|
HC HOSP OUTPT VISIT NEW LVL 3
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000122
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT VISIT NEW LVL 3
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000122
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$71.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.25
|
| Rate for Payer: BCBS Complete |
$95.86
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.00
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Mclaren Medicaid |
$91.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$95.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Senior Care Partners |
$65.55
|
| Rate for Payer: PACE SWMI |
$69.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| Rate for Payer: Railroad Medicare Medicare |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$91.29
|
| Rate for Payer: VA VA |
$69.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT VISIT NEW LVL 4
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000123
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$71.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.25
|
| Rate for Payer: BCBS Complete |
$95.86
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.00
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Mclaren Medicaid |
$91.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$95.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Senior Care Partners |
$65.55
|
| Rate for Payer: PACE SWMI |
$69.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| Rate for Payer: Railroad Medicare Medicare |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$91.29
|
| Rate for Payer: VA VA |
$69.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT VISIT NEW LVL 4
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000123
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT VISIT NEW LVL 5
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000124
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: Aetna Medicare |
$71.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.25
|
| Rate for Payer: BCBS Complete |
$95.86
|
| Rate for Payer: BCBS MAPPO |
$69.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.90
|
| Rate for Payer: BCN Commercial |
$214.59
|
| Rate for Payer: BCN Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.00
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Mclaren Medicaid |
$91.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.45
|
| Rate for Payer: Meridian Medicaid |
$95.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PACE Senior Care Partners |
$65.55
|
| Rate for Payer: PACE SWMI |
$69.00
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: PHP Medicare Advantage |
$69.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Medicare |
$69.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| Rate for Payer: Railroad Medicare Medicare |
$69.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.00
|
| Rate for Payer: UHC Exchange |
$69.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.00
|
| Rate for Payer: UHCCP Medicaid |
$91.29
|
| Rate for Payer: VA VA |
$69.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOSP OUTPT VISIT NEW LVL 5
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000124
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$234.60
|
| Rate for Payer: BCBS Trust/PPO |
$225.30
|
| Rate for Payer: BCN Commercial |
$213.29
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.80
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.60
|
| Rate for Payer: Nomi Health Commercial |
$226.32
|
| Rate for Payer: PHP Commercial |
$234.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.40
|
| Rate for Payer: Priority Health HMO/PPO |
$240.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.88
|
| Rate for Payer: UHC Core |
$230.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.00
|
|
|
HC HOT BIOPSY
|
Facility
|
OP
|
$488.74
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.08 |
| Max. Negotiated Rate |
$439.87 |
| Rate for Payer: Aetna Commercial |
$415.43
|
| Rate for Payer: Aetna Medicare |
$127.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.73
|
| Rate for Payer: BCBS Complete |
$195.50
|
| Rate for Payer: BCBS MAPPO |
$122.18
|
| Rate for Payer: BCBS Trust/PPO |
$401.79
|
| Rate for Payer: BCN Commercial |
$380.00
|
| Rate for Payer: BCN Medicare Advantage |
$122.18
|
| Rate for Payer: Cash Price |
$390.99
|
| Rate for Payer: Cofinity Commercial |
$420.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.18
|
| Rate for Payer: Healthscope Commercial |
$439.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.43
