|
HC HEPATITIS B SURFACE ANTIGEN
|
Facility
|
OP
|
$38.09
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600139
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$34.28 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$9.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.90
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$9.52
|
| Rate for Payer: BCBS Trust/PPO |
$29.61
|
| Rate for Payer: BCN Commercial |
$29.61
|
| Rate for Payer: BCN Medicare Advantage |
$9.52
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cofinity Commercial |
$32.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.52
|
| Rate for Payer: Healthscope Commercial |
$34.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.57
|
| Rate for Payer: Mclaren Medicaid |
$7.62
|
| Rate for Payer: Meridian Medicaid |
$8.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.38
|
| Rate for Payer: PACE Senior Care Partners |
$9.05
|
| Rate for Payer: PACE SWMI |
$9.52
|
| Rate for Payer: PHP Commercial |
$32.38
|
| Rate for Payer: PHP Medicare Advantage |
$9.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.14
|
| Rate for Payer: Priority Health Medicare |
$9.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.23
|
| Rate for Payer: Railroad Medicare Medicare |
$9.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.52
|
| Rate for Payer: UHC Core |
$31.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.52
|
| Rate for Payer: UHC Medicare Advantage |
$9.81
|
| Rate for Payer: VA VA |
$9.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.57
|
|
|
HC HEPATITIS B SURFACE ANTIGEN
|
Facility
|
IP
|
$38.09
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600139
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$34.28 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: BCBS Trust/PPO |
$29.44
|
| Rate for Payer: BCN Commercial |
$29.44
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cofinity Commercial |
$32.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.47
|
| Rate for Payer: Healthscope Commercial |
$34.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.38
|
| Rate for Payer: PHP Commercial |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.52
|
| Rate for Payer: UHC Core |
$31.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.57
|
|
|
HC HEPATITIS B SURFACE ANTIGEN NEUTRALIZATION
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
30600141
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna Commercial |
$62.05
|
| Rate for Payer: BCBS Trust/PPO |
$56.41
|
| Rate for Payer: BCN Commercial |
$56.41
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.40
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.05
|
| Rate for Payer: PHP Commercial |
$62.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.24
|
| Rate for Payer: UHC Core |
$60.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.75
|
|
|
HC HEPATITIS B SURFACE ANTIGEN NEUTRALIZATION
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 87341
|
| Hospital Charge Code |
30600141
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna Commercial |
$62.05
|
| Rate for Payer: Aetna Medicare |
$18.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.81
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$18.25
|
| Rate for Payer: BCBS Trust/PPO |
$56.76
|
| Rate for Payer: BCN Commercial |
$56.76
|
| Rate for Payer: BCN Medicare Advantage |
$18.25
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.25
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.75
|
| Rate for Payer: Mclaren Medicaid |
$7.62
|
| Rate for Payer: Meridian Medicaid |
$8.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.05
|
| Rate for Payer: PACE Senior Care Partners |
$17.34
|
| Rate for Payer: PACE SWMI |
$18.25
|
| Rate for Payer: PHP Commercial |
$62.05
|
| Rate for Payer: PHP Medicare Advantage |
$18.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.51
|
| Rate for Payer: Priority Health Medicare |
$18.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.52
|
| Rate for Payer: Railroad Medicare Medicare |
$18.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.24
|
| Rate for Payer: UHC Core |
$60.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.25
|
| Rate for Payer: UHC Medicare Advantage |
$18.80
|
| Rate for Payer: VA VA |
$18.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.75
|
|
|
HC HEPATITIS B VACCINE ADULT, 3 DOSE IM
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
63600026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$21.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.82
|
| Rate for Payer: BCBS Complete |
$33.05
|
| Rate for Payer: BCBS MAPPO |
$20.66
|
| Rate for Payer: BCBS Trust/PPO |
$64.24
|
| Rate for Payer: BCN Commercial |
$64.24
|
| Rate for Payer: BCN Medicare Advantage |
$20.66
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.66
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: PACE Senior Care Partners |
$19.62
|
