41.34 |
| Rate for Payer: Aetna Commercial |
$39.04
|
| Rate for Payer: Aetna Medicare |
$11.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.35
|
| Rate for Payer: BCBS Complete |
$7.84
|
| Rate for Payer: BCBS MAPPO |
$11.48
|
| Rate for Payer: BCBS Trust/PPO |
$37.76
|
| Rate for Payer: BCN Commercial |
$35.71
|
| Rate for Payer: BCN Medicare Advantage |
$11.48
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cofinity Commercial |
$39.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$41.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.45
|
| Rate for Payer: Mclaren Medicaid |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.06
|
| Rate for Payer: Meridian Medicaid |
$7.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.04
|
| Rate for Payer: Nomi Health Commercial |
$37.66
|
| Rate for Payer: PACE Senior Care Partners |
$10.91
|
| Rate for Payer: PACE SWMI |
$11.48
|
| Rate for Payer: PHP Commercial |
$39.04
|
| Rate for Payer: PHP Medicare Advantage |
$11.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.85
|
| Rate for Payer: Priority Health HMO/PPO |
$39.96
|
| Rate for Payer: Priority Health Medicare |
$11.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.77
|
| Rate for Payer: Railroad Medicare Medicare |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.42
|
| Rate for Payer: UHC Core |
$38.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.48
|
| Rate for Payer: UHC Exchange |
$11.48
|
| Rate for Payer: UHC Medicare Advantage |
$11.48
|
| Rate for Payer: UHCCP Medicaid |
$7.47
|
| Rate for Payer: VA VA |
$11.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.45
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
OP
|
$332.93
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.07 |
| Max. Negotiated Rate |
$299.64 |
| Rate for Payer: Aetna Commercial |
$282.99
|
| Rate for Payer: Aetna Medicare |
$86.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.04
|
| Rate for Payer: BCBS Complete |
$133.17
|
| Rate for Payer: BCBS MAPPO |
$83.23
|
| Rate for Payer: BCBS Trust/PPO |
$273.70
|
| Rate for Payer: BCN Commercial |
$258.85
|
| Rate for Payer: BCN Medicare Advantage |
$83.23
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$286.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$299.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.99
|
| Rate for Payer: Nomi Health Commercial |
$273.00
|
| Rate for Payer: PACE Senior Care Partners |
$79.07
|
| Rate for Payer: PACE SWMI |
$83.23
|
| Rate for Payer: PHP Commercial |
$282.99
|
| Rate for Payer: PHP Medicare Advantage |
$83.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.40
|
| Rate for Payer: Priority Health HMO/PPO |
$289.65
|
| Rate for Payer: Priority Health Medicare |
$84.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.06
|
| Rate for Payer: Railroad Medicare Medicare |
$83.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.98
|
| Rate for Payer: UHC Core |
$278.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.23
|
| Rate for Payer: UHC Exchange |
$83.23
|
| Rate for Payer: UHC Medicare Advantage |
$83.23
|
| Rate for Payer: VA VA |
$83.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.70
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
IP
|
$332.93
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$216.40 |
| Max. Negotiated Rate |
$299.64 |
| Rate for Payer: Aetna Commercial |
$282.99
|
| Rate for Payer: BCBS Trust/PPO |
$271.77
|
| Rate for Payer: BCN Commercial |
$257.29
|
| Rate for Payer: Cash Price |
$266.34
|
| Rate for Payer: Cofinity Commercial |
$286.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.34
|
| Rate for Payer: Healthscope Commercial |
$299.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.99
|
| Rate for Payer: Nomi Health Commercial |
$273.00
|
| Rate for Payer: PHP Commercial |
$282.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.40
|
| Rate for Payer: Priority Health HMO/PPO |
$289.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.98
|
| Rate for Payer: UHC Core |
$278.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.70
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
OP
|
$421.13
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$100.02 |
| Max. Negotiated Rate |
$379.02 |
| Rate for Payer: Aetna Commercial |
$357.96
|
| Rate for Payer: Aetna Medicare |
$109.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.60
|
| Rate for Payer: BCBS Complete |
$195.46
|
| Rate for Payer: BCBS MAPPO |
$105.28
|
| Rate for Payer: BCBS Trust/PPO |
$346.21
|
| Rate for Payer: BCN Commercial |
$327.43
|
| Rate for Payer: BCN Medicare Advantage |
$105.28
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cofinity Commercial |
$362.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$379.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.85
|
| Rate for Payer: Mclaren Medicaid |
$186.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.55
|
| Rate for Payer: Meridian Medicaid |
$195.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.96
|
| Rate for Payer: Nomi Health Commercial |
$345.33
|
| Rate for Payer: PACE Senior Care Partners |
$100.02
|
| Rate for Payer: PACE SWMI |
$105.28
|
| Rate for Payer: PHP Commercial |
$357.96
|
| Rate for Payer: PHP Medicare Advantage |
$105.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.73
|
| Rate for Payer: Priority Health HMO/PPO |
$366.38
|
| Rate for Payer: Priority Health Medicare |
$106.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.16
|
| Rate for Payer: Railroad Medicare Medicare |
$105.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.59
|
| Rate for Payer: UHC Core |
$351.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.28
|
| Rate for Payer: UHC Exchange |
$105.28
|
| Rate for Payer: UHC Medicare Advantage |
$105.28
|
| Rate for Payer: UHCCP Medicaid |
$186.14
|
| Rate for Payer: VA VA |
$105.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.85
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
IP
|
$421.13
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$273.73 |
| Max. Negotiated Rate |
$379.02 |
| Rate for Payer: Aetna Commercial |
$357.96
|
| Rate for Payer: BCBS Trust/PPO |
$343.77
|
| Rate for Payer: BCN Commercial |
$325.45
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cofinity Commercial |
$362.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.90
|
| Rate for Payer: Healthscope Commercial |