|
| Rate for Payer: Nomi Health Commercial |
$400.77
|
| Rate for Payer: PACE Senior Care Partners |
$116.08
|
| Rate for Payer: PACE SWMI |
$122.18
|
| Rate for Payer: PHP Commercial |
$415.43
|
| Rate for Payer: PHP Medicare Advantage |
$122.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.68
|
| Rate for Payer: Priority Health HMO/PPO |
$425.20
|
| Rate for Payer: Priority Health Medicare |
$123.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.46
|
| Rate for Payer: Railroad Medicare Medicare |
$122.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$430.09
|
| Rate for Payer: UHC Core |
$408.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.18
|
| Rate for Payer: UHC Exchange |
$122.18
|
| Rate for Payer: UHC Medicare Advantage |
$122.18
|
| Rate for Payer: VA VA |
$122.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.56
|
|
|
HC HOT BIOPSY
|
Facility
|
IP
|
$488.74
|
|
| Hospital Charge Code |
36000053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$317.68 |
| Max. Negotiated Rate |
$439.87 |
| Rate for Payer: Aetna Commercial |
$415.43
|
| Rate for Payer: BCBS Trust/PPO |
$398.96
|
| Rate for Payer: BCN Commercial |
$377.70
|
| Rate for Payer: Cash Price |
$390.99
|
| Rate for Payer: Cofinity Commercial |
$420.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.99
|
| Rate for Payer: Healthscope Commercial |
$439.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.43
|
| Rate for Payer: Nomi Health Commercial |
$400.77
|
| Rate for Payer: PHP Commercial |
$415.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.68
|
| Rate for Payer: Priority Health HMO/PPO |
$425.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$430.09
|
| Rate for Payer: UHC Core |
$408.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.56
|
|
|
HC HPV SEPARATELY REPORTABLE HR 16/18
|
Facility
|
IP
|
$97.13
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
30600346
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$63.13 |
| Max. Negotiated Rate |
$87.42 |
| Rate for Payer: Aetna Commercial |
$82.56
|
| Rate for Payer: BCBS Trust/PPO |
$79.29
|
| Rate for Payer: BCN Commercial |
$75.06
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$83.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.70
|
| Rate for Payer: Healthscope Commercial |
$87.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.56
|
| Rate for Payer: Nomi Health Commercial |
$79.65
|
| Rate for Payer: PHP Commercial |
$82.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.13
|
| Rate for Payer: Priority Health HMO/PPO |
$84.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.47
|
| Rate for Payer: UHC Core |
$81.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.85
|
|
|
HC HPV SEPARATELY REPORTABLE HR 16/18
|
Facility
|
OP
|
$97.13
|
|
|
Service Code
|
CPT 87626
|
| Hospital Charge Code |
30600346
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$87.42 |
| Rate for Payer: Aetna Commercial |
$82.56
|
| Rate for Payer: Aetna Medicare |
$25.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.35
|
| Rate for Payer: BCBS Complete |
$53.30
|
| Rate for Payer: BCBS MAPPO |
$24.28
|
| Rate for Payer: BCBS Trust/PPO |
$79.85
|
| Rate for Payer: BCCCP Commercial |
$70.02
|
| Rate for Payer: BCN Commercial |
$75.52
|
| Rate for Payer: BCN Medicare Advantage |
$24.28
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$83.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.28
|
| Rate for Payer: Healthscope Commercial |
$87.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.85
|
| Rate for Payer: Mclaren Medicaid |
$50.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.50
|
| Rate for Payer: Meridian Medicaid |
$53.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.56
|
| Rate for Payer: Nomi Health Commercial |
$79.65
|
| Rate for Payer: PACE Senior Care Partners |
$23.07
|
| Rate for Payer: PACE SWMI |
$24.28
|
| Rate for Payer: PHP Commercial |
$82.56
|
| Rate for Payer: PHP Medicare Advantage |
$24.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.13
|
| Rate for Payer: Priority Health HMO/PPO |
$84.50
|
| Rate for Payer: Priority Health Medicare |
$24.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.08
|
| Rate for Payer: Railroad Medicare Medicare |
$24.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.47
|
| Rate for Payer: UHC Core |
$81.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.28
|
| Rate for Payer: UHC Exchange |
$24.28
|
| Rate for Payer: UHC Medicare Advantage |
$24.28
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: VA VA |
