|
HC LYME CSF COMPONENT 2
|
Facility
|
IP
|
$165.42
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.13 |
| Max. Negotiated Rate |
$148.88 |
| Rate for Payer: Aetna Commercial |
$140.61
|
| Rate for Payer: BCBS Trust/PPO |
$136.62
|
| Rate for Payer: BCN Commercial |
$136.62
|
| Rate for Payer: Cash Price |
$132.34
|
| Rate for Payer: Cofinity Commercial |
$142.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.34
|
| Rate for Payer: Healthscope Commercial |
$148.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.61
|
| Rate for Payer: Nomi Health Commercial |
$135.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.06
|
| Rate for Payer: PHP Commercial |
$140.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.57
|
| Rate for Payer: UHC Core |
$138.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.06
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
OP
|
$165.42
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.16 |
| Max. Negotiated Rate |
$148.88 |
| Rate for Payer: Aetna Commercial |
$140.61
|
| Rate for Payer: Aetna Medicare |
$43.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.69
|
| Rate for Payer: BCBS Complete |
$30.62
|
| Rate for Payer: BCBS MAPPO |
$41.35
|
| Rate for Payer: BCBS Trust/PPO |
$135.99
|
| Rate for Payer: BCN Commercial |
$135.99
|
| Rate for Payer: BCN Medicare Advantage |
$41.35
|
| Rate for Payer: Cash Price |
$132.34
|
| Rate for Payer: Cofinity Commercial |
$142.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.35
|
| Rate for Payer: Healthscope Commercial |
$148.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.06
|
| Rate for Payer: Mclaren Medicaid |
$29.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.42
|
| Rate for Payer: Meridian Medicaid |
$30.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.61
|
| Rate for Payer: Nomi Health Commercial |
$135.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.06
|
| Rate for Payer: PACE Senior Care Partners |
$39.29
|
| Rate for Payer: PACE SWMI |
$41.35
|
| Rate for Payer: PHP Commercial |
$140.61
|
| Rate for Payer: PHP Medicare Advantage |
$41.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.92
|
| Rate for Payer: Priority Health Medicare |
$41.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.13
|
| Rate for Payer: Railroad Medicare Medicare |
$41.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.57
|
| Rate for Payer: UHC Core |
$138.13
|
| Rate for Payer: UHC Exchange |
$41.35
|
| Rate for Payer: UHC Medicaid |
$29.16
|
| Rate for Payer: UHC Medicare Advantage |
$41.35
|
| Rate for Payer: UHCCP Medicaid |
$29.16
|
| Rate for Payer: VA VA |
$41.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.06
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
IP
|
$90.51
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.99 |
| Max. Negotiated Rate |
$81.46 |
| Rate for Payer: Aetna Commercial |
$76.93
|
| Rate for Payer: BCBS Trust/PPO |
$74.75
|
| Rate for Payer: BCN Commercial |
$74.75
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Commercial |
$77.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Healthscope Commercial |
$81.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.93
|
| Rate for Payer: Nomi Health Commercial |
$74.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.88
|
| Rate for Payer: PHP Commercial |
$76.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$78.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.65
|
| Rate for Payer: UHC Core |
$75.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.88
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
OP
|
$90.51
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$81.46 |
| Rate for Payer: Aetna Commercial |
$76.93
|
| Rate for Payer: Aetna Medicare |
$23.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.28
|
| Rate for Payer: BCBS Complete |
$16.75
|
| Rate for Payer: BCBS MAPPO |
$22.63
|
| Rate for Payer: BCBS Trust/PPO |
$74.41
|
| Rate for Payer: BCN Commercial |
$74.41
|
| Rate for Payer: BCN Medicare Advantage |
$22.63
|
| Rate for Payer: Cash Price |
$72.41
|
| Rate for Payer: Cofinity Commercial |
$77.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.63
|
| Rate for Payer: Healthscope Commercial |
$81.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.88
|
| Rate for Payer: Mclaren Medicaid |
$15.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.76
|
| Rate for Payer: Meridian Medicaid |
$16.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.93