$379.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.96
|
| Rate for Payer: Nomi Health Commercial |
$345.33
|
| Rate for Payer: PHP Commercial |
$357.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.73
|
| Rate for Payer: Priority Health HMO/PPO |
$366.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.59
|
| Rate for Payer: UHC Core |
$351.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.85
|
|
|
HC HER2 DUAL ISH
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000065
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.13 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: Aetna Medicare |
$81.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.54
|
| Rate for Payer: BCBS Complete |
$273.10
|
| Rate for Payer: BCBS MAPPO |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$256.59
|
| Rate for Payer: BCN Commercial |
$242.67
|
| Rate for Payer: BCN Medicare Advantage |
$78.03
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.03
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: Mclaren Medicaid |
$260.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.93
|
| Rate for Payer: Meridian Medicaid |
$273.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: PACE Senior Care Partners |
$74.13
|
| Rate for Payer: PACE SWMI |
$78.03
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: PHP Medicare Advantage |
$78.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: Priority Health HMO/PPO |
$271.54
|
| Rate for Payer: Priority Health Medicare |
$78.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.12
|
| Rate for Payer: Railroad Medicare Medicare |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.67
|
| Rate for Payer: UHC Core |
$260.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.03
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Medicare Advantage |
$78.03
|
| Rate for Payer: UHCCP Medicaid |
$260.08
|
| Rate for Payer: VA VA |
$78.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
HC HER2 DUAL ISH
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000065
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$202.88 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: BCBS Trust/PPO |
$254.78
|
| Rate for Payer: BCN Commercial |
$241.21
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: Priority Health HMO/PPO |
$271.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.67
|
| Rate for Payer: UHC Core |
$260.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
HC HER2 DUAL ISH CMPT
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$202.88 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: BCBS Trust/PPO |
$254.78
|
| Rate for Payer: BCN Commercial |
$241.21
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: Priority Health HMO/PPO |
$271.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.67
|
| Rate for Payer: UHC Core |
$260.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
HC HER2 DUAL ISH CMPT
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000066
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.13 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: Aetna Medicare |
$81.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.54
|
| Rate for Payer: BCBS Complete |
$273.10
|
| Rate for Payer: BCBS MAPPO |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$256.59
|
| Rate for Payer: BCN Commercial |
$242.67
|
| Rate for Payer: BCN Medicare Advantage |
$78.03
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.03
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: Mclaren Medicaid |
$260.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.93
|
| Rate for Payer: Meridian Medicaid |
$273.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: PACE Senior Care Partners |
$74.13
|
| Rate for Payer: PACE SWMI |
$78.03
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: PHP Medicare Advantage |
$78.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: Priority Health HMO/PPO |
$271.54
|
| Rate for Payer: Priority Health Medicare |
$78.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.12
|
| Rate for Payer: Railroad Medicare Medicare |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.67
|
| Rate for Payer: UHC Core |
$260.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.03
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Medicare Advantage |
$78.03
|
| Rate for Payer: UHCCP Medicaid |
$260.08
|
| Rate for Payer: VA VA |
$78.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
HC HER-2 NEU QUANTITATIVE
|
Facility
|
OP
|
$248.88
|
|
|
Service Code
|
CPT 83950
|
| Hospital Charge Code |
30100382
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$223.99 |
| Rate for Payer: Aetna Commercial |
$211.55
|
| Rate for Payer: Aetna Medicare |
$64.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.78
|
| Rate for Payer: BCBS Complete |
$48.90
|
| Rate for Payer: BCBS MAPPO |
$62.22
|
| Rate for Payer: BCBS Trust/PPO |
$204.60
|
| Rate for Payer: BCN Commercial |
$193.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.22
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cofinity Commercial |
$214.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.22
|
| Rate for Payer: Healthscope Commercial |
$223.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.66
|
| Rate for Payer: Mclaren Medicaid |
$46.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.33
|
| Rate for Payer: Meridian Medicaid |
$48.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.55
|
| Rate for Payer: Nomi Health Commercial |
$204.08
|
| Rate for Payer: PACE Senior Care Partners |
$59.11
|
| Rate for Payer: PACE SWMI |
$62.22
|
| Rate for Payer: PHP Commercial |
$211.55
|
| Rate for Payer: PHP Medicare Advantage |
$62.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.77
|
| Rate for Payer: Priority Health HMO/PPO |
$216.53
|
| Rate for Payer: Priority Health Medicare |
$62.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.75
|
| Rate for Payer: Railroad Medicare Medicare |
$62.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.01
|
| Rate for Payer: UHC Core |
$207.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.22
|
| Rate for Payer: UHC Exchange |
$62.22
|
| Rate for Payer: UHC Medicare Advantage |
$62.22
|
| Rate for Payer: UHCCP Medicaid |
$46.57
|
| Rate for Payer: VA VA |
$62.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.66
|
|
