|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
OP
|
$991.36
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$235.45 |
| Max. Negotiated Rate |
$892.22 |
| Rate for Payer: Aetna Commercial |
$842.66
|
| Rate for Payer: Aetna Medicare |
$257.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$309.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$309.80
|
| Rate for Payer: BCBS Complete |
$396.54
|
| Rate for Payer: BCBS MAPPO |
$247.84
|
| Rate for Payer: BCBS Trust/PPO |
$815.00
|
| Rate for Payer: BCN Commercial |
$770.78
|
| Rate for Payer: BCN Medicare Advantage |
$247.84
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cofinity Commercial |
$852.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.84
|
| Rate for Payer: Healthscope Commercial |
$892.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.66
|
| Rate for Payer: Nomi Health Commercial |
$812.92
|
| Rate for Payer: PACE Senior Care Partners |
$235.45
|
| Rate for Payer: PACE SWMI |
$247.84
|
| Rate for Payer: PHP Commercial |
$842.66
|
| Rate for Payer: PHP Medicare Advantage |
$247.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.38
|
| Rate for Payer: Priority Health HMO/PPO |
$862.48
|
| Rate for Payer: Priority Health Medicare |
$250.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$664.21
|
| Rate for Payer: Railroad Medicare Medicare |
$247.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.40
|
| Rate for Payer: UHC Core |
$827.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$247.84
|
| Rate for Payer: UHC Exchange |
$247.84
|
| Rate for Payer: UHC Medicare Advantage |
$247.84
|
| Rate for Payer: VA VA |
$247.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.52
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
IP
|
$991.36
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$644.38 |
| Max. Negotiated Rate |
$892.22 |
| Rate for Payer: Aetna Commercial |
$842.66
|
| Rate for Payer: BCBS Trust/PPO |
$809.25
|
| Rate for Payer: BCN Commercial |
$766.12
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cofinity Commercial |
$852.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.09
|
| Rate for Payer: Healthscope Commercial |
$892.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.66
|
| Rate for Payer: Nomi Health Commercial |
$812.92
|
| Rate for Payer: PHP Commercial |
$842.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.38
|
| Rate for Payer: Priority Health HMO/PPO |
$862.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$664.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.40
|
| Rate for Payer: UHC Core |
$827.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.52
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$74.94
|
| Rate for Payer: BCN Commercial |
$70.94
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCN Commercial |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$10.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: Meridian Medicaid |
$11.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.95
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: UHCCP Medicaid |
$10.88
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
OP
|
$251.10
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$225.99 |
| Rate for Payer: Aetna Commercial |
$213.44
|
| Rate for Payer: Aetna Medicare |
$65.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.47
|
| Rate for Payer: BCBS Complete |
$116.54
|
| Rate for Payer: BCBS MAPPO |
$62.78
|
| Rate for Payer: BCBS Trust/PPO |
$206.43
|
| Rate for Payer: BCN Commercial |
$195.23
|
| Rate for Payer: BCN Medicare Advantage |
$62.78
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cofinity Commercial |
$215.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.78
|
| Rate for Payer: Healthscope Commercial |
$225.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.32
|
| Rate for Payer: Mclaren Medicaid |
$110.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.91
|
| Rate for Payer: Meridian Medicaid |
$116.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.44
|
| Rate for Payer: Nomi Health Commercial |
$205.90
|
| Rate for Payer: PACE Senior Care Partners |
$59.64
|
| Rate for Payer: PACE SWMI |
$62.78
|
| Rate for Payer: PHP Commercial |
$213.44
|
| Rate for Payer: PHP Medicare Advantage |
$62.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.22
|
| Rate for Payer: Priority Health HMO/PPO |
$218.46
|
| Rate for Payer: Priority Health Medicare |
$63.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.24
|
| Rate for Payer: Railroad Medicare Medicare |
$62.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.97
|
| Rate for Payer: UHC Core |
$209.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.78
|
| Rate for Payer: UHC Exchange |
$62.78
|
| Rate for Payer: UHC Medicare Advantage |
$62.78
|
| Rate for Payer: UHCCP Medicaid |
$110.98
|
| Rate for Payer: VA VA |
