|
HC LVAD INSERTION
|
Facility
|
IP
|
$3,223.64
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,095.37 |
| Max. Negotiated Rate |
$2,901.28 |
| Rate for Payer: Aetna Commercial |
$2,740.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,631.46
|
| Rate for Payer: BCN Commercial |
$2,491.23
|
| Rate for Payer: Cash Price |
$2,578.91
|
| Rate for Payer: Cofinity Commercial |
$2,772.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.91
|
| Rate for Payer: Healthscope Commercial |
$2,901.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,417.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,740.09
|
| Rate for Payer: Nomi Health Commercial |
$2,643.38
|
| Rate for Payer: PHP Commercial |
$2,740.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.37
|
| Rate for Payer: Priority Health HMO/PPO |
$2,804.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,159.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,836.80
|
| Rate for Payer: UHC Core |
$2,691.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,417.73
|
|
|
HC LVDS PLT PER LEUKO RED IRRAD
|
Facility
|
OP
|
$2,832.80
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000088
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$478.63 |
| Max. Negotiated Rate |
$2,549.52 |
| Rate for Payer: Aetna Commercial |
$2,407.88
|
| Rate for Payer: Aetna Medicare |
$736.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$885.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$885.25
|
| Rate for Payer: BCBS Complete |
$502.59
|
| Rate for Payer: BCBS MAPPO |
$708.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,328.84
|
| Rate for Payer: BCN Commercial |
$2,202.50
|
| Rate for Payer: BCN Medicare Advantage |
$708.20
|
| Rate for Payer: Cash Price |
$2,266.24
|
| Rate for Payer: Cash Price |
$2,266.24
|
| Rate for Payer: Cofinity Commercial |
$2,436.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.20
|
| Rate for Payer: Healthscope Commercial |
$2,549.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,124.60
|
| Rate for Payer: Mclaren Medicaid |
$478.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$743.61
|
| Rate for Payer: Meridian Medicaid |
$502.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$814.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.88
|
| Rate for Payer: Nomi Health Commercial |
$2,322.90
|
| Rate for Payer: PACE Senior Care Partners |
$672.79
|
| Rate for Payer: PACE SWMI |
$708.20
|
| Rate for Payer: PHP Commercial |
$2,407.88
|
| Rate for Payer: PHP Medicare Advantage |
$708.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.32
|
| Rate for Payer: Priority Health HMO/PPO |
$2,464.54
|
| Rate for Payer: Priority Health Medicare |
$715.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,897.98
|
| Rate for Payer: Railroad Medicare Medicare |
$708.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,492.86
|
| Rate for Payer: UHC Core |
$2,365.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$708.20
|
| Rate for Payer: UHC Exchange |
$708.20
|
| Rate for Payer: UHC Medicare Advantage |
$708.20
|
| Rate for Payer: UHCCP Medicaid |
$478.63
|
| Rate for Payer: VA VA |
$708.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,124.60
|
|
|
HC LVDS PLT PER LEUKO RED IRRAD
|
Facility
|
IP
|
$2,832.80
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000088
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,841.32 |
| Max. Negotiated Rate |
$2,549.52 |
| Rate for Payer: Aetna Commercial |
$2,407.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,312.41
|
| Rate for Payer: BCN Commercial |
$2,189.19
|
| Rate for Payer: Cash Price |
$2,266.24
|
| Rate for Payer: Cofinity Commercial |
$2,436.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,266.24
|
| Rate for Payer: Healthscope Commercial |
$2,549.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,124.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,407.88
|
| Rate for Payer: Nomi Health Commercial |
$2,322.90
|
| Rate for Payer: PHP Commercial |
$2,407.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.32
|
| Rate for Payer: Priority Health HMO/PPO |
$2,464.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,897.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,492.86
|
| Rate for Payer: UHC Core |
$2,365.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,124.60
|
|
|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
IP
|
$2,200.05
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,430.03 |
| Max. Negotiated Rate |
$1,980.04 |
| Rate for Payer: Aetna Commercial |
$1,870.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,795.90
|
| Rate for Payer: BCN Commercial |
$1,700.20
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cofinity Commercial |
