|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
IP
|
$3,481.61
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,123.43 |
| Max. Negotiated Rate |
$3,133.45 |
| Rate for Payer: Aetna Commercial |
$2,959.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,690.59
|
| Rate for Payer: BCN Commercial |
$2,690.59
|
| Rate for Payer: Cash Price |
$2,785.29
|
| Rate for Payer: Cofinity Commercial |
$2,994.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,785.29
|
| Rate for Payer: Healthscope Commercial |
$3,133.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,611.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,959.37
|
| Rate for Payer: PHP Commercial |
$2,959.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,437.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,029.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,123.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,063.82
|
| Rate for Payer: UHC Core |
$2,907.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,611.21
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
OP
|
$128.20
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$115.38 |
| Rate for Payer: Aetna Commercial |
$108.97
|
| Rate for Payer: Aetna Medicare |
$33.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.06
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS MAPPO |
$32.05
|
| Rate for Payer: BCBS Trust/PPO |
$99.68
|
| Rate for Payer: BCN Commercial |
$99.68
|
| Rate for Payer: BCN Medicare Advantage |
$32.05
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$110.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.05
|
| Rate for Payer: Healthscope Commercial |
$115.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.15
|
| Rate for Payer: Mclaren Medicaid |
$8.31
|
| Rate for Payer: Meridian Medicaid |
$8.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.97
|
| Rate for Payer: PACE Senior Care Partners |
$30.45
|
| Rate for Payer: PACE SWMI |
$32.05
|
| Rate for Payer: PHP Commercial |
$108.97
|
| Rate for Payer: PHP Medicare Advantage |
$32.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.53
|
| Rate for Payer: Priority Health Medicare |
$32.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.19
|
| Rate for Payer: Railroad Medicare Medicare |
$32.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.82
|
| Rate for Payer: UHC Core |
$107.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.05
|
| Rate for Payer: UHC Medicare Advantage |
$33.01
|
| Rate for Payer: VA VA |
$32.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.15
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
IP
|
$128.20
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$115.38 |
| Rate for Payer: Aetna Commercial |
$108.97
|
| Rate for Payer: BCBS Trust/PPO |
$99.07
|
| Rate for Payer: BCN Commercial |
$99.07
|
| Rate for Payer: Cash Price |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$110.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.56
|
| Rate for Payer: Healthscope Commercial |
$115.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.97
|
| Rate for Payer: PHP Commercial |
$108.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.82
|
| Rate for Payer: UHC Core |
$107.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.15
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.75
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS MAPPO |
$75.00
|
| Rate for Payer: BCBS Trust/PPO |
$233.25
|
| Rate for Payer: BCN Commercial |
$233.25
|
| Rate for Payer: BCN Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Mclaren Medicaid |
$35.15
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PACE Senior Care Partners |
$71.25
|
| Rate for Payer: PACE SWMI |
$75.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Medicare Advantage |
$75.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.00
|
| Rate for Payer: Priority Health Medicare |
$75.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.97
|
| Rate for Payer: Railroad Medicare Medicare |
$75.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$77.25
|
| Rate for Payer: VA VA |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$182.97 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: BCBS Trust/PPO |
$231.84
|
| Rate for Payer: BCN Commercial |
$231.84
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC HEPATITIS A IGG
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.39
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$10.71
|
| Rate for Payer: BCBS Trust/PPO |
$33.31
|
| Rate for Payer: BCN Commercial |
$33.31
|
| Rate for Payer: BCN Medicare Advantage |
$10.71
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$9.14
|
| Rate for Payer: Meridian Medicaid |
$9.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
| Rate for Payer: PACE Senior Care Partners |
$10.17
|
| Rate for Payer: PACE SWMI |
$10.71
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.27
|
| Rate for Payer: Priority Health Medicare |
$10.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.13
|
| Rate for Payer: Railroad Medicare Medicare |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.71
|
| Rate for Payer: UHC Medicare Advantage |
$11.03
|
| Rate for Payer: VA VA |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC HEPATITIS A IGG
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: BCBS Trust/PPO |
$33.11
|
| Rate for Payer: BCN Commercial |
$33.11
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
OP
|
$46.92
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$42.23 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: Aetna Medicare |
$12.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.66
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$11.73
|
| Rate for Payer: BCBS Trust/PPO |
$36.48
|
| Rate for Payer: BCN Commercial |
$36.48
|
| Rate for Payer: BCN Medicare Advantage |