|
| Rate for Payer: Nomi Health Commercial |
$74.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.88
|
| Rate for Payer: PACE Senior Care Partners |
$21.50
|
| Rate for Payer: PACE SWMI |
$22.63
|
| Rate for Payer: PHP Commercial |
$76.93
|
| Rate for Payer: PHP Medicare Advantage |
$22.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$78.74
|
| Rate for Payer: Priority Health Medicare |
$22.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.99
|
| Rate for Payer: Railroad Medicare Medicare |
$22.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.65
|
| Rate for Payer: UHC Core |
$75.58
|
| Rate for Payer: UHC Exchange |
$22.63
|
| Rate for Payer: UHC Medicaid |
$15.96
|
| Rate for Payer: UHC Medicare Advantage |
$22.63
|
| Rate for Payer: UHCCP Medicaid |
$15.96
|
| Rate for Payer: VA VA |
$22.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.88
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
IP
|
$73.87
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.41 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: BCBS Trust/PPO |
$61.01
|
| Rate for Payer: BCN Commercial |
$61.01
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.40
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.01
|
| Rate for Payer: UHC Core |
$61.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.40
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
OP
|
$73.87
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: Aetna Medicare |
$19.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.08
|
| Rate for Payer: BCBS Complete |
$13.67
|
| Rate for Payer: BCBS MAPPO |
$18.47
|
| Rate for Payer: BCBS Trust/PPO |
$60.73
|
| Rate for Payer: BCN Commercial |
$60.73
|
| Rate for Payer: BCN Medicare Advantage |
$18.47
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.47
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.40
|
| Rate for Payer: Mclaren Medicaid |
$13.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.39
|
| Rate for Payer: Meridian Medicaid |
$13.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$60.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.40
|
| Rate for Payer: PACE Senior Care Partners |
$17.54
|
| Rate for Payer: PACE SWMI |
$18.47
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: PHP Medicare Advantage |
$18.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.27
|
| Rate for Payer: Priority Health Medicare |
$18.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.41
|
| Rate for Payer: Railroad Medicare Medicare |
$18.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.01
|
| Rate for Payer: UHC Core |
$61.68
|
| Rate for Payer: UHC Exchange |
$18.47
|
| Rate for Payer: UHC Medicaid |
$13.02
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: UHCCP Medicaid |
$13.02
|
| Rate for Payer: VA VA |
$18.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.40
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: BCBS Trust/PPO |
$39.44
|
| Rate for Payer: BCN Commercial |
$39.44
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.03
|
| Rate for Payer: UHC Core |
$39.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.82
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.93
|
| Rate for Payer: BCBS Complete |
$8.84
|
| Rate for Payer: BCBS MAPPO |
$11.94
|
| Rate for Payer: BCBS Trust/PPO |
$39.26
|
| Rate for Payer: BCN Commercial |
$39.26
|
| Rate for Payer: BCN Medicare Advantage |
$11.94
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.94
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.82
|
| Rate for Payer: Mclaren Medicaid |
$8.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.54
|
| Rate for Payer: Meridian Medicaid |
$8.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PACE Senior Care Partners |
$11.34
|
| Rate for Payer: PACE SWMI |
$11.94
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: PHP Medicare Advantage |
$11.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.55
|
| Rate for Payer: Priority Health Medicare |
$12.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.24
|
| Rate for Payer: Railroad Medicare Medicare |
$11.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.03
|
| Rate for Payer: UHC Core |
$39.88
|
| Rate for Payer: UHC Exchange |
$11.94
|
| Rate for Payer: UHC Medicaid |
$8.42
|
| Rate for Payer: UHC Medicare Advantage |
$11.94
|
| Rate for Payer: UHCCP Medicaid |
$8.42
|
| Rate for Payer: VA VA |
$11.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.82