$24.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.85
|
|
|
HC HPV TYPES 6,11,16,18,31,33,45,53,58, NONVALENT (9VHPV), 3 DOSE IM
|
Facility
|
OP
|
$193.51
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
63600071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.96 |
| Max. Negotiated Rate |
$174.16 |
| Rate for Payer: Aetna Commercial |
$164.48
|
| Rate for Payer: Aetna Medicare |
$50.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.47
|
| Rate for Payer: BCBS Complete |
$77.40
|
| Rate for Payer: BCBS MAPPO |
$48.38
|
| Rate for Payer: BCBS Trust/PPO |
$159.08
|
| Rate for Payer: BCN Commercial |
$150.45
|
| Rate for Payer: BCN Medicare Advantage |
$48.38
|
| Rate for Payer: Cash Price |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$166.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$174.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.48
|
| Rate for Payer: Nomi Health Commercial |
$158.68
|
| Rate for Payer: PACE Senior Care Partners |
$45.96
|
| Rate for Payer: PACE SWMI |
$48.38
|
| Rate for Payer: PHP Commercial |
$164.48
|
| Rate for Payer: PHP Medicare Advantage |
$48.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.78
|
| Rate for Payer: Priority Health HMO/PPO |
$168.35
|
| Rate for Payer: Priority Health Medicare |
$48.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.65
|
| Rate for Payer: Railroad Medicare Medicare |
$48.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.29
|
| Rate for Payer: UHC Core |
$161.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.38
|
| Rate for Payer: UHC Exchange |
$48.38
|
| Rate for Payer: UHC Medicare Advantage |
$48.38
|
| Rate for Payer: VA VA |
$48.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.13
|
|
|
HC HPV TYPES 6,11,16,18,31,33,45,53,58, NONVALENT (9VHPV), 3 DOSE IM
|
Facility
|
IP
|
$193.51
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
63600071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.78 |
| Max. Negotiated Rate |
$174.16 |
| Rate for Payer: Aetna Commercial |
$164.48
|
| Rate for Payer: BCBS Trust/PPO |
$157.96
|
| Rate for Payer: BCN Commercial |
$149.54
|
| Rate for Payer: Cash Price |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$166.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.81
|
| Rate for Payer: Healthscope Commercial |
$174.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.48
|
| Rate for Payer: Nomi Health Commercial |
$158.68
|
| Rate for Payer: PHP Commercial |
$164.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.78
|
| Rate for Payer: Priority Health HMO/PPO |
$168.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.29
|
| Rate for Payer: UHC Core |
$161.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.13
|
|
|
HC HPV TYPES 6, 11, 16, 18 QUADRIVALENT (4VHPV), 3 DOSE IM
|
Facility
|
OP
|
$212.86
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.55 |
| Max. Negotiated Rate |
$191.57 |
| Rate for Payer: Aetna Commercial |
$180.93
|
| Rate for Payer: Aetna Medicare |
$55.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.52
|
| Rate for Payer: BCBS Complete |
$85.14
|
| Rate for Payer: BCBS MAPPO |
$53.22
|
| Rate for Payer: BCBS Trust/PPO |
$174.99
|
| Rate for Payer: BCN Commercial |
$165.50
|
| Rate for Payer: BCN Medicare Advantage |
$53.22
|
| Rate for Payer: Cash Price |
$170.29
|
| Rate for Payer: Cofinity Commercial |
$183.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.22
|
| Rate for Payer: Healthscope Commercial |
$191.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.93
|
| Rate for Payer: Nomi Health Commercial |
$174.55
|
| Rate for Payer: PACE Senior Care Partners |
$50.55
|
| Rate for Payer: PACE SWMI |
$53.22
|
| Rate for Payer: PHP Commercial |
$180.93
|
| Rate for Payer: PHP Medicare Advantage |
$53.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.36
|
| Rate for Payer: Priority Health HMO/PPO |
$185.19
|
| Rate for Payer: Priority Health Medicare |
$53.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.62
|
| Rate for Payer: Railroad Medicare Medicare |
$53.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.32
|
| Rate for Payer: UHC Core |
$177.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.22
|
| Rate for Payer: UHC Exchange |
$53.22
|
| Rate for Payer: UHC Medicare Advantage |
$53.22
|
| Rate for Payer: VA VA |
$53.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.64
|
|
|
HC HPV TYPES 6, 11, 16, 18 QUADRIVALENT (4VHPV), 3 DOSE IM
|
Facility
|
IP
|
$212.86
|
|
|
Service Code
|
CPT 90649
|
| Hospital Charge Code |
63600070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.36 |
| Max. Negotiated Rate |