$62.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.32
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
IP
|
$251.10
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$163.22 |
| Max. Negotiated Rate |
$225.99 |
| Rate for Payer: Aetna Commercial |
$213.44
|
| Rate for Payer: BCBS Trust/PPO |
$204.97
|
| Rate for Payer: BCN Commercial |
$194.05
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cofinity Commercial |
$215.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.88
|
| Rate for Payer: Healthscope Commercial |
$225.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.44
|
| Rate for Payer: Nomi Health Commercial |
$205.90
|
| Rate for Payer: PHP Commercial |
$213.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.22
|
| Rate for Payer: Priority Health HMO/PPO |
$218.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.97
|
| Rate for Payer: UHC Core |
$209.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.32
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
OP
|
$2,181.53
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$498.41 |
| Max. Negotiated Rate |
$1,963.38 |
| Rate for Payer: Aetna Commercial |
$1,854.30
|
| Rate for Payer: Aetna Medicare |
$567.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$681.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$681.73
|
| Rate for Payer: BCBS Complete |
$523.36
|
| Rate for Payer: BCBS MAPPO |
$545.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,793.44
|
| Rate for Payer: BCN Commercial |
$1,696.14
|
| Rate for Payer: BCN Medicare Advantage |
$545.38
|
| Rate for Payer: Cash Price |
$1,745.22
|
| Rate for Payer: Cash Price |
$1,745.22
|
| Rate for Payer: Cofinity Commercial |
$1,876.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,745.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$545.38
|
| Rate for Payer: Healthscope Commercial |
$1,963.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,636.15
|
| Rate for Payer: Mclaren Medicaid |
$498.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$572.65
|
| Rate for Payer: Meridian Medicaid |
$523.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$627.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,854.30
|
| Rate for Payer: Nomi Health Commercial |
$1,788.85
|
| Rate for Payer: PACE Senior Care Partners |
$518.11
|
| Rate for Payer: PACE SWMI |
$545.38
|
| Rate for Payer: PHP Commercial |
$1,854.30
|
| Rate for Payer: PHP Medicare Advantage |
$545.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,417.99
|
| Rate for Payer: Priority Health HMO/PPO |
$1,897.93
|
| Rate for Payer: Priority Health Medicare |
$550.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,461.63
|
| Rate for Payer: Railroad Medicare Medicare |
$545.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,919.75
|
| Rate for Payer: UHC Core |
$1,821.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$545.38
|
| Rate for Payer: UHC Exchange |
$545.38
|
| Rate for Payer: UHC Medicare Advantage |
$545.38
|
| Rate for Payer: UHCCP Medicaid |
$498.41
|
| Rate for Payer: VA VA |
$545.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,636.15
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
IP
|
$2,181.53
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,417.99 |
| Max. Negotiated Rate |
$1,963.38 |
| Rate for Payer: Aetna Commercial |
$1,854.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,780.78
|
| Rate for Payer: BCN Commercial |
$1,685.89
|
| Rate for Payer: Cash Price |
$1,745.22
|
| Rate for Payer: Cofinity Commercial |
$1,876.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,745.22
|
| Rate for Payer: Healthscope Commercial |
$1,963.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,636.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,854.30
|
| Rate for Payer: Nomi Health Commercial |
$1,788.85
|
| Rate for Payer: PHP Commercial |
$1,854.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,417.99
|
| Rate for Payer: Priority Health HMO/PPO |
$1,897.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,461.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,919.75
|
| Rate for Payer: UHC Core |
$1,821.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,636.15
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
IP
|
$4,281.51
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,782.98 |
| Max. Negotiated Rate |
$3,853.36 |
| Rate for Payer: Aetna Commercial |
$3,639.28
|
| Rate for Payer: BCBS Trust/PPO |
$3,495.00
|
| Rate for Payer: BCN Commercial |
$3,308.75
|
| Rate for Payer: Cash Price |
$3,425.21
|
| Rate for Payer: Cofinity Commercial |
$3,682.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,425.21
|
| Rate for Payer: Healthscope Commercial |
$3,853.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,211.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,639.28
|
| Rate for Payer: Nomi Health Commercial |
$3,510.84
|
| Rate for Payer: PHP Commercial |