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
IP
|
$264.91
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$184.38 |
| Max. Negotiated Rate |
$238.42 |
| Rate for Payer: Aetna Commercial |
$225.17
|
| Rate for Payer: BCBS Trust/PPO |
$218.79
|
| Rate for Payer: BCN Commercial |
$218.79
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cofinity Commercial |
$227.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.93
|
| Rate for Payer: Healthscope Commercial |
$238.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.17
|
| Rate for Payer: Nomi Health Commercial |
$217.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.68
|
| Rate for Payer: PHP Commercial |
$225.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$230.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.12
|
| Rate for Payer: UHC Core |
$221.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.68
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
OP
|
$264.91
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$238.42 |
| Rate for Payer: Aetna Commercial |
$225.17
|
| Rate for Payer: Aetna Medicare |
$68.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.78
|
| Rate for Payer: BCBS Complete |
$49.03
|
| Rate for Payer: BCBS MAPPO |
$66.23
|
| Rate for Payer: BCBS Trust/PPO |
$217.78
|
| Rate for Payer: BCN Commercial |
$217.78
|
| Rate for Payer: BCN Medicare Advantage |
$66.23
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cofinity Commercial |
$227.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.23
|
| Rate for Payer: Healthscope Commercial |
$238.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.68
|
| Rate for Payer: Mclaren Medicaid |
$46.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.54
|
| Rate for Payer: Meridian Medicaid |
$49.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.17
|
| Rate for Payer: Nomi Health Commercial |
$217.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.68
|
| Rate for Payer: PACE Senior Care Partners |
$62.92
|
| Rate for Payer: PACE SWMI |
$66.23
|
| Rate for Payer: PHP Commercial |
$225.17
|
| Rate for Payer: PHP Medicare Advantage |
$66.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$230.47
|
| Rate for Payer: Priority Health Medicare |
$66.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.38
|
| Rate for Payer: Railroad Medicare Medicare |
$66.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.12
|
| Rate for Payer: UHC Core |
$221.20
|
| Rate for Payer: UHC Exchange |
$66.23
|
| Rate for Payer: UHC Medicaid |
$46.70
|
| Rate for Payer: UHC Medicare Advantage |
$66.23
|
| Rate for Payer: UHCCP Medicaid |
$46.70
|
| Rate for Payer: VA VA |
$66.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.68
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
IP
|
$285.69
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$198.84 |
| Max. Negotiated Rate |
$257.12 |
| Rate for Payer: Aetna Commercial |
$242.84
|
| Rate for Payer: BCBS Trust/PPO |
$235.95
|
| Rate for Payer: BCN Commercial |
$235.95
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cofinity Commercial |
$245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.55
|
| Rate for Payer: Healthscope Commercial |
$257.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.84
|
| Rate for Payer: Nomi Health Commercial |
$234.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.27
|
| Rate for Payer: PHP Commercial |
$242.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.41
|
| Rate for Payer: UHC Core |
$238.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.27
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
OP
|
$285.69
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.37 |
| Max. Negotiated Rate |
$257.12 |
| Rate for Payer: Aetna Commercial |
$242.84
|
| Rate for Payer: Aetna Medicare |
$74.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.28
|
| Rate for Payer: BCBS Complete |
$52.88
|
| Rate for Payer: BCBS MAPPO |
$71.42
|
| Rate for Payer: BCBS Trust/PPO |
$234.87
|
| Rate for Payer: BCN Commercial |
$234.87
|
| Rate for Payer: BCN Medicare Advantage |
$71.42
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cofinity Commercial |
$245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$257.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.27
|
| Rate for Payer: Mclaren Medicaid |
$50.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.99
|
| Rate for Payer: Meridian Medicaid |
$52.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.84
|
