|
HC IGG SYNTHESIS RATE CSF ALBUMIN
|
Facility
|
OP
|
$16.32
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna Medicare |
$4.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.10
|
| Rate for Payer: BCBS Complete |
$6.03
|
| Rate for Payer: BCBS MAPPO |
$4.08
|
| Rate for Payer: BCBS Trust/PPO |
$12.69
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: BCN Medicare Advantage |
$4.08
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Mclaren Medicaid |
$5.74
|
| Rate for Payer: Meridian Medicaid |
$6.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.87
|
| Rate for Payer: PACE Senior Care Partners |
$3.88
|
| Rate for Payer: PACE SWMI |
$4.08
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: PHP Medicare Advantage |
$4.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.20
|
| Rate for Payer: Priority Health Medicare |
$4.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.36
|
| Rate for Payer: UHC Core |
$13.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.08
|
| Rate for Payer: UHC Medicare Advantage |
$4.20
|
| Rate for Payer: VA VA |
$4.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
|
|
HC IGG SYNTHESIS RATE CSF ALBUMIN
|
Facility
|
IP
|
$16.32
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$12.61
|
| Rate for Payer: BCN Commercial |
$12.61
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.87
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.36
|
| Rate for Payer: UHC Core |
$13.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
|
|
HC IGG SYNTHESIS RATE CSF-IGG
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC IGG SYNTHESIS RATE CSF-IGG
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Mclaren Medicaid |
$6.86
|
| Rate for Payer: Meridian Medicaid |
$7.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: BCBS Trust/PPO |
$7.88
|
| Rate for Payer: BCN Commercial |
$7.88
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.98
|
| Rate for Payer: UHC Core |
$8.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.65
|
|
|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$9.18 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna Medicare |
$2.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.19
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$2.55
|
| Rate for Payer: BCBS Trust/PPO |
$7.93
|
| Rate for Payer: BCN Commercial |
$7.93
|
| Rate for Payer: BCN Medicare Advantage |
$2.55
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cash Price |
$8.16
|
| Rate for Payer: Cofinity Commercial |
$8.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$9.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.65
|
| Rate for Payer: Mclaren Medicaid |
$3.65
|
| Rate for Payer: Meridian Medicaid |
$3.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.67
|
| Rate for Payer: PACE Senior Care Partners |
$2.42
|
| Rate for Payer: PACE SWMI |
$2.55
|
| Rate for Payer: PHP Commercial |
$8.67
|
| Rate for Payer: PHP Medicare Advantage |
$2.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.87
|
| Rate for Payer: Priority Health Medicare |
$2.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.22
|
| Rate for Payer: Railroad Medicare Medicare |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.98
|
| Rate for Payer: UHC Core |
$8.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.55
|
| Rate for Payer: UHC Medicare Advantage |
$2.63
|
| Rate for Payer: VA VA |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.65
|
|
|
HC IGH IN BCLL
|
Facility
|
OP
|
$439.22
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$104.31 |
| Max. Negotiated Rate |
$395.30 |
| Rate for Payer: Aetna Commercial |
$373.34
|
| Rate for Payer: Aetna Medicare |
$114.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.26
|
| Rate for Payer: BCBS Complete |
$228.22
|
| Rate for Payer: BCBS MAPPO |
$109.80
|
| Rate for Payer: BCBS Trust/PPO |
$341.49
|
| Rate for Payer: BCN Commercial |
$341.49
|
| Rate for Payer: BCN Medicare Advantage |
$109.80
|
| Rate for Payer: Cash Price |
$351.38
|
| Rate for Payer: Cash Price |
$351.38
|
| Rate for Payer: Cofinity Commercial |
$377.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.80
|
| Rate for Payer: Healthscope Commercial |
$395.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.42
|
| Rate for Payer: Mclaren Medicaid |
$217.36
|
| Rate for Payer: Meridian Medicaid |
$228.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$115.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.34
|
| Rate for Payer: PACE Senior Care Partners |
$104.31
|
| Rate for Payer: PACE SWMI |
$109.80
|
| Rate for Payer: PHP Commercial |
$373.34
|
| Rate for Payer: PHP Medicare Advantage |
$109.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.12
|
| Rate for Payer: Priority Health Medicare |
$109.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.88
|
| Rate for Payer: Railroad Medicare Medicare |
$109.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.51
|
| Rate for Payer: UHC Core |
$366.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.80
|
| Rate for Payer: UHC Medicare Advantage |
$113.10
|
| Rate for Payer: VA VA |
$109.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.42
|
|
|
HC IGH IN BCLL
|
Facility
|
IP
|
$439.22
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$267.88 |
| Max. Negotiated Rate |
$395.30 |
| Rate for Payer: Aetna Commercial |
$373.34
|
| Rate for Payer: BCBS Trust/PPO |
$339.43
|
| Rate for Payer: BCN Commercial |
$339.43
|
| Rate for Payer: Cash Price |
$351.38
|
| Rate for Payer: Cofinity Commercial |