$3,639.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,782.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3,724.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,868.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,767.73
|
| Rate for Payer: UHC Core |
$3,575.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,211.13
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
OP
|
$4,281.51
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,016.86 |
| Max. Negotiated Rate |
$6,156.08 |
| Rate for Payer: Aetna Commercial |
$3,639.28
|
| Rate for Payer: Aetna Medicare |
$1,113.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,337.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,337.97
|
| Rate for Payer: BCBS Complete |
$6,156.08
|
| Rate for Payer: BCBS MAPPO |
$1,070.38
|
| Rate for Payer: BCBS Trust/PPO |
$3,519.83
|
| Rate for Payer: BCN Commercial |
$3,328.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,070.38
|
| Rate for Payer: Cash Price |
$3,425.21
|
| Rate for Payer: Cash Price |
$3,425.21
|
| Rate for Payer: Cofinity Commercial |
$3,682.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,425.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,070.38
|
| Rate for Payer: Healthscope Commercial |
$3,853.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,211.13
|
| Rate for Payer: Mclaren Medicaid |
$5,862.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,123.90
|
| Rate for Payer: Meridian Medicaid |
$6,156.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,230.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,639.28
|
| Rate for Payer: Nomi Health Commercial |
$3,510.84
|
| Rate for Payer: PACE Senior Care Partners |
$1,016.86
|
| Rate for Payer: PACE SWMI |
$1,070.38
|
| Rate for Payer: PHP Commercial |
$3,639.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,070.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,862.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,782.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3,724.91
|
| Rate for Payer: Priority Health Medicare |
$1,081.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,868.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,070.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,767.73
|
| Rate for Payer: UHC Core |
$3,575.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,070.38
|
| Rate for Payer: UHC Exchange |
$1,070.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,070.38
|
| Rate for Payer: UHCCP Medicaid |
$5,862.55
|
| Rate for Payer: VA VA |
$1,070.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,211.13
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
IP
|
$10,450.82
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,793.03 |
| Max. Negotiated Rate |
$9,405.74 |
| Rate for Payer: Aetna Commercial |
$8,883.20
|
| Rate for Payer: BCBS Trust/PPO |
$8,531.00
|
| Rate for Payer: BCN Commercial |
$8,076.39
|
| Rate for Payer: Cash Price |
$8,360.66
|
| Rate for Payer: Cofinity Commercial |
$8,987.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,360.66
|
| Rate for Payer: Healthscope Commercial |
$9,405.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,838.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,883.20
|
| Rate for Payer: Nomi Health Commercial |
$8,569.67
|
| Rate for Payer: PHP Commercial |
$8,883.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,793.03
|
| Rate for Payer: Priority Health HMO/PPO |
$9,092.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,002.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,196.72
|
| Rate for Payer: UHC Core |
$8,726.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,838.12
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
OP
|
$10,450.82
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,482.07 |
| Max. Negotiated Rate |
$9,405.74 |
| Rate for Payer: Aetna Commercial |
$8,883.20
|
| Rate for Payer: Aetna Medicare |
$2,717.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,265.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,265.88
|
| Rate for Payer: BCBS Complete |
$4,180.33
|
| Rate for Payer: BCBS MAPPO |
$2,612.70
|
| Rate for Payer: BCBS Trust/PPO |
$8,591.62
|
| Rate for Payer: BCN Commercial |
$8,125.51
|
| Rate for Payer: BCN Medicare Advantage |
$2,612.70
|
| Rate for Payer: Cash Price |
$8,360.66
|
| Rate for Payer: Cofinity Commercial |
$8,987.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,360.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,612.70
|
| Rate for Payer: Healthscope Commercial |
$9,405.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,838.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,743.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,004.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,883.20
|
| Rate for Payer: Nomi Health Commercial |
$8,569.67
|
| Rate for Payer: PACE Senior Care Partners |