| Rate for Payer: Nomi Health Commercial |
$234.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.27
|
| Rate for Payer: PACE Senior Care Partners |
$67.85
|
| Rate for Payer: PACE SWMI |
$71.42
|
| Rate for Payer: PHP Commercial |
$242.84
|
| Rate for Payer: PHP Medicare Advantage |
$71.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.55
|
| Rate for Payer: Priority Health Medicare |
$72.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.84
|
| Rate for Payer: Railroad Medicare Medicare |
$71.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.41
|
| Rate for Payer: UHC Core |
$238.55
|
| Rate for Payer: UHC Exchange |
$71.42
|
| Rate for Payer: UHC Medicaid |
$50.37
|
| Rate for Payer: UHC Medicare Advantage |
$71.42
|
| Rate for Payer: UHCCP Medicaid |
$50.37
|
| Rate for Payer: VA VA |
$71.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.27
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOGEN
|
Facility
|
OP
|
$240.33
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.37 |
| Max. Negotiated Rate |
$216.30 |
| Rate for Payer: Aetna Commercial |
$204.28
|
| Rate for Payer: Aetna Medicare |
$62.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.10
|
| Rate for Payer: BCBS Complete |
$44.49
|
| Rate for Payer: BCBS MAPPO |
$60.08
|
| Rate for Payer: BCBS Trust/PPO |
$197.58
|
| Rate for Payer: BCN Commercial |
$197.58
|
| Rate for Payer: BCN Medicare Advantage |
$60.08
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cofinity Commercial |
$206.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.08
|
| Rate for Payer: Healthscope Commercial |
$216.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.25
|
| Rate for Payer: Mclaren Medicaid |
$42.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.09
|
| Rate for Payer: Meridian Medicaid |
$44.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.28
|
| Rate for Payer: Nomi Health Commercial |
$197.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.25
|
| Rate for Payer: PACE Senior Care Partners |
$57.08
|
| Rate for Payer: PACE SWMI |
$60.08
|
| Rate for Payer: PHP Commercial |
$204.28
|
| Rate for Payer: PHP Medicare Advantage |
$60.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.09
|
| Rate for Payer: Priority Health Medicare |
$60.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.27
|
| Rate for Payer: Railroad Medicare Medicare |
$60.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.49
|
| Rate for Payer: UHC Core |
$200.68
|
| Rate for Payer: UHC Exchange |
$60.08
|
| Rate for Payer: UHC Medicaid |
$42.37
|
| Rate for Payer: UHC Medicare Advantage |
$60.08
|
| Rate for Payer: UHCCP Medicaid |
$42.37
|
| Rate for Payer: VA VA |
$60.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.25
|
|
|
HC LYMPHOCYTE PROLIFERATION MITOGEN
|
Facility
|
IP
|
$240.33
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$167.27 |
| Max. Negotiated Rate |
$216.30 |
| Rate for Payer: Aetna Commercial |
$204.28
|
| Rate for Payer: BCBS Trust/PPO |
$198.49
|
| Rate for Payer: BCN Commercial |
$198.49
|
| Rate for Payer: Cash Price |
$192.26
|
| Rate for Payer: Cofinity Commercial |
$206.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.26
|
| Rate for Payer: Healthscope Commercial |
$216.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.28
|
| Rate for Payer: Nomi Health Commercial |
$197.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.25
|
| Rate for Payer: PHP Commercial |
$204.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.49
|
| Rate for Payer: UHC Core |
$200.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.25
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS
|
Facility
|
OP
|
$264.91
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200473
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.70 |
| Max. Negotiated Rate |
$238.42 |
| Rate for Payer: Aetna Commercial |
$225.17
|
| Rate for Payer: Aetna Medicare |
$68.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.78
|
| Rate for Payer: BCBS Complete |
$49.03
|
| Rate for Payer: BCBS MAPPO |
$66.23
|
| Rate for Payer: BCBS Trust/PPO |
$217.78
|
| Rate for Payer: BCN Commercial |
$217.78
|
| Rate for Payer: BCN Medicare Advantage |
$66.23
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cofinity Commercial |
$227.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.23
|
| Rate for Payer: Healthscope Commercial |
$238.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.68
|
| Rate for Payer: Mclaren Medicaid |