$191.57 |
| Rate for Payer: Aetna Commercial |
$180.93
|
| Rate for Payer: BCBS Trust/PPO |
$173.76
|
| Rate for Payer: BCN Commercial |
$164.50
|
| Rate for Payer: Cash Price |
$170.29
|
| Rate for Payer: Cofinity Commercial |
$183.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.29
|
| Rate for Payer: Healthscope Commercial |
$191.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.93
|
| Rate for Payer: Nomi Health Commercial |
$174.55
|
| Rate for Payer: PHP Commercial |
$180.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.36
|
| Rate for Payer: Priority Health HMO/PPO |
$185.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.32
|
| Rate for Payer: UHC Core |
$177.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.64
|
|
|
HC H PYLORI AG STOOL
|
Facility
|
IP
|
$120.26
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
30600138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$108.23 |
| Rate for Payer: Aetna Commercial |
$102.22
|
| Rate for Payer: BCBS Trust/PPO |
$98.17
|
| Rate for Payer: BCN Commercial |
$92.94
|
| Rate for Payer: Cash Price |
$96.21
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.21
|
| Rate for Payer: Healthscope Commercial |
$108.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.22
|
| Rate for Payer: Nomi Health Commercial |
$98.61
|
| Rate for Payer: PHP Commercial |
$102.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.17
|
| Rate for Payer: Priority Health HMO/PPO |
$104.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.83
|
| Rate for Payer: UHC Core |
$100.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.20
|
|
|
HC H PYLORI AG STOOL
|
Facility
|
OP
|
$120.26
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
30600138
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$108.23 |
| Rate for Payer: Aetna Commercial |
$102.22
|
| Rate for Payer: Aetna Medicare |
$31.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.58
|
| Rate for Payer: BCBS Complete |
$10.92
|
| Rate for Payer: BCBS MAPPO |
$30.06
|
| Rate for Payer: BCBS Trust/PPO |
$98.87
|
| Rate for Payer: BCN Commercial |
$93.50
|
| Rate for Payer: BCN Medicare Advantage |
$30.06
|
| Rate for Payer: Cash Price |
$96.21
|
| Rate for Payer: Cash Price |
$96.21
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.06
|
| Rate for Payer: Healthscope Commercial |
$108.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.20
|
| Rate for Payer: Mclaren Medicaid |
$10.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.57
|
| Rate for Payer: Meridian Medicaid |
$10.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.22
|
| Rate for Payer: Nomi Health Commercial |
$98.61
|
| Rate for Payer: PACE Senior Care Partners |
$28.56
|
| Rate for Payer: PACE SWMI |
$30.06
|
| Rate for Payer: PHP Commercial |
$102.22
|
| Rate for Payer: PHP Medicare Advantage |
$30.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.17
|
| Rate for Payer: Priority Health HMO/PPO |
$104.63
|
| Rate for Payer: Priority Health Medicare |
$30.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.57
|
| Rate for Payer: Railroad Medicare Medicare |
$30.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.83
|
| Rate for Payer: UHC Core |
$100.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.06
|
| Rate for Payer: UHC Exchange |
$30.06
|
| Rate for Payer: UHC Medicare Advantage |
$30.06
|
| Rate for Payer: UHCCP Medicaid |
$10.40
|
| Rate for Payer: VA VA |
$30.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.20
|
|
|
HC H PYLORI CLARITHRO RESIST PCR CMPT
|
Facility
|
IP
|
$65.44
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.54 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$55.62
|
| Rate for Payer: BCBS Trust/PPO |
$53.42
|
| Rate for Payer: BCN Commercial |
$50.57
|
| Rate for Payer: Cash Price |
$52.35
|
| Rate for Payer: Cofinity Commercial |
$56.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.35
|
| Rate for Payer: Healthscope Commercial |
$58.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.62
|
| Rate for Payer: Nomi Health Commercial |
$53.66
|
| Rate for Payer: PHP Commercial |
$55.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.54
|
| Rate for Payer: Priority Health HMO/PPO |
$56.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.59
|
| Rate for Payer: UHC Core |
$54.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.08
|
|
|
HC H PYLORI CLARITHRO RESIST PCR CMPT
|
Facility
|
OP
|
$65.44
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600326
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$55.62
|
| Rate for Payer: Aetna Medicare |