$2,482.07
|
| Rate for Payer: PACE SWMI |
$2,612.70
|
| Rate for Payer: PHP Commercial |
$8,883.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,612.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,793.03
|
| Rate for Payer: Priority Health HMO/PPO |
$9,092.21
|
| Rate for Payer: Priority Health Medicare |
$2,638.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,002.05
|
| Rate for Payer: Railroad Medicare Medicare |
$2,612.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,196.72
|
| Rate for Payer: UHC Core |
$8,726.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,612.70
|
| Rate for Payer: UHC Exchange |
$2,612.70
|
| Rate for Payer: UHC Medicare Advantage |
$2,612.70
|
| Rate for Payer: VA VA |
$2,612.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,838.12
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.82 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare |
$17.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.81
|
| Rate for Payer: BCBS Complete |
$23.52
|
| Rate for Payer: BCBS MAPPO |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCN Commercial |
$51.77
|
| Rate for Payer: BCN Medicare Advantage |
$16.65
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.94
|
| Rate for Payer: Mclaren Medicaid |
$22.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.48
|
| Rate for Payer: Meridian Medicaid |
$23.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: PACE Senior Care Partners |
$15.82
|
| Rate for Payer: PACE SWMI |
$16.65
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: PHP Medicare Advantage |
$16.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health HMO/PPO |
$57.93
|
| Rate for Payer: Priority Health Medicare |
$16.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.62
|
| Rate for Payer: Railroad Medicare Medicare |
$16.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.60
|
| Rate for Payer: UHC Core |
$55.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.65
|
| Rate for Payer: UHC Exchange |
$16.65
|
| Rate for Payer: UHC Medicare Advantage |
$16.65
|
| Rate for Payer: UHCCP Medicaid |
$22.40
|
| Rate for Payer: VA VA |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.94
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.28 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: BCBS Trust/PPO |
$54.36
|
| Rate for Payer: BCN Commercial |
$51.46
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.28
|
| Rate for Payer: Priority Health HMO/PPO |
$57.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.60
|
| Rate for Payer: UHC Core |
$55.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.94
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
IP
|
$345.41
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$224.52 |
| Max. Negotiated Rate |
$310.87 |
| Rate for Payer: Aetna Commercial |
$293.60
|
| Rate for Payer: BCBS Trust/PPO |
$281.96
|
| Rate for Payer: BCN Commercial |
$266.93
|
| Rate for Payer: Cash Price |
$276.33
|
| Rate for Payer: Cofinity Commercial |
$297.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.33
|
| Rate for Payer: Healthscope Commercial |
$310.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.60
|
| Rate for Payer: Nomi Health Commercial |
$283.24
|
| Rate for Payer: PHP Commercial |
$293.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.52
|
| Rate for Payer: Priority Health HMO/PPO |
$300.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.96
|
| Rate for Payer: UHC Core |
$288.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.06
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
OP
|
$345.41
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$310.87 |
| Rate for Payer: Aetna Commercial |
$293.60
|
| Rate for Payer: Aetna Medicare |
$89.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.94
|
| Rate for Payer: BCBS Complete |
$13.95
|
| Rate for Payer: BCBS MAPPO |
$86.35
|
| Rate for Payer: BCBS Trust/PPO |
$283.96
|
| Rate for Payer: BCN Commercial |
$268.56
|
| Rate for Payer: BCN Medicare Advantage |
$86.35
|
| Rate for Payer: Cash Price |
$276.33
|
| Rate for Payer: Cash Price |
$276.33
|
| Rate for Payer: Cofinity Commercial |
$297.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.35
|
| Rate for Payer: Healthscope Commercial |
$310.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.06
|
| Rate for Payer: Mclaren Medicaid |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.67
|
| Rate for Payer: Meridian Medicaid |
$13.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.60
|
| Rate for Payer: Nomi Health Commercial |
$283.24
|
| Rate for Payer: PACE Senior Care Partners |
$82.03
|
| Rate for Payer: PACE SWMI |
$86.35
|
| Rate for Payer: PHP Commercial |
$293.60
|
| Rate for Payer: PHP Medicare Advantage |
$86.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.52
|
| Rate for Payer: Priority Health HMO/PPO |
$300.51
|