| Rate for Payer: PACE SWMI |
$20.66
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: PHP Medicare Advantage |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.88
|
| Rate for Payer: Priority Health Medicare |
$20.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.39
|
| Rate for Payer: Railroad Medicare Medicare |
$20.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.71
|
| Rate for Payer: UHC Core |
$68.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.66
|
| Rate for Payer: UHC Medicare Advantage |
$21.27
|
| Rate for Payer: VA VA |
$20.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.96
|
|
|
HC HEPATITIS B VACCINE ADULT, 3 DOSE IM
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
63600026
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: BCBS Trust/PPO |
$63.85
|
| Rate for Payer: BCN Commercial |
$63.85
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.71
|
| Rate for Payer: UHC Core |
$68.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.96
|
|
|
HC HEPATITIS C ANTIBODY
|
Facility
|
OP
|
$48.26
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
30200336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$43.43 |
| Rate for Payer: Aetna Commercial |
$41.02
|
| Rate for Payer: Aetna Medicare |
$12.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.08
|
| Rate for Payer: BCBS Complete |
$11.06
|
| Rate for Payer: BCBS MAPPO |
$12.06
|
| Rate for Payer: BCBS Trust/PPO |
$37.52
|
| Rate for Payer: BCN Commercial |
$37.52
|
| Rate for Payer: BCN Medicare Advantage |
$12.06
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cofinity Commercial |
$41.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.06
|
| Rate for Payer: Healthscope Commercial |
$43.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.20
|
| Rate for Payer: Mclaren Medicaid |
$10.53
|
| Rate for Payer: Meridian Medicaid |
$11.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.02
|
| Rate for Payer: PACE Senior Care Partners |
$11.46
|
| Rate for Payer: PACE SWMI |
$12.06
|
| Rate for Payer: PHP Commercial |
$41.02
|
| Rate for Payer: PHP Medicare Advantage |
$12.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.99
|
| Rate for Payer: Priority Health Medicare |
$12.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.43
|
| Rate for Payer: Railroad Medicare Medicare |
$12.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.47
|
| Rate for Payer: UHC Core |
$40.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.06
|
| Rate for Payer: UHC Medicare Advantage |
$12.43
|
| Rate for Payer: VA VA |
$12.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.20
|
|
|
HC HEPATITIS C ANTIBODY
|
Facility
|
IP
|
$48.26
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
30200336
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.43 |
| Max. Negotiated Rate |
$43.43 |
| Rate for Payer: Aetna Commercial |
$41.02
|
| Rate for Payer: BCBS Trust/PPO |
$37.30
|
| Rate for Payer: BCN Commercial |
$37.30
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cofinity Commercial |
$41.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.61
|
| Rate for Payer: Healthscope Commercial |
$43.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.02
|
| Rate for Payer: PHP Commercial |
$41.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.47
|
| Rate for Payer: UHC Core |
$40.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.20
|
|
|
HC HEPATITIS C ANTIBODY BY RIBA
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
30200337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: BCBS Trust/PPO |
$62.60
|
| Rate for Payer: BCN Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.85
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.28
|
| Rate for Payer: UHC Core |
$67.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
|
HC HEPATITIS C ANTIBODY BY RIBA
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86804
|
| Hospital Charge Code |
30200337
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$21.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.31
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$20.25
|
| Rate for Payer: BCBS Trust/PPO |
$62.98
|
| Rate for Payer: BCN Commercial |
$62.98
|
| Rate for Payer: BCN Medicare Advantage |
$20.25
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Mclaren Medicaid |
$11.43
|
| Rate for Payer: Meridian Medicaid |
$12.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.85
|
| Rate for Payer: PACE Senior Care Partners |
$19.24
|
| Rate for Payer: PACE SWMI |
$20.25
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Medicare Advantage |
$20.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.47
|
| Rate for Payer: Priority Health Medicare |
$20.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.40
|
| Rate for Payer: Railroad Medicare Medicare |
$20.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.28
|
| Rate for Payer: UHC Core |
$67.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.25