$17.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.45
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$16.36
|
| Rate for Payer: BCBS Trust/PPO |
$53.80
|
| Rate for Payer: BCN Commercial |
$50.88
|
| Rate for Payer: BCN Medicare Advantage |
$16.36
|
| Rate for Payer: Cash Price |
$52.35
|
| Rate for Payer: Cash Price |
$52.35
|
| Rate for Payer: Cofinity Commercial |
$56.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.36
|
| Rate for Payer: Healthscope Commercial |
$58.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.08
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.18
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.62
|
| Rate for Payer: Nomi Health Commercial |
$53.66
|
| Rate for Payer: PACE Senior Care Partners |
$15.54
|
| Rate for Payer: PACE SWMI |
$16.36
|
| Rate for Payer: PHP Commercial |
$55.62
|
| Rate for Payer: PHP Medicare Advantage |
$16.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.54
|
| Rate for Payer: Priority Health HMO/PPO |
$56.93
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.84
|
| Rate for Payer: Railroad Medicare Medicare |
$16.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.59
|
| Rate for Payer: UHC Core |
$54.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.36
|
| Rate for Payer: UHC Exchange |
$16.36
|
| Rate for Payer: UHC Medicare Advantage |
$16.36
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$16.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.08
|
|
|
HC H PYLORI CLARITHRO RESIST PCR, FECES
|
Facility
|
IP
|
$65.44
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600325
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.54 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$55.62
|
| Rate for Payer: BCBS Trust/PPO |
$53.42
|
| Rate for Payer: BCN Commercial |
$50.57
|
| Rate for Payer: Cash Price |
$52.35
|
| Rate for Payer: Cofinity Commercial |
$56.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.35
|
| Rate for Payer: Healthscope Commercial |
$58.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.62
|
| Rate for Payer: Nomi Health Commercial |
$53.66
|
| Rate for Payer: PHP Commercial |
$55.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.54
|
| Rate for Payer: Priority Health HMO/PPO |
$56.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.59
|
| Rate for Payer: UHC Core |
$54.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.08
|
|
|
HC H PYLORI CLARITHRO RESIST PCR, FECES
|
Facility
|
OP
|
$65.44
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600325
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$55.62
|
| Rate for Payer: Aetna Medicare |
$17.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.45
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$16.36
|
| Rate for Payer: BCBS Trust/PPO |
$53.80
|
| Rate for Payer: BCN Commercial |
$50.88
|
| Rate for Payer: BCN Medicare Advantage |
$16.36
|
| Rate for Payer: Cash Price |
$52.35
|
| Rate for Payer: Cash Price |
$52.35
|
| Rate for Payer: Cofinity Commercial |
$56.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.36
|
| Rate for Payer: Healthscope Commercial |
$58.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.08
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.18
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.62
|
| Rate for Payer: Nomi Health Commercial |
$53.66
|
| Rate for Payer: PACE Senior Care Partners |
$15.54
|
| Rate for Payer: PACE SWMI |
$16.36
|
| Rate for Payer: PHP Commercial |
$55.62
|
| Rate for Payer: PHP Medicare Advantage |
$16.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.54
|
| Rate for Payer: Priority Health HMO/PPO |
$56.93
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.84
|
| Rate for Payer: Railroad Medicare Medicare |
$16.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.59
|
| Rate for Payer: UHC Core |
$54.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.36
|
| Rate for Payer: UHC Exchange |
$16.36
|
| Rate for Payer: UHC Medicare Advantage |
$16.36
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$16.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.08
|
|
|
HC H PYLORI W SUSCEPTIBILITIES
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
30600333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna Medicare |
$23.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.82
|
| Rate for Payer: BCBS Complete |
$5.03
|
| Rate for Payer: BCBS MAPPO |
$23.05
|
| Rate for Payer: BCBS Trust/PPO |
$75.81
|
| Rate for Payer: BCN Commercial |
$71.69
|
| Rate for Payer: BCN Medicare Advantage |
$23.05
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.05