$1,892.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.04
|
| Rate for Payer: Healthscope Commercial |
$1,980.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,650.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.04
|
| Rate for Payer: Nomi Health Commercial |
$1,804.04
|
| Rate for Payer: PHP Commercial |
$1,870.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.03
|
| Rate for Payer: Priority Health HMO/PPO |
$1,914.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,474.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,936.04
|
| Rate for Payer: UHC Core |
$1,837.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,650.04
|
|
|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
OP
|
$2,200.05
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$345.05 |
| Max. Negotiated Rate |
$1,980.04 |
| Rate for Payer: Aetna Commercial |
$1,870.04
|
| Rate for Payer: Aetna Medicare |
$572.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$687.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$687.52
|
| Rate for Payer: BCBS Complete |
$362.33
|
| Rate for Payer: BCBS MAPPO |
$550.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.66
|
| Rate for Payer: BCN Commercial |
$1,710.54
|
| Rate for Payer: BCN Medicare Advantage |
$550.01
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cash Price |
$1,760.04
|
| Rate for Payer: Cofinity Commercial |
$1,892.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,760.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$550.01
|
| Rate for Payer: Healthscope Commercial |
$1,980.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,650.04
|
| Rate for Payer: Mclaren Medicaid |
$345.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$577.51
|
| Rate for Payer: Meridian Medicaid |
$362.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$632.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,870.04
|
| Rate for Payer: Nomi Health Commercial |
$1,804.04
|
| Rate for Payer: PACE Senior Care Partners |
$522.51
|
| Rate for Payer: PACE SWMI |
$550.01
|
| Rate for Payer: PHP Commercial |
$1,870.04
|
| Rate for Payer: PHP Medicare Advantage |
$550.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.03
|
| Rate for Payer: Priority Health HMO/PPO |
$1,914.04
|
| Rate for Payer: Priority Health Medicare |
$555.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,474.03
|
| Rate for Payer: Railroad Medicare Medicare |
$550.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,936.04
|
| Rate for Payer: UHC Core |
$1,837.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$550.01
|
| Rate for Payer: UHC Exchange |
$550.01
|
| Rate for Payer: UHC Medicare Advantage |
$550.01
|
| Rate for Payer: UHCCP Medicaid |
$345.05
|
| Rate for Payer: VA VA |
$550.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,650.04
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
IP
|
$9,273.79
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,027.96 |
| Max. Negotiated Rate |
$8,346.41 |
| Rate for Payer: Aetna Commercial |
$7,882.72
|
| Rate for Payer: BCBS Trust/PPO |
$7,570.19
|
| Rate for Payer: BCN Commercial |
$7,166.78
|
| Rate for Payer: Cash Price |
$7,419.03
|
| Rate for Payer: Cofinity Commercial |
$7,975.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,419.03
|
| Rate for Payer: Healthscope Commercial |
$8,346.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,955.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,882.72
|
| Rate for Payer: Nomi Health Commercial |
$7,604.51
|
| Rate for Payer: PHP Commercial |
$7,882.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,027.96
|
| Rate for Payer: Priority Health HMO/PPO |
$8,068.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,213.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,160.94
|
| Rate for Payer: UHC Core |
$7,743.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,955.34
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
OP
|
$9,273.79
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,202.53 |
| Max. Negotiated Rate |
$8,346.41 |
| Rate for Payer: Aetna Commercial |
$7,882.72
|
| Rate for Payer: Aetna Medicare |
$2,411.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,898.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,898.06
|
| Rate for Payer: BCBS Complete |
$3,709.52
|
| Rate for Payer: BCBS MAPPO |
$2,318.45
|
| Rate for Payer: BCBS Trust/PPO |
$7,623.98
|
| Rate for Payer: BCN Commercial |
$7,210.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,318.45
|
| Rate for Payer: Cash Price |
$7,419.03
|
| Rate for Payer: Cofinity Commercial |
$7,975.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,419.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,318.45
|
| Rate for Payer: Healthscope Commercial |