$46.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.54
|
| Rate for Payer: Meridian Medicaid |
$49.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.17
|
| Rate for Payer: Nomi Health Commercial |
$217.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.68
|
| Rate for Payer: PACE Senior Care Partners |
$62.92
|
| Rate for Payer: PACE SWMI |
$66.23
|
| Rate for Payer: PHP Commercial |
$225.17
|
| Rate for Payer: PHP Medicare Advantage |
$66.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$230.47
|
| Rate for Payer: Priority Health Medicare |
$66.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.38
|
| Rate for Payer: Railroad Medicare Medicare |
$66.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.12
|
| Rate for Payer: UHC Core |
$221.20
|
| Rate for Payer: UHC Exchange |
$66.23
|
| Rate for Payer: UHC Medicaid |
$46.70
|
| Rate for Payer: UHC Medicare Advantage |
$66.23
|
| Rate for Payer: UHCCP Medicaid |
$46.70
|
| Rate for Payer: VA VA |
$66.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.68
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS
|
Facility
|
IP
|
$264.91
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200473
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$184.38 |
| Max. Negotiated Rate |
$238.42 |
| Rate for Payer: Aetna Commercial |
$225.17
|
| Rate for Payer: BCBS Trust/PPO |
$218.79
|
| Rate for Payer: BCN Commercial |
$218.79
|
| Rate for Payer: Cash Price |
$211.93
|
| Rate for Payer: Cofinity Commercial |
$227.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.93
|
| Rate for Payer: Healthscope Commercial |
$238.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.17
|
| Rate for Payer: Nomi Health Commercial |
$217.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.68
|
| Rate for Payer: PHP Commercial |
$225.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$230.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.12
|
| Rate for Payer: UHC Core |
$221.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.68
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS CMPT
|
Facility
|
OP
|
$285.69
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200474
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.37 |
| Max. Negotiated Rate |
$257.12 |
| Rate for Payer: Aetna Commercial |
$242.84
|
| Rate for Payer: Aetna Medicare |
$74.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.28
|
| Rate for Payer: BCBS Complete |
$52.88
|
| Rate for Payer: BCBS MAPPO |
$71.42
|
| Rate for Payer: BCBS Trust/PPO |
$234.87
|
| Rate for Payer: BCN Commercial |
$234.87
|
| Rate for Payer: BCN Medicare Advantage |
$71.42
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cofinity Commercial |
$245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.42
|
| Rate for Payer: Healthscope Commercial |
$257.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.27
|
| Rate for Payer: Mclaren Medicaid |
$50.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.99
|
| Rate for Payer: Meridian Medicaid |
$52.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.84
|
| Rate for Payer: Nomi Health Commercial |
$234.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.27
|
| Rate for Payer: PACE Senior Care Partners |
$67.85
|
| Rate for Payer: PACE SWMI |
$71.42
|
| Rate for Payer: PHP Commercial |
$242.84
|
| Rate for Payer: PHP Medicare Advantage |
$71.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.55
|
| Rate for Payer: Priority Health Medicare |
$72.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.84
|
| Rate for Payer: Railroad Medicare Medicare |
$71.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.41
|
| Rate for Payer: UHC Core |
$238.55
|
| Rate for Payer: UHC Exchange |
$71.42
|
| Rate for Payer: UHC Medicaid |
$50.37
|
| Rate for Payer: UHC Medicare Advantage |
$71.42
|
| Rate for Payer: UHCCP Medicaid |
$50.37
|
| Rate for Payer: VA VA |
$71.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.27
|
|
|
HC LYMPHOCYTE PROLIFERATION, MITOGENS CMPT
|
Facility
|
IP
|
$285.69
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200474
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$198.84 |
| Max. Negotiated Rate |
$257.12 |
| Rate for Payer: Aetna Commercial |
$242.84
|
| Rate for Payer: BCBS Trust/PPO |
$235.95
|
| Rate for Payer: BCN Commercial |
$235.95
|
| Rate for Payer: Cash Price |
$228.55
|
| Rate for Payer: Cofinity Commercial |
$245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.55
|
| Rate for Payer: Healthscope Commercial |