$377.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.38
|
| Rate for Payer: Healthscope Commercial |
$395.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.34
|
| Rate for Payer: PHP Commercial |
$373.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.51
|
| Rate for Payer: UHC Core |
$366.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.42
|
|
|
HC ILEOSCOPY
|
Facility
|
OP
|
$2,263.54
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.59 |
| Max. Negotiated Rate |
$2,037.19 |
| Rate for Payer: Aetna Commercial |
$1,924.01
|
| Rate for Payer: Aetna Medicare |
$588.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$707.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$707.36
|
| Rate for Payer: BCBS Complete |
$905.42
|
| Rate for Payer: BCBS MAPPO |
$565.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,759.90
|
| Rate for Payer: BCN Commercial |
$1,759.90
|
| Rate for Payer: BCN Medicare Advantage |
$565.88
|
| Rate for Payer: Cash Price |
$1,810.83
|
| Rate for Payer: Cofinity Commercial |
$1,946.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,810.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$565.88
|
| Rate for Payer: Healthscope Commercial |
$2,037.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,697.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$594.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$650.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,924.01
|
| Rate for Payer: PACE Senior Care Partners |
$537.59
|
| Rate for Payer: PACE SWMI |
$565.88
|
| Rate for Payer: PHP Commercial |
$1,924.01
|
| Rate for Payer: PHP Medicare Advantage |
$565.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,584.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,969.28
|
| Rate for Payer: Priority Health Medicare |
$565.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,380.53
|
| Rate for Payer: Railroad Medicare Medicare |
$565.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,991.92
|
| Rate for Payer: UHC Core |
$1,890.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$565.88
|
| Rate for Payer: UHC Medicare Advantage |
$582.86
|
| Rate for Payer: VA VA |
$565.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,697.66
|
|
|
HC ILEOSCOPY
|
Facility
|
IP
|
$2,263.54
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,380.53 |
| Max. Negotiated Rate |
$2,037.19 |
| Rate for Payer: Aetna Commercial |
$1,924.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.26
|
| Rate for Payer: BCN Commercial |
$1,749.26
|
| Rate for Payer: Cash Price |
$1,810.83
|
| Rate for Payer: Cofinity Commercial |
$1,946.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,810.83
|
| Rate for Payer: Healthscope Commercial |
$2,037.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,697.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,924.01
|
| Rate for Payer: PHP Commercial |
$1,924.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,584.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,969.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,380.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,991.92
|
| Rate for Payer: UHC Core |
$1,890.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,697.66
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
OP
|
$2,701.70
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$641.65 |
| Max. Negotiated Rate |
$2,431.53 |
| Rate for Payer: Aetna Commercial |
$2,296.44
|
| Rate for Payer: Aetna Medicare |
$702.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.28
|
| Rate for Payer: BCBS Complete |
$1,080.68
|
| Rate for Payer: BCBS MAPPO |
$675.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,100.57
|
| Rate for Payer: BCN Commercial |
$2,100.57
|
| Rate for Payer: BCN Medicare Advantage |
$675.42
|
| Rate for Payer: Cash Price |
$2,161.36
|
| Rate for Payer: Cofinity Commercial |
$2,323.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,161.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.42
|
| Rate for Payer: Healthscope Commercial |
$2,431.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,026.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$709.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,296.44
|
| Rate for Payer: PACE Senior Care Partners |
$641.65
|
| Rate for Payer: PACE SWMI |
$675.42
|
| Rate for Payer: PHP Commercial |
$2,296.44
|
| Rate for Payer: PHP Medicare Advantage |
$675.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,891.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,350.48
|
| Rate for Payer: Priority Health Medicare |
$675.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,647.77
|
| Rate for Payer: Railroad Medicare Medicare |
$675.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,377.50
|
| Rate for Payer: UHC Core |
$2,255.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.42
|
| Rate for Payer: UHC Medicare Advantage |
$695.69
|
| Rate for Payer: VA VA |
$675.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,026.28
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
IP
|
$2,701.70
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,647.77 |
| Max. Negotiated Rate |
$2,431.53 |
| Rate for Payer: Aetna Commercial |
$2,296.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,087.87
|
| Rate for Payer: BCN Commercial |
$2,087.87
|
| Rate for Payer: Cash Price |
$2,161.36
|
| Rate for Payer: Cofinity Commercial |
$2,323.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,161.36
|
| Rate for Payer: Healthscope Commercial |