$8,346.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,955.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,434.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,666.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,882.72
|
| Rate for Payer: Nomi Health Commercial |
$7,604.51
|
| Rate for Payer: PACE Senior Care Partners |
$2,202.53
|
| Rate for Payer: PACE SWMI |
$2,318.45
|
| Rate for Payer: PHP Commercial |
$7,882.72
|
| Rate for Payer: PHP Medicare Advantage |
$2,318.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,027.96
|
| Rate for Payer: Priority Health HMO/PPO |
$8,068.20
|
| Rate for Payer: Priority Health Medicare |
$2,341.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,213.44
|
| Rate for Payer: Railroad Medicare Medicare |
$2,318.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,160.94
|
| Rate for Payer: UHC Core |
$7,743.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,318.45
|
| Rate for Payer: UHC Exchange |
$2,318.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,318.45
|
| Rate for Payer: VA VA |
$2,318.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,955.34
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
OP
|
$3,588.43
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$852.25 |
| Max. Negotiated Rate |
$3,229.59 |
| Rate for Payer: Aetna Commercial |
$3,050.17
|
| Rate for Payer: Aetna Medicare |
$932.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,121.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,121.38
|
| Rate for Payer: BCBS Complete |
$2,341.27
|
| Rate for Payer: BCBS MAPPO |
$897.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,950.05
|
| Rate for Payer: BCN Commercial |
$2,790.00
|
| Rate for Payer: BCN Medicare Advantage |
$897.11
|
| Rate for Payer: Cash Price |
$2,870.74
|
| Rate for Payer: Cash Price |
$2,870.74
|
| Rate for Payer: Cofinity Commercial |
$3,086.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,870.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$897.11
|
| Rate for Payer: Healthscope Commercial |
$3,229.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,691.32
|
| Rate for Payer: Mclaren Medicaid |
$2,229.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$941.96
|
| Rate for Payer: Meridian Medicaid |
$2,341.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,031.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,050.17
|
| Rate for Payer: Nomi Health Commercial |
$2,942.51
|
| Rate for Payer: PACE Senior Care Partners |
$852.25
|
| Rate for Payer: PACE SWMI |
$897.11
|
| Rate for Payer: PHP Commercial |
$3,050.17
|
| Rate for Payer: PHP Medicare Advantage |
$897.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,229.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,332.48
|
| Rate for Payer: Priority Health HMO/PPO |
$3,121.93
|
| Rate for Payer: Priority Health Medicare |
$906.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,404.25
|
| Rate for Payer: Railroad Medicare Medicare |
$897.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,157.82
|
| Rate for Payer: UHC Core |
$2,996.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$897.11
|
| Rate for Payer: UHC Exchange |
$897.11
|
| Rate for Payer: UHC Medicare Advantage |
$897.11
|
| Rate for Payer: UHCCP Medicaid |
$2,229.63
|
| Rate for Payer: VA VA |
$897.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,691.32
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
IP
|
$3,588.43
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,332.48 |
| Max. Negotiated Rate |
$3,229.59 |
| Rate for Payer: Aetna Commercial |
$3,050.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,929.24
|
| Rate for Payer: BCN Commercial |
$2,773.14
|
| Rate for Payer: Cash Price |
$2,870.74
|
| Rate for Payer: Cofinity Commercial |
$3,086.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,870.74
|
| Rate for Payer: Healthscope Commercial |
$3,229.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,691.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,050.17
|
| Rate for Payer: Nomi Health Commercial |
$2,942.51
|
| Rate for Payer: PHP Commercial |
$3,050.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,332.48
|
| Rate for Payer: Priority Health HMO/PPO |
$3,121.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,404.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,157.82
|
| Rate for Payer: UHC Core |
$2,996.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,691.32
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
OP
|
$34.33
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$30.90 |
| Rate for Payer: Aetna Commercial |
$29.18
|
| Rate for Payer: Aetna Medicare |
$8.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.73
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$8.58
|