|
| Rate for Payer: UHC Medicare Advantage |
$20.86
|
| Rate for Payer: VA VA |
$20.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANT
|
Facility
|
IP
|
$149.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$134.95 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: BCBS Trust/PPO |
$115.87
|
| Rate for Payer: BCN Commercial |
$115.87
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$128.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.95
|
| Rate for Payer: Healthscope Commercial |
$134.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.45
|
| Rate for Payer: PHP Commercial |
$127.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.95
|
| Rate for Payer: UHC Core |
$125.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.46
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANT
|
Facility
|
OP
|
$149.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600295
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$134.95 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna Medicare |
$38.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.86
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$37.48
|
| Rate for Payer: BCBS Trust/PPO |
$116.58
|
| Rate for Payer: BCN Commercial |
$116.58
|
| Rate for Payer: BCN Medicare Advantage |
$37.48
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$128.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$134.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.46
|
| Rate for Payer: Mclaren Medicaid |
$31.62
|
| Rate for Payer: Meridian Medicaid |
$33.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.45
|
| Rate for Payer: PACE Senior Care Partners |
$35.61
|
| Rate for Payer: PACE SWMI |
$37.48
|
| Rate for Payer: PHP Commercial |
$127.45
|
| Rate for Payer: PHP Medicare Advantage |
$37.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.45
|
| Rate for Payer: Priority Health Medicare |
$37.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.45
|
| Rate for Payer: Railroad Medicare Medicare |
$37.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.95
|
| Rate for Payer: UHC Core |
$125.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.48
|
| Rate for Payer: UHC Medicare Advantage |
$38.61
|
| Rate for Payer: VA VA |
$37.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.46
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANTIFICATION
|
Facility
|
IP
|
$149.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600157
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$91.45 |
| Max. Negotiated Rate |
$134.95 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: BCBS Trust/PPO |
$115.87
|
| Rate for Payer: BCN Commercial |
$115.87
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$128.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.95
|
| Rate for Payer: Healthscope Commercial |
$134.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.45
|
| Rate for Payer: PHP Commercial |
$127.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.95
|
| Rate for Payer: UHC Core |
$125.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.46
|
|
|
HC HEPATITIS C RNA PCR DETECT & QUANTIFICATION
|
Facility
|
OP
|
$149.94
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
30600157
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$134.95 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna Medicare |
$38.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.86
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$37.48
|
| Rate for Payer: BCBS Trust/PPO |
$116.58
|
| Rate for Payer: BCN Commercial |
$116.58
|
| Rate for Payer: BCN Medicare Advantage |
$37.48
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$128.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$134.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.46
|
| Rate for Payer: Mclaren Medicaid |
$31.62
|
| Rate for Payer: Meridian Medicaid |
$33.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.45
|
| Rate for Payer: PACE Senior Care Partners |
$35.61
|
| Rate for Payer: PACE SWMI |
$37.48
|
| Rate for Payer: PHP Commercial |
$127.45
|
| Rate for Payer: PHP Medicare Advantage |
$37.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.45
|
| Rate for Payer: Priority Health Medicare |
$37.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.45
|
| Rate for Payer: Railroad Medicare Medicare |
$37.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.95
|
| Rate for Payer: UHC Core |
$125.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.48
|
| Rate for Payer: UHC Medicare Advantage |
$38.61
|
| Rate for Payer: VA VA |
$37.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.46
|
|
|
HC HEPATITS B VACCINE (HEPB), PEDIATRIC/ADOLESCENT, 3 DOSE IM
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: BCBS Trust/PPO |
$27.59
|
| Rate for Payer: BCN Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC HEPATITS B VACCINE (HEPB), PEDIATRIC/ADOLESCENT, 3 DOSE IM