$11.73
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$40.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.73
|
| Rate for Payer: Healthscope Commercial |
$42.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.19
|
| Rate for Payer: Mclaren Medicaid |
$9.14
|
| Rate for Payer: Meridian Medicaid |
$9.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: PACE Senior Care Partners |
$11.14
|
| Rate for Payer: PACE SWMI |
$11.73
|
| Rate for Payer: PHP Commercial |
$39.88
|
| Rate for Payer: PHP Medicare Advantage |
$11.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.82
|
| Rate for Payer: Priority Health Medicare |
$11.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.29
|
| Rate for Payer: UHC Core |
$39.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.73
|
| Rate for Payer: UHC Medicare Advantage |
$12.08
|
| Rate for Payer: VA VA |
$11.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.19
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
IP
|
$46.92
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$42.23 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: BCBS Trust/PPO |
$36.26
|
| Rate for Payer: BCN Commercial |
$36.26
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$40.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$42.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: PHP Commercial |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.29
|
| Rate for Payer: UHC Core |
$39.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.19
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: BCBS Trust/PPO |
$69.37
|
| Rate for Payer: BCN Commercial |
$69.37
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.99
|
| Rate for Payer: UHC Core |
$74.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.32
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna Medicare |
$23.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.05
|
| Rate for Payer: BCBS Complete |
$35.90
|
| Rate for Payer: BCBS MAPPO |
$22.44
|
| Rate for Payer: BCBS Trust/PPO |
$69.79
|
| Rate for Payer: BCN Commercial |
$69.79
|
| Rate for Payer: BCN Medicare Advantage |
$22.44
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.44
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PACE Senior Care Partners |
$21.32
|
| Rate for Payer: PACE SWMI |
$22.44
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: PHP Medicare Advantage |
$22.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.09
|
| Rate for Payer: Priority Health Medicare |
$22.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.74
|
| Rate for Payer: Railroad Medicare Medicare |
$22.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.99
|
| Rate for Payer: UHC Core |
$74.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$23.11
|
| Rate for Payer: VA VA |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.32
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.77 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: BCBS Trust/PPO |
$75.73
|
| Rate for Payer: BCN Commercial |
$75.73
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.24
|
| Rate for Payer: UHC Core |
$81.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.50
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Medicare |
$25.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.62
|
| Rate for Payer: BCBS Complete |
$9.12
|
| Rate for Payer: BCBS MAPPO |
$24.50
|
| Rate for Payer: BCBS Trust/PPO |
$76.20
|
| Rate for Payer: BCN Commercial |
$76.20
|
| Rate for Payer: BCN Medicare Advantage |
$24.50
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$84.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.50
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.50
|
| Rate for Payer: Mclaren Medicaid |
$8.69
|
| Rate for Payer: Meridian Medicaid |
$9.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.30
|
| Rate for Payer: PACE Senior Care Partners |
$23.28
|
| Rate for Payer: PACE SWMI |
$24.50
|
| Rate for Payer: PHP Commercial |
$83.30
|
| Rate for Payer: PHP Medicare Advantage |
$24.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.26
|
| Rate for Payer: Priority Health Medicare |
$24.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.77
|
| Rate for Payer: Railroad Medicare Medicare |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.24
|
| Rate for Payer: UHC Core |
$81.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.50
|
| Rate for Payer: UHC Medicare Advantage |
$25.24
|
| Rate for Payer: VA VA |
$24.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.50
|
|
|
HC HEPATITIS B CORE AB TOTAL.
|
Facility
|
OP
|
$47.84
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.66
|
| Rate for Payer: Aetna Medicare |
$12.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.95
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$11.96
|
| Rate for Payer: BCBS Trust/PPO |
$37.20
|
| Rate for Payer: BCN Commercial |
$37.20
|
| Rate for Payer: BCN Medicare Advantage |
$11.96
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.96
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.88
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.66
|
| Rate for Payer: PACE Senior Care Partners |
$11.36
|
| Rate for Payer: PACE SWMI |
$11.96
|
| Rate for Payer: PHP Commercial |
$40.66
|
| Rate for Payer: PHP Medicare Advantage |
$11.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.62
|
| Rate for Payer: Priority Health Medicare |
$11.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.18
|
| Rate for Payer: Railroad Medicare Medicare |
$11.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.10
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.96
|
| Rate for Payer: UHC Medicare Advantage |
$12.32
|
| Rate for Payer: VA VA |
$11.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.88
|
|
|
HC HEPATITIS B CORE AB TOTAL.