| Rate for Payer: BCBS Trust/PPO |
$28.22
|
| Rate for Payer: BCN Commercial |
$26.69
|
| Rate for Payer: BCN Medicare Advantage |
$8.58
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cofinity Commercial |
$29.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.58
|
| Rate for Payer: Healthscope Commercial |
$30.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.75
|
| Rate for Payer: Mclaren Medicaid |
$11.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.01
|
| Rate for Payer: Meridian Medicaid |
$11.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.18
|
| Rate for Payer: Nomi Health Commercial |
$28.15
|
| Rate for Payer: PACE Senior Care Partners |
$8.15
|
| Rate for Payer: PACE SWMI |
$8.58
|
| Rate for Payer: PHP Commercial |
$29.18
|
| Rate for Payer: PHP Medicare Advantage |
$8.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.31
|
| Rate for Payer: Priority Health HMO/PPO |
$29.87
|
| Rate for Payer: Priority Health Medicare |
$8.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.00
|
| Rate for Payer: Railroad Medicare Medicare |
$8.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.21
|
| Rate for Payer: UHC Core |
$28.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.58
|
| Rate for Payer: UHC Exchange |
$8.58
|
| Rate for Payer: UHC Medicare Advantage |
$8.58
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: VA VA |
$8.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.75
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
IP
|
$34.33
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$30.90 |
| Rate for Payer: Aetna Commercial |
$29.18
|
| Rate for Payer: BCBS Trust/PPO |
$28.02
|
| Rate for Payer: BCN Commercial |
$26.53
|
| Rate for Payer: Cash Price |
$27.46
|
| Rate for Payer: Cofinity Commercial |
$29.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.46
|
| Rate for Payer: Healthscope Commercial |
$30.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.18
|
| Rate for Payer: Nomi Health Commercial |
$28.15
|
| Rate for Payer: PHP Commercial |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.31
|
| Rate for Payer: Priority Health HMO/PPO |
$29.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.21
|
| Rate for Payer: UHC Core |
$28.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.75
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
IP
|
$60.18
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.12 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: BCBS Trust/PPO |
$49.12
|
| Rate for Payer: BCN Commercial |
$46.51
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.15
|
| Rate for Payer: Nomi Health Commercial |
$49.35
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.12
|
| Rate for Payer: Priority Health HMO/PPO |
$52.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.96
|
| Rate for Payer: UHC Core |
$50.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.14
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
OP
|
$60.18
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$5.91
|
| Rate for Payer: BCBS MAPPO |
$15.04
|
| Rate for Payer: BCBS Trust/PPO |
$49.47
|
| Rate for Payer: BCN Commercial |
$46.79
|
| Rate for Payer: BCN Medicare Advantage |
$15.04
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.04
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.14
|
| Rate for Payer: Mclaren Medicaid |
$5.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$5.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.15
|
| Rate for Payer: Nomi Health Commercial |
$49.35
|
| Rate for Payer: PACE Senior Care Partners |
$14.29
|
| Rate for Payer: PACE SWMI |
$15.04
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: PHP Medicare Advantage |
$15.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.12
|
| Rate for Payer: Priority Health HMO/PPO |
$52.36
|
| Rate for Payer: Priority Health Medicare |
$15.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.32
|
| Rate for Payer: Railroad Medicare Medicare |
$15.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.96
|
| Rate for Payer: UHC Core |
$50.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.04
|
| Rate for Payer: UHC Exchange |
$15.04
|
| Rate for Payer: UHC Medicare Advantage |
$15.04
|
| Rate for Payer: UHCCP Medicaid |
$5.62
|
| Rate for Payer: VA VA |
$15.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.14
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
OP
|
$162.18
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$145.96 |
| Rate for Payer: Aetna Commercial |
$137.85
|
| Rate for Payer: Aetna Medicare |
$42.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.68
|
| Rate for Payer: BCBS Complete |
$12.93
|
| Rate for Payer: BCBS MAPPO |
$40.54
|
| Rate for Payer: BCBS Trust/PPO |
$133.33
|
| Rate for Payer: BCN Commercial |