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.16
|
| Rate for Payer: Mclaren Medicaid |
$4.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.21
|
| Rate for Payer: Meridian Medicaid |
$5.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: PACE Senior Care Partners |
$21.90
|
| Rate for Payer: PACE SWMI |
$23.05
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: PHP Medicare Advantage |
$23.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health HMO/PPO |
$80.22
|
| Rate for Payer: Priority Health Medicare |
$23.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.78
|
| Rate for Payer: Railroad Medicare Medicare |
$23.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.14
|
| Rate for Payer: UHC Core |
$77.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.05
|
| Rate for Payer: UHC Exchange |
$23.05
|
| Rate for Payer: UHC Medicare Advantage |
$23.05
|
| Rate for Payer: UHCCP Medicaid |
$4.79
|
| Rate for Payer: VA VA |
$23.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.16
|
|
|
HC H PYLORI W SUSCEPTIBILITIES
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
30600333
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: BCBS Trust/PPO |
$75.27
|
| Rate for Payer: BCN Commercial |
$71.26
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: Nomi Health Commercial |
$75.61
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health HMO/PPO |
$80.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.14
|
| Rate for Payer: UHC Core |
$77.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.16
|
|
|
HC HSV 1 IGM TITER
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: BCBS Trust/PPO |
$55.21
|
| Rate for Payer: BCN Commercial |
$52.26
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health HMO/PPO |
$58.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.51
|
| Rate for Payer: UHC Core |
$56.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
HC HSV 1 IGM TITER
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200384
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$17.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.13
|
| Rate for Payer: BCBS Complete |
$10.01
|
| Rate for Payer: BCBS MAPPO |
$16.91
|
| Rate for Payer: BCBS Trust/PPO |
$55.60
|
| Rate for Payer: BCN Commercial |
$52.58
|
| Rate for Payer: BCN Medicare Advantage |
$16.91
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Mclaren Medicaid |
$9.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.75
|
| Rate for Payer: Meridian Medicaid |
$10.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: PACE Senior Care Partners |
$16.06
|
| Rate for Payer: PACE SWMI |
$16.91
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$16.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health HMO/PPO |
$58.84
|
| Rate for Payer: Priority Health Medicare |
$17.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.51
|
| Rate for Payer: UHC Core |
$56.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.91
|
| Rate for Payer: UHC Exchange |
$16.91
|
| Rate for Payer: UHC Medicare Advantage |
$16.91
|
| Rate for Payer: UHCCP Medicaid |
$9.54
|
| Rate for Payer: VA VA |
$16.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
HC HSV 2 IGM TITER
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200385
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$17.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.13
|
| Rate for Payer: BCBS Complete |
$14.69
|
| Rate for Payer: BCBS MAPPO |
$16.91
|
| Rate for Payer: BCBS Trust/PPO |
$55.60
|
| Rate for Payer: BCN Commercial |
$52.58
|
| Rate for Payer: BCN Medicare Advantage |
$16.91
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Mclaren Medicaid |
$13.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.75
|
| Rate for Payer: Meridian Medicaid |
$14.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: PACE Senior Care Partners |
$16.06
|
| Rate for Payer: PACE SWMI |
$16.91
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$16.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health HMO/PPO |
$58.84
|
| Rate for Payer: Priority Health Medicare |
$17.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.31
|
| Rate for Payer: Railroad Medicare Medicare |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.51
|
| Rate for Payer: UHC Core |
$56.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.91
|
| Rate for Payer: UHC Exchange |
$16.91
|
| Rate for Payer: UHC Medicare Advantage |
$16.91
|
| Rate for Payer: UHCCP Medicaid |
$13.99
|
| Rate for Payer: VA VA |
$16.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