$257.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.84
|
| Rate for Payer: Nomi Health Commercial |
$234.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.27
|
| Rate for Payer: PHP Commercial |
$242.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.41
|
| Rate for Payer: UHC Core |
$238.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.27
|
|
|
HC LYMPHOMA IMMUNOPHENO 2
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
30500014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.97
|
| Rate for Payer: BCBS Complete |
$2.95
|
| Rate for Payer: BCBS MAPPO |
$3.98
|
| Rate for Payer: BCBS Trust/PPO |
$13.09
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: BCN Medicare Advantage |
$3.98
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.94
|
| Rate for Payer: Mclaren Medicaid |
$2.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.18
|
| Rate for Payer: Meridian Medicaid |
$2.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PACE Senior Care Partners |
$3.78
|
| Rate for Payer: PACE SWMI |
$3.98
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: PHP Medicare Advantage |
$3.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.85
|
| Rate for Payer: Priority Health Medicare |
$4.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.01
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: UHC Exchange |
$3.98
|
| Rate for Payer: UHC Medicaid |
$2.81
|
| Rate for Payer: UHC Medicare Advantage |
$3.98
|
| Rate for Payer: UHCCP Medicaid |
$2.81
|
| Rate for Payer: VA VA |
$3.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.94
|
|
|
HC LYMPHOMA IMMUNOPHENO 2
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
30500014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: BCBS Trust/PPO |
$13.15
|
| Rate for Payer: BCN Commercial |
$13.15
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.01
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.94
|
|
|
HC LYMPH SUPPLY CUSTOM GARMEN
|
Facility
|
IP
|
$686.66
|
|
| Hospital Charge Code |
96000003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$477.92 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: BCBS Trust/PPO |
$567.11
|
| Rate for Payer: BCN Commercial |
$567.11
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$597.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.26
|
| Rate for Payer: UHC Core |
$573.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC LYMPH SUPPLY CUSTOM GARMEN
|
Facility
|
OP
|
$686.66
|
|
| Hospital Charge Code |
96000003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.06 |
| Max. Negotiated Rate |
$617.99 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Aetna Medicare |
$178.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.58
|
| Rate for Payer: BCBS Complete |
$127.10
|
| Rate for Payer: BCBS MAPPO |
$171.66
|
| Rate for Payer: BCBS Trust/PPO |
$564.50
|
| Rate for Payer: BCN Commercial |
$564.50
|
| Rate for Payer: BCN Medicare Advantage |
$171.66
|
| Rate for Payer: Cash Price |
$549.33
|
| Rate for Payer: Cofinity Commercial |
$590.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.66
|
| Rate for Payer: Healthscope Commercial |
$617.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.00
|
| Rate for Payer: Mclaren Medicaid |
$121.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.25
|
| Rate for Payer: Meridian Medicaid |
$127.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$188.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.66
|
| Rate for Payer: Nomi Health Commercial |
$563.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$515.00
|
| Rate for Payer: PACE Senior Care Partners |
$163.08
|
| Rate for Payer: PACE SWMI |
$171.66
|
| Rate for Payer: PHP Commercial |
$583.66
|
| Rate for Payer: PHP Medicare Advantage |
$171.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$597.39
|
| Rate for Payer: Priority Health Medicare |
$173.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.92
|
| Rate for Payer: Railroad Medicare Medicare |
$171.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.26
|
| Rate for Payer: UHC Core |
$573.36
|
| Rate for Payer: UHC Exchange |
$171.66
|
| Rate for Payer: UHC Medicaid |
$121.06
|
| Rate for Payer: UHC Medicare Advantage |
$171.66
|
| Rate for Payer: UHCCP Medicaid |
$121.06
|
| Rate for Payer: VA VA |
$171.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.00
|
|
|
HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Facility
|
OP
|
$3,805.47
|
|
|
Service Code
|
CPT 54162