$126.09
|
| Rate for Payer: BCN Medicare Advantage |
$40.54
|
| Rate for Payer: Cash Price |
$129.74
|
| Rate for Payer: Cash Price |
$129.74
|
| Rate for Payer: Cofinity Commercial |
$139.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.54
|
| Rate for Payer: Healthscope Commercial |
$145.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.64
|
| Rate for Payer: Mclaren Medicaid |
$12.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.57
|
| Rate for Payer: Meridian Medicaid |
$12.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.85
|
| Rate for Payer: Nomi Health Commercial |
$132.99
|
| Rate for Payer: PACE Senior Care Partners |
$38.52
|
| Rate for Payer: PACE SWMI |
$40.54
|
| Rate for Payer: PHP Commercial |
$137.85
|
| Rate for Payer: PHP Medicare Advantage |
$40.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.42
|
| Rate for Payer: Priority Health HMO/PPO |
$141.10
|
| Rate for Payer: Priority Health Medicare |
$40.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.66
|
| Rate for Payer: Railroad Medicare Medicare |
$40.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.72
|
| Rate for Payer: UHC Core |
$135.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.54
|
| Rate for Payer: UHC Exchange |
$40.54
|
| Rate for Payer: UHC Medicare Advantage |
$40.54
|
| Rate for Payer: UHCCP Medicaid |
$12.31
|
| Rate for Payer: VA VA |
$40.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.64
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
IP
|
$162.18
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$105.42 |
| Max. Negotiated Rate |
$145.96 |
| Rate for Payer: Aetna Commercial |
$137.85
|
| Rate for Payer: BCBS Trust/PPO |
$132.39
|
| Rate for Payer: BCN Commercial |
$125.33
|
| Rate for Payer: Cash Price |
$129.74
|
| Rate for Payer: Cofinity Commercial |
$139.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.74
|
| Rate for Payer: Healthscope Commercial |
$145.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.85
|
| Rate for Payer: Nomi Health Commercial |
$132.99
|
| Rate for Payer: PHP Commercial |
$137.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.42
|
| Rate for Payer: Priority Health HMO/PPO |
$141.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.72
|
| Rate for Payer: UHC Core |
$135.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.64
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
OP
|
$88.74
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$79.87 |
| Rate for Payer: Aetna Commercial |
$75.43
|
| Rate for Payer: Aetna Medicare |
$23.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.73
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS MAPPO |
$22.18
|
| Rate for Payer: BCBS Trust/PPO |
$72.95
|
| Rate for Payer: BCN Commercial |
$69.00
|
| Rate for Payer: BCN Medicare Advantage |
$22.18
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$76.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.18
|
| Rate for Payer: Healthscope Commercial |
$79.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.56
|
| Rate for Payer: Mclaren Medicaid |
$6.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.29
|
| Rate for Payer: Meridian Medicaid |
$7.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.43
|
| Rate for Payer: Nomi Health Commercial |
$72.77
|
| Rate for Payer: PACE Senior Care Partners |
$21.08
|
| Rate for Payer: PACE SWMI |
$22.18
|
| Rate for Payer: PHP Commercial |
$75.43
|
| Rate for Payer: PHP Medicare Advantage |
$22.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.68
|
| Rate for Payer: Priority Health HMO/PPO |
$77.20
|
| Rate for Payer: Priority Health Medicare |
$22.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.46
|
| Rate for Payer: Railroad Medicare Medicare |
$22.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.09
|
| Rate for Payer: UHC Core |
$74.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.18
|
| Rate for Payer: UHC Exchange |
$22.18
|
| Rate for Payer: UHC Medicare Advantage |
$22.18
|
| Rate for Payer: UHCCP Medicaid |
$6.72
|
| Rate for Payer: VA VA |
$22.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.56
|
|
|
HC LYME CSF COMPONENT 3
|
Facility
|
IP
|
$88.74
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$79.87 |
| Rate for Payer: Aetna Commercial |
$75.43
|
| Rate for Payer: BCBS Trust/PPO |
$72.44
|
| Rate for Payer: BCN Commercial |
$68.58
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$76.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.99
|
| Rate for Payer: Healthscope Commercial |
$79.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.43
|
| Rate for Payer: Nomi Health Commercial |
$72.77
|
| Rate for Payer: PHP Commercial |
$75.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.68
|