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
63600086
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$14.28
|
| Rate for Payer: BCBS MAPPO |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$27.76
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: BCN Medicare Advantage |
$8.92
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.92
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Senior Care Partners |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.92
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.06
|
| Rate for Payer: Priority Health Medicare |
$8.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: Railroad Medicare Medicare |
$8.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.92
|
| Rate for Payer: UHC Medicare Advantage |
$9.19
|
| Rate for Payer: VA VA |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
OP
|
$33.50
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$32.72 |
| Rate for Payer: Aetna Commercial |
$28.48
|
| Rate for Payer: Aetna Medicare |
$8.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.47
|
| Rate for Payer: BCBS Complete |
$32.72
|
| Rate for Payer: BCBS MAPPO |
$8.38
|
| Rate for Payer: BCBS Trust/PPO |
$26.05
|
| Rate for Payer: BCN Commercial |
$26.05
|
| Rate for Payer: BCN Medicare Advantage |
$8.38
|
| Rate for Payer: Cash Price |
$26.80
|
| Rate for Payer: Cash Price |
$26.80
|
| Rate for Payer: Cofinity Commercial |
$28.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.38
|
| Rate for Payer: Healthscope Commercial |
$30.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.12
|
| Rate for Payer: Mclaren Medicaid |
$31.16
|
| Rate for Payer: Meridian Medicaid |
$32.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.48
|
| Rate for Payer: PACE Senior Care Partners |
$7.96
|
| Rate for Payer: PACE SWMI |
$8.38
|
| Rate for Payer: PHP Commercial |
$28.48
|
| Rate for Payer: PHP Medicare Advantage |
$8.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.14
|
| Rate for Payer: Priority Health Medicare |
$8.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.43
|
| Rate for Payer: Railroad Medicare Medicare |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.48
|
| Rate for Payer: UHC Core |
$27.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.38
|
| Rate for Payer: UHC Medicare Advantage |
$8.63
|
| Rate for Payer: VA VA |
$8.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.12
|
|
|
HC HEP B ADMINISTRATION
|
Facility
|
IP
|
$33.50
|
|
|
Service Code
|
HCPCS G0010
|
| Hospital Charge Code |
77100008
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.43 |
| Max. Negotiated Rate |
$30.15 |
| Rate for Payer: Aetna Commercial |
$28.48
|
| Rate for Payer: BCBS Trust/PPO |
$25.89
|
| Rate for Payer: BCN Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$26.80
|
| Rate for Payer: Cofinity Commercial |
$28.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.80
|
| Rate for Payer: Healthscope Commercial |
$30.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.48
|
| Rate for Payer: PHP Commercial |
$28.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.48
|
| Rate for Payer: UHC Core |
$27.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.12
|
|
|
HC HEP B CORE AB TOTAL.
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| 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 |
$9.34
|
| 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 |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| 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 |
$8.89
|
| 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 HEP B CORE AB TOTAL.
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200293
|
|
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 HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
OP
|
$45.03
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$40.53 |
| Rate for Payer: Aetna Commercial |
$38.28
|
| Rate for Payer: Aetna Medicare |
$11.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.07
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$11.26
|
| Rate for Payer: BCBS Trust/PPO |
$35.01
|
| Rate for Payer: BCN Commercial |
$35.01
|
| Rate for Payer: BCN Medicare Advantage |
$11.26
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cofinity Commercial |
$38.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$40.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.77
|
| Rate for Payer: Mclaren Medicaid |
$7.62
|
| Rate for Payer: Meridian Medicaid |
$8.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.28
|
| Rate for Payer: PACE Senior Care Partners |
$10.69
|
| Rate for Payer: PACE SWMI |
$11.26
|
| Rate for Payer: PHP Commercial |
$38.28
|
| Rate for Payer: PHP Medicare Advantage |
$11.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.18
|
| Rate for Payer: Priority Health Medicare |
$11.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.46
|
| Rate for Payer: Railroad Medicare Medicare |