| Rate for Payer: Priority Health Medicare |
$87.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.42
|
| Rate for Payer: Railroad Medicare Medicare |
$86.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.96
|
| Rate for Payer: UHC Core |
$288.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.35
|
| Rate for Payer: UHC Exchange |
$86.35
|
| Rate for Payer: UHC Medicare Advantage |
$86.35
|
| Rate for Payer: UHCCP Medicaid |
$13.28
|
| Rate for Payer: VA VA |
$86.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.06
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
IP
|
$105.08
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$94.57 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: BCBS Trust/PPO |
$85.78
|
| Rate for Payer: BCN Commercial |
$81.21
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$90.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Healthscope Commercial |
$94.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: PHP Commercial |
$89.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health HMO/PPO |
$91.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.47
|
| Rate for Payer: UHC Core |
$87.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.81
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
OP
|
$105.08
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$94.57 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Aetna Medicare |
$27.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.84
|
| Rate for Payer: BCBS Complete |
$13.95
|
| Rate for Payer: BCBS MAPPO |
$26.27
|
| Rate for Payer: BCBS Trust/PPO |
$86.39
|
| Rate for Payer: BCN Commercial |
$81.70
|
| Rate for Payer: BCN Medicare Advantage |
$26.27
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$90.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.27
|
| Rate for Payer: Healthscope Commercial |
$94.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.81
|
| Rate for Payer: Mclaren Medicaid |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.58
|
| Rate for Payer: Meridian Medicaid |
$13.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: PACE Senior Care Partners |
$24.96
|
| Rate for Payer: PACE SWMI |
$26.27
|
| Rate for Payer: PHP Commercial |
$89.32
|
| Rate for Payer: PHP Medicare Advantage |
$26.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health HMO/PPO |
$91.42
|
| Rate for Payer: Priority Health Medicare |
$26.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.40
|
| Rate for Payer: Railroad Medicare Medicare |
$26.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.47
|
| Rate for Payer: UHC Core |
$87.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.27
|
| Rate for Payer: UHC Exchange |
$26.27
|
| Rate for Payer: UHC Medicare Advantage |
$26.27
|
| Rate for Payer: UHCCP Medicaid |
$13.28
|
| Rate for Payer: VA VA |
$26.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.81
|
|
|
HC SEROTONIN RELEASE ASSAY PORCINE
|
Facility
|
OP
|
$407.84
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200132
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$367.06 |
| Rate for Payer: Aetna Commercial |
$346.66
|
| Rate for Payer: Aetna Medicare |
$106.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.45
|
| Rate for Payer: BCBS Complete |
$13.95
|
| Rate for Payer: BCBS MAPPO |
$101.96
|
| Rate for Payer: BCBS Trust/PPO |
$335.29
|
| Rate for Payer: BCN Commercial |
$317.10
|
| Rate for Payer: BCN Medicare Advantage |
$101.96
|
| Rate for Payer: Cash Price |
$326.27
|
| Rate for Payer: Cash Price |
$326.27
|
| Rate for Payer: Cofinity Commercial |
$350.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.96
|
| Rate for Payer: Healthscope Commercial |
$367.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.88
|
| Rate for Payer: Mclaren Medicaid |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.06
|
| Rate for Payer: Meridian Medicaid |
$13.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.66
|
| Rate for Payer: Nomi Health Commercial |
$334.43
|
| Rate for Payer: PACE Senior Care Partners |
$96.86
|
| Rate for Payer: PACE SWMI |
$101.96
|
| Rate for Payer: PHP Commercial |
$346.66
|
| Rate for Payer: PHP Medicare Advantage |
$101.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.10
|
| Rate for Payer: Priority Health HMO/PPO |
$354.82
|
| Rate for Payer: Priority Health Medicare |
$102.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.25
|
| Rate for Payer: Railroad Medicare Medicare |
$101.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.90
|
| Rate for Payer: UHC Core |
$340.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.96
|
| Rate for Payer: UHC Exchange |
$101.96
|
| Rate for Payer: UHC Medicare Advantage |
$101.96
|
| Rate for Payer: UHCCP Medicaid |
$13.28
|
| Rate for Payer: VA VA |
$101.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.88
|
|
|
HC SEROTONIN RELEASE ASSAY PORCINE
|
Facility
|
IP
|
$407.84