| Rate for Payer: Priority Health HMO/PPO |
$77.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.09
|
| Rate for Payer: UHC Core |
$74.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.56
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
IP
|
$72.42
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$59.12
|
| Rate for Payer: BCN Commercial |
$55.97
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$62.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.94
|
| Rate for Payer: Healthscope Commercial |
$65.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.56
|
| Rate for Payer: Nomi Health Commercial |
$59.38
|
| Rate for Payer: PHP Commercial |
$61.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.07
|
| Rate for Payer: Priority Health HMO/PPO |
$63.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.73
|
| Rate for Payer: UHC Core |
$60.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.32
|
|
|
HC LYME CSF IGG AB INDEX
|
Facility
|
OP
|
$72.42
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100668
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Aetna Medicare |
$18.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.63
|
| Rate for Payer: BCBS Complete |
$3.76
|
| Rate for Payer: BCBS MAPPO |
$18.10
|
| Rate for Payer: BCBS Trust/PPO |
$59.54
|
| Rate for Payer: BCN Commercial |
$56.31
|
| Rate for Payer: BCN Medicare Advantage |
$18.10
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$62.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.10
|
| Rate for Payer: Healthscope Commercial |
$65.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.32
|
| Rate for Payer: Mclaren Medicaid |
$3.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.01
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.56
|
| Rate for Payer: Nomi Health Commercial |
$59.38
|
| Rate for Payer: PACE Senior Care Partners |
$17.20
|
| Rate for Payer: PACE SWMI |
$18.10
|
| Rate for Payer: PHP Commercial |
$61.56
|
| Rate for Payer: PHP Medicare Advantage |
$18.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.07
|
| Rate for Payer: Priority Health HMO/PPO |
$63.01
|
| Rate for Payer: Priority Health Medicare |
$18.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.52
|
| Rate for Payer: Railroad Medicare Medicare |
$18.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.73
|
| Rate for Payer: UHC Core |
$60.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.10
|
| Rate for Payer: UHC Exchange |
$18.10
|
| Rate for Payer: UHC Medicare Advantage |
$18.10
|
| Rate for Payer: UHCCP Medicaid |
$3.58
|
| Rate for Payer: VA VA |
$18.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.32
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: BCBS Trust/PPO |
$38.22
|
| Rate for Payer: BCN Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC LYME DISEASE ANTIBODY
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200486
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$12.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.63
|
| Rate for Payer: BCBS Complete |
$12.93
|
| Rate for Payer: BCBS MAPPO |
$11.70
|
| Rate for Payer: BCBS Trust/PPO |
$38.49
|
| Rate for Payer: BCN Commercial |
$36.40
|
| Rate for Payer: BCN Medicare Advantage |
$11.70
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Mclaren Medicaid |
$12.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.29
|
| Rate for Payer: Meridian Medicaid |
$12.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PACE Senior Care Partners |
$11.12
|
| Rate for Payer: PACE SWMI |
$11.70
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.70
|
| Rate for Payer: UHC Exchange |
$11.70
|
| Rate for Payer: UHC Medicare Advantage |
$11.70
|
| Rate for Payer: UHCCP Medicaid |
$12.31
|
| Rate for Payer: VA VA |
$11.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
OP
|
$259.72
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.45 |
| Max. Negotiated Rate |
$233.75 |
| Rate for Payer: Aetna Commercial |
$220.76
|
| Rate for Payer: Aetna Medicare |
$67.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.16
|
| Rate for Payer: BCBS Complete |
$37.22
|
| Rate for Payer: BCBS MAPPO |
$64.93
|
| Rate for Payer: BCBS Trust/PPO |
$213.52
|
| Rate for Payer: BCN Commercial |
$201.93
|
| Rate for Payer: BCN Medicare Advantage |
$64.93
|
| Rate for Payer: Cash Price |
$207.78
|
| Rate for Payer: Cash Price |
$207.78
|
| Rate for Payer: Cofinity Commercial |
$223.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.93
|
| Rate for Payer: Healthscope Commercial |
$233.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.79
|
| Rate for Payer: Mclaren Medicaid |
$35.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.18
|
| Rate for Payer: Meridian Medicaid |
$37.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.76