|
Facility
|
IP
|
$47.84
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.66
|
| Rate for Payer: BCBS Trust/PPO |
$36.97
|
| Rate for Payer: BCN Commercial |
$36.97
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.27
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.66
|
| Rate for Payer: PHP Commercial |
$40.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.10
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.88
|
|
|
HC HEPATITIS B DNA QUANTITATION
|
Facility
|
IP
|
$173.40
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
30600154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$105.76 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$147.39
|
| Rate for Payer: BCBS Trust/PPO |
$134.00
|
| Rate for Payer: BCN Commercial |
$134.00
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$149.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.39
|
| Rate for Payer: PHP Commercial |
$147.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.59
|
| Rate for Payer: UHC Core |
$144.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.05
|
|
|
HC HEPATITIS B DNA QUANTITATION
|
Facility
|
OP
|
$173.40
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
30600154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$147.39
|
| Rate for Payer: Aetna Medicare |
$45.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.19
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$134.82
|
| Rate for Payer: BCN Commercial |
$134.82
|
| Rate for Payer: BCN Medicare Advantage |
$43.35
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$149.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.05
|
| Rate for Payer: Mclaren Medicaid |
$31.62
|
| Rate for Payer: Meridian Medicaid |
$33.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.39
|
| Rate for Payer: PACE Senior Care Partners |
$41.18
|
| Rate for Payer: PACE SWMI |
$43.35
|
| Rate for Payer: PHP Commercial |
$147.39
|
| Rate for Payer: PHP Medicare Advantage |
$43.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.86
|
| Rate for Payer: Priority Health Medicare |
$43.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.76
|
| Rate for Payer: Railroad Medicare Medicare |
$43.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.59
|
| Rate for Payer: UHC Core |
$144.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.35
|
| Rate for Payer: UHC Medicare Advantage |
$44.65
|
| Rate for Payer: VA VA |
$43.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.05
|
|
|
HC HEPATITIS BE ANTIBODY
|
Facility
|
OP
|
$46.92
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
30200297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$42.23 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: Aetna Medicare |
$12.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.66
|
| Rate for Payer: BCBS Complete |
$8.97
|
| Rate for Payer: BCBS MAPPO |
$11.73
|
| Rate for Payer: BCBS Trust/PPO |
$36.48
|
| Rate for Payer: BCN Commercial |
$36.48
|
| Rate for Payer: BCN Medicare Advantage |
$11.73
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$40.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.73
|
| Rate for Payer: Healthscope Commercial |
$42.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.19
|
| Rate for Payer: Mclaren Medicaid |
$8.54
|
| Rate for Payer: Meridian Medicaid |
$8.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: PACE Senior Care Partners |
$11.14
|
| Rate for Payer: PACE SWMI |
$11.73
|
| Rate for Payer: PHP Commercial |
$39.88
|
| Rate for Payer: PHP Medicare Advantage |
$11.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.82
|
| Rate for Payer: Priority Health Medicare |
$11.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.29
|
| Rate for Payer: UHC Core |
$39.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.73
|
| Rate for Payer: UHC Medicare Advantage |
$12.08
|
| Rate for Payer: VA VA |
$11.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.19
|
|
|
HC HEPATITIS BE ANTIBODY
|
Facility
|
IP
|
$46.92
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
30200297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$42.23 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: BCBS Trust/PPO |
$36.26
|
| Rate for Payer: BCN Commercial |
$36.26
|
| Rate for Payer: Cash Price |
$37.54
|
| Rate for Payer: Cofinity Commercial |
$40.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.54
|
| Rate for Payer: Healthscope Commercial |
$42.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.88
|
| Rate for Payer: PHP Commercial |
$39.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.29
|
| Rate for Payer: UHC Core |
$39.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.19
|
|
|
HC HEPATITIS BE ANTIGEN
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
30600142
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.45 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna Commercial |
$73.10
|
| Rate for Payer: BCBS Trust/PPO |
$66.46
|
| Rate for Payer: BCN Commercial |
$66.46
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$73.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.80
|
| Rate for Payer: Healthscope Commercial |
$77.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.10
|
| Rate for Payer: PHP Commercial |
$73.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.68
|
| Rate for Payer: UHC Core |
$71.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.50
|
|
|
HC HEPATITIS BE ANTIGEN
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
30600142
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna Commercial |
$73.10
|
| Rate for Payer: Aetna Medicare |
$22.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.88
|
| Rate for Payer: BCBS Complete |
$8.93
|
| Rate for Payer: BCBS MAPPO |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$66.86
|
| Rate for Payer: BCN Commercial |
$66.86
|
| Rate for Payer: BCN Medicare Advantage |
$21.50
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$73.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$77.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.50
|
| Rate for Payer: Mclaren Medicaid |
$8.51
|
| Rate for Payer: Meridian Medicaid |
$8.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.10
|
| Rate for Payer: PACE Senior Care Partners |
$20.42
|
| Rate for Payer: PACE SWMI |
$21.50
|
| Rate for Payer: PHP Commercial |
$73.10
|
| Rate for Payer: PHP Medicare Advantage |
$21.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.82
|
| Rate for Payer: Priority Health Medicare |
$21.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.45
|
| Rate for Payer: Railroad Medicare Medicare |
$21.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.68
|
| Rate for Payer: UHC Core |
$71.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.50
|
| Rate for Payer: UHC Medicare Advantage |
$22.14
|
| Rate for Payer: VA VA |
$21.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.50
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
30200296
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HEPATITIS B SURFACE ANTIBODY
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
30200296
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$7.93
|
| Rate for Payer: Meridian Medicaid |
$8.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