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200132
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$265.10 |
| Max. Negotiated Rate |
$367.06 |
| Rate for Payer: Aetna Commercial |
$346.66
|
| Rate for Payer: BCBS Trust/PPO |
$332.92
|
| Rate for Payer: BCN Commercial |
$315.18
|
| Rate for Payer: Cash Price |
$326.27
|
| Rate for Payer: Cofinity Commercial |
$350.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.27
|
| Rate for Payer: Healthscope Commercial |
$367.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.66
|
| Rate for Payer: Nomi Health Commercial |
$334.43
|
| Rate for Payer: PHP Commercial |
$346.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.10
|
| Rate for Payer: Priority Health HMO/PPO |
$354.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.90
|
| Rate for Payer: UHC Core |
$340.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.88
|
|
|
HC SERUM FREE LIGHT CHAIN
|
Facility
|
IP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$65.81
|
| Rate for Payer: BCBS Trust/PPO |
$63.20
|
| Rate for Payer: BCN Commercial |
$59.83
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$66.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: PHP Commercial |
$65.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health HMO/PPO |
$67.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.13
|
| Rate for Payer: UHC Core |
$64.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.06
|
|
|
HC SERUM FREE LIGHT CHAIN
|
Facility
|
OP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$65.81
|
| Rate for Payer: Aetna Medicare |
$20.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS MAPPO |
$19.36
|
| Rate for Payer: BCBS Trust/PPO |
$63.65
|
| Rate for Payer: BCN Commercial |
$60.19
|
| Rate for Payer: BCN Medicare Advantage |
$19.36
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$66.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.36
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.06
|
| Rate for Payer: Mclaren Medicaid |
$12.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: PACE Senior Care Partners |
$18.39
|
| Rate for Payer: PACE SWMI |
$19.36
|
| Rate for Payer: PHP Commercial |
$65.81
|
| Rate for Payer: PHP Medicare Advantage |
$19.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health HMO/PPO |
$67.36
|
| Rate for Payer: Priority Health Medicare |
$19.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.87
|
| Rate for Payer: Railroad Medicare Medicare |
$19.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.13
|
| Rate for Payer: UHC Core |
$64.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.36
|
| Rate for Payer: UHC Exchange |
$19.36
|
| Rate for Payer: UHC Medicare Advantage |
$19.36
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
| Rate for Payer: VA VA |
$19.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.06
|
|
|
HC SERUM FREE LIGHT CHAIN CMPT
|
Facility
|
IP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$65.81
|
| Rate for Payer: BCBS Trust/PPO |
$63.20
|
| Rate for Payer: BCN Commercial |
$59.83
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$66.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: PHP Commercial |
$65.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health HMO/PPO |
$67.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.13
|
| Rate for Payer: UHC Core |
$64.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.06
|
|
|
HC SERUM FREE LIGHT CHAIN CMPT
|
Facility
|
OP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$65.81
|
| Rate for Payer: Aetna Medicare |
$20.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS MAPPO |
$19.36
|
| Rate for Payer: BCBS Trust/PPO |
$63.65
|
| Rate for Payer: BCN Commercial |
$60.19
|
| Rate for Payer: BCN Medicare Advantage |
$19.36
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$66.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.36
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.06
|
| Rate for Payer: Mclaren Medicaid |
$12.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: PACE Senior Care Partners |
$18.39
|
| Rate for Payer: PACE SWMI |
$19.36
|
| Rate for Payer: PHP Commercial |
$65.81
|
| Rate for Payer: PHP Medicare Advantage |
$19.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health HMO/PPO |
$67.36
|
| Rate for Payer: Priority Health Medicare |
$19.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.87
|
| Rate for Payer: Railroad Medicare Medicare |
$19.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.13
|
| Rate for Payer: UHC Core |
$64.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.36
|
| Rate for Payer: UHC Exchange |
$19.36
|
| Rate for Payer: UHC Medicare Advantage |
$19.36
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
| Rate for Payer: VA VA |
$19.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.06
|
|
|
HC SESAME SEED IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