|
| Rate for Payer: Nomi Health Commercial |
$212.97
|
| Rate for Payer: PACE Senior Care Partners |
$61.68
|
| Rate for Payer: PACE SWMI |
$64.93
|
| Rate for Payer: PHP Commercial |
$220.76
|
| Rate for Payer: PHP Medicare Advantage |
$64.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.82
|
| Rate for Payer: Priority Health HMO/PPO |
$225.96
|
| Rate for Payer: Priority Health Medicare |
$65.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.01
|
| Rate for Payer: Railroad Medicare Medicare |
$64.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.55
|
| Rate for Payer: UHC Core |
$216.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.93
|
| Rate for Payer: UHC Exchange |
$64.93
|
| Rate for Payer: UHC Medicare Advantage |
$64.93
|
| Rate for Payer: UHCCP Medicaid |
$35.45
|
| Rate for Payer: VA VA |
$64.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.79
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS
|
Facility
|
IP
|
$259.72
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200472
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$168.82 |
| Max. Negotiated Rate |
$233.75 |
| Rate for Payer: Aetna Commercial |
$220.76
|
| Rate for Payer: BCBS Trust/PPO |
$212.01
|
| Rate for Payer: BCN Commercial |
$200.71
|
| Rate for Payer: Cash Price |
$207.78
|
| Rate for Payer: Cofinity Commercial |
$223.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.78
|
| Rate for Payer: Healthscope Commercial |
$233.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.76
|
| Rate for Payer: Nomi Health Commercial |
$212.97
|
| Rate for Payer: PHP Commercial |
$220.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.82
|
| Rate for Payer: Priority Health HMO/PPO |
$225.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.55
|
| Rate for Payer: UHC Core |
$216.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.79
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
OP
|
$280.09
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.45 |
| Max. Negotiated Rate |
$252.08 |
| Rate for Payer: Aetna Commercial |
$238.08
|
| Rate for Payer: Aetna Medicare |
$72.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.53
|
| Rate for Payer: BCBS Complete |
$37.22
|
| Rate for Payer: BCBS MAPPO |
$70.02
|
| Rate for Payer: BCBS Trust/PPO |
$230.26
|
| Rate for Payer: BCN Commercial |
$217.77
|
| Rate for Payer: BCN Medicare Advantage |
$70.02
|
| Rate for Payer: Cash Price |
$224.07
|
| Rate for Payer: Cash Price |
$224.07
|
| Rate for Payer: Cofinity Commercial |
$240.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.02
|
| Rate for Payer: Healthscope Commercial |
$252.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.07
|
| Rate for Payer: Mclaren Medicaid |
$35.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.52
|
| Rate for Payer: Meridian Medicaid |
$37.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.08
|
| Rate for Payer: Nomi Health Commercial |
$229.67
|
| Rate for Payer: PACE Senior Care Partners |
$66.52
|
| Rate for Payer: PACE SWMI |
$70.02
|
| Rate for Payer: PHP Commercial |
$238.08
|
| Rate for Payer: PHP Medicare Advantage |
$70.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.06
|
| Rate for Payer: Priority Health HMO/PPO |
$243.68
|
| Rate for Payer: Priority Health Medicare |
$70.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.66
|
| Rate for Payer: Railroad Medicare Medicare |
$70.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.48
|
| Rate for Payer: UHC Core |
$233.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.02
|
| Rate for Payer: UHC Exchange |
$70.02
|
| Rate for Payer: UHC Medicare Advantage |
$70.02
|
| Rate for Payer: UHCCP Medicaid |
$35.45
|
| Rate for Payer: VA VA |
$70.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.07
|
|
|
HC LYMPHOCYTE PROLIFERATION, ANTIGENS CMPT
|
Facility
|
IP
|
$280.09
|
|
|
Service Code
|
CPT 86353
|
| Hospital Charge Code |
30200475
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$182.06 |
| Max. Negotiated Rate |
$252.08 |
| Rate for Payer: Aetna Commercial |
$238.08
|
| Rate for Payer: BCBS Trust/PPO |
$228.64
|
| Rate for Payer: BCN Commercial |
$216.45
|
| Rate for Payer: Cash Price |
$224.07
|
| Rate for Payer: Cofinity Commercial |
$240.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.07
|
| Rate for Payer: Healthscope Commercial |
$252.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.08
|
| Rate for Payer: Nomi Health Commercial |
$229.67
|
| Rate for Payer: PHP Commercial |
$238.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.06
|
| Rate for Payer: Priority Health HMO/PPO |
$243.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.48
|
| Rate for Payer: UHC Core |
$233.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.07
|
|