|
| Hospital Charge Code |
36100617
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$670.90 |
| Max. Negotiated Rate |
$3,424.92 |
| Rate for Payer: Aetna Commercial |
$3,234.65
|
| Rate for Payer: Aetna Medicare |
$989.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,189.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,189.21
|
| Rate for Payer: BCBS Complete |
$704.39
|
| Rate for Payer: BCBS MAPPO |
$951.37
|
| Rate for Payer: BCBS Trust/PPO |
$3,128.48
|
| Rate for Payer: BCN Commercial |
$3,128.48
|
| Rate for Payer: BCN Medicare Advantage |
$951.37
|
| Rate for Payer: Cash Price |
$3,044.38
|
| Rate for Payer: Cofinity Commercial |
$3,272.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,044.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$951.37
|
| Rate for Payer: Healthscope Commercial |
$3,424.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,854.10
|
| Rate for Payer: Mclaren Medicaid |
$670.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$998.94
|
| Rate for Payer: Meridian Medicaid |
$704.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,094.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,046.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,234.65
|
| Rate for Payer: Nomi Health Commercial |
$3,120.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,854.10
|
| Rate for Payer: PACE Senior Care Partners |
$903.80
|
| Rate for Payer: PACE SWMI |
$951.37
|
| Rate for Payer: PHP Commercial |
$3,234.65
|
| Rate for Payer: PHP Medicare Advantage |
$951.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$670.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,310.76
|
| Rate for Payer: Priority Health Medicare |
$960.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,648.61
|
| Rate for Payer: Railroad Medicare Medicare |
$951.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,348.81
|
| Rate for Payer: UHC Core |
$3,177.57
|
| Rate for Payer: UHC Exchange |
$951.37
|
| Rate for Payer: UHC Medicaid |
$670.90
|
| Rate for Payer: UHC Medicare Advantage |
$951.37
|
| Rate for Payer: UHCCP Medicaid |
$670.90
|
| Rate for Payer: VA VA |
$951.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,854.10
|
|
|
HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Facility
|
IP
|
$3,805.47
|
|
|
Service Code
|
CPT 54162
|
| Hospital Charge Code |
36100617
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,648.61 |
| Max. Negotiated Rate |
$3,424.92 |
| Rate for Payer: Aetna Commercial |
$3,234.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,142.94
|
| Rate for Payer: BCN Commercial |
$3,142.94
|
| Rate for Payer: Cash Price |
$3,044.38
|
| Rate for Payer: Cofinity Commercial |
$3,272.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,044.38
|
| Rate for Payer: Healthscope Commercial |
$3,424.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,854.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,234.65
|
| Rate for Payer: Nomi Health Commercial |
$3,120.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,854.10
|
| Rate for Payer: PHP Commercial |
$3,234.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,310.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,648.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,348.81
|
| Rate for Payer: UHC Core |
$3,177.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,854.10
|
|
|
HC LYSIS INTRANASAL SYNECHIA
|
Facility
|
IP
|
$1,404.54
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
76100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$977.56 |
| Max. Negotiated Rate |
$1,264.09 |
| Rate for Payer: Aetna Commercial |
$1,193.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.01
|
| Rate for Payer: BCN Commercial |
$1,160.01
|
| Rate for Payer: Cash Price |
$1,123.63
|
| Rate for Payer: Cofinity Commercial |
$1,207.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,123.63
|
| Rate for Payer: Healthscope Commercial |
$1,264.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,053.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.86
|
| Rate for Payer: Nomi Health Commercial |
$1,151.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.40
|
| Rate for Payer: PHP Commercial |
$1,193.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,221.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$977.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,236.00
|
| Rate for Payer: UHC Core |
$1,172.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,053.40
|
|