$11.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.63
|
| Rate for Payer: UHC Core |
$37.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.26
|
| Rate for Payer: UHC Medicare Advantage |
$11.60
|
| Rate for Payer: VA VA |
$11.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.77
|
|
|
HC HEP B SURFACE ANTIGEN CONFIRMATION
|
Facility
|
IP
|
$45.03
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
30600140
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$40.53 |
| Rate for Payer: Aetna Commercial |
$38.28
|
| Rate for Payer: BCBS Trust/PPO |
$34.80
|
| Rate for Payer: BCN Commercial |
$34.80
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cofinity Commercial |
$38.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.02
|
| Rate for Payer: Healthscope Commercial |
$40.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.28
|
| Rate for Payer: PHP Commercial |
$38.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.63
|
| Rate for Payer: UHC Core |
$37.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.77
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
IP
|
$326.40
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$199.07 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$277.44
|
| Rate for Payer: BCBS Trust/PPO |
$252.24
|
| Rate for Payer: BCN Commercial |
$252.24
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cofinity Commercial |
$280.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.12
|
| Rate for Payer: Healthscope Commercial |
$293.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.44
|
| Rate for Payer: PHP Commercial |
$277.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.23
|
| Rate for Payer: UHC Core |
$272.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.80
|
|
|
HC HEP B VACC 2 DOSE ADULT IM
|
Facility
|
OP
|
$326.40
|
|
|
Service Code
|
CPT 90739
|
| Hospital Charge Code |
63600181
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.52 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$277.44
|
| Rate for Payer: Aetna Medicare |
$84.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.00
|
| Rate for Payer: BCBS Complete |
$130.56
|
| Rate for Payer: BCBS MAPPO |
$81.60
|
| Rate for Payer: BCBS Trust/PPO |
$253.78
|
| Rate for Payer: BCN Commercial |
$253.78
|
| Rate for Payer: BCN Medicare Advantage |
$81.60
|
| Rate for Payer: Cash Price |
$261.12
|
| Rate for Payer: Cofinity Commercial |
$280.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$293.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$277.44
|
| Rate for Payer: PACE Senior Care Partners |
$77.52
|
| Rate for Payer: PACE SWMI |
$81.60
|
| Rate for Payer: PHP Commercial |
$277.44
|
| Rate for Payer: PHP Medicare Advantage |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.97
|
| Rate for Payer: Priority Health Medicare |
$81.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.07
|
| Rate for Payer: Railroad Medicare Medicare |
$81.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.23
|
| Rate for Payer: UHC Core |
$272.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.60
|
| Rate for Payer: UHC Medicare Advantage |
$84.05
|
| Rate for Payer: VA VA |
$81.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.80
|
|
|
HC HEP C GENO SUBTYPES
|
Facility
|
OP
|
$406.67
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600256
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$96.58 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Aetna Commercial |
$345.67
|
| Rate for Payer: Aetna Medicare |
$105.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.08
|
| Rate for Payer: BCBS Complete |
$199.50
|
| Rate for Payer: BCBS MAPPO |
$101.67
|
| Rate for Payer: BCBS Trust/PPO |
$316.19
|
| Rate for Payer: BCN Commercial |
$316.19
|
| Rate for Payer: BCN Medicare Advantage |
$101.67
|
| Rate for Payer: Cash Price |
$325.34
|
| Rate for Payer: Cash Price |
$325.34
|
| Rate for Payer: Cofinity Commercial |
$349.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.67
|
| Rate for Payer: Healthscope Commercial |
$366.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.00
|
| Rate for Payer: Mclaren Medicaid |
$190.00
|
| Rate for Payer: Meridian Medicaid |
$199.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.67
|
| Rate for Payer: PACE Senior Care Partners |
$96.58
|
| Rate for Payer: PACE SWMI |
$101.67
|
| Rate for Payer: PHP Commercial |
$345.67
|
| Rate for Payer: PHP Medicare Advantage |
$101.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.80
|
| Rate for Payer: Priority Health Medicare |
$101.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.03
|
| Rate for Payer: Railroad Medicare Medicare |
$101.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.87
|
| Rate for Payer: UHC Core |
$339.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.67
|
| Rate for Payer: UHC Medicare Advantage |
$104.72
|
| Rate for Payer: VA VA |
$101.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.00
|
|