$2,431.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,026.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,296.44
|
| Rate for Payer: PHP Commercial |
$2,296.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,891.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,350.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,647.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,377.50
|
| Rate for Payer: UHC Core |
$2,255.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,026.28
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$136.65
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$83.34 |
| Max. Negotiated Rate |
$122.98 |
| Rate for Payer: Aetna Commercial |
$116.15
|
| Rate for Payer: BCBS Trust/PPO |
$105.60
|
| Rate for Payer: BCN Commercial |
$105.60
|
| Rate for Payer: Cash Price |
$109.32
|
| Rate for Payer: Cofinity Commercial |
$117.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.32
|
| Rate for Payer: Healthscope Commercial |
$122.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.15
|
| Rate for Payer: PHP Commercial |
$116.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.25
|
| Rate for Payer: UHC Core |
$114.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.49
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$136.65
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$122.98 |
| Rate for Payer: Aetna Commercial |
$116.15
|
| Rate for Payer: Aetna Medicare |
$35.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.70
|
| Rate for Payer: BCBS Complete |
$117.65
|
| Rate for Payer: BCBS MAPPO |
$34.16
|
| Rate for Payer: BCBS Trust/PPO |
$106.25
|
| Rate for Payer: BCN Commercial |
$106.25
|
| Rate for Payer: BCN Medicare Advantage |
$34.16
|
| Rate for Payer: Cash Price |
$109.32
|
| Rate for Payer: Cash Price |
$109.32
|
| Rate for Payer: Cofinity Commercial |
$117.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.16
|
| Rate for Payer: Healthscope Commercial |
$122.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.49
|
| Rate for Payer: Mclaren Medicaid |
$112.04
|
| Rate for Payer: Meridian Medicaid |
$117.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.15
|
| Rate for Payer: PACE Senior Care Partners |
$32.45
|
| Rate for Payer: PACE SWMI |
$34.16
|
| Rate for Payer: PHP Commercial |
$116.15
|
| Rate for Payer: PHP Medicare Advantage |
$34.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.89
|
| Rate for Payer: Priority Health Medicare |
$34.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.34
|
| Rate for Payer: Railroad Medicare Medicare |
$34.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.25
|
| Rate for Payer: UHC Core |
$114.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.16
|
| Rate for Payer: UHC Medicare Advantage |
$35.19
|
| Rate for Payer: VA VA |
$34.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.49
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$103.91
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$93.52 |
| Rate for Payer: Aetna Commercial |
$88.32
|
| Rate for Payer: Aetna Medicare |
$27.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.47
|
| Rate for Payer: BCBS Complete |
$41.56
|
| Rate for Payer: BCBS MAPPO |
$25.98
|
| Rate for Payer: BCBS Trust/PPO |
$80.79
|
| Rate for Payer: BCN Commercial |
$80.79
|
| Rate for Payer: BCN Medicare Advantage |
$25.98
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Cofinity Commercial |
$89.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.98
|
| Rate for Payer: Healthscope Commercial |
$93.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.32
|
| Rate for Payer: PACE Senior Care Partners |
$24.68
|
| Rate for Payer: PACE SWMI |
$25.98
|
| Rate for Payer: PHP Commercial |
$88.32
|
| Rate for Payer: PHP Medicare Advantage |
$25.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.40
|
| Rate for Payer: Priority Health Medicare |
$25.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.37
|
| Rate for Payer: Railroad Medicare Medicare |
$25.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.44
|
| Rate for Payer: UHC Core |
$86.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.98
|
| Rate for Payer: UHC Medicare Advantage |
$26.76
|
| Rate for Payer: VA VA |
$25.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.93
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$103.91
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$63.37 |
| Max. Negotiated Rate |
$93.52 |
| Rate for Payer: Aetna Commercial |
$88.32
|
| Rate for Payer: BCBS Trust/PPO |
$80.30
|
| Rate for Payer: BCN Commercial |
$80.30
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Cofinity Commercial |
$89.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.13
|
| Rate for Payer: Healthscope Commercial |
$93.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.32
|
| Rate for Payer: PHP Commercial |
$88.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.44
|
| Rate for Payer: UHC Core |
$86.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.93
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$59.87
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$53.88 |
| Rate for Payer: Aetna Commercial |
$50.89
|
| Rate for Payer: Aetna Medicare |
$15.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.71
|
| Rate for Payer: BCBS Complete |
$27.69
|
| Rate for Payer: BCBS MAPPO |
$14.97
|
| Rate for Payer: BCBS Trust/PPO |
$46.55
|
| Rate for Payer: BCN Commercial |
$46.55
|
| Rate for Payer: BCN Medicare Advantage |
$14.97
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Cofinity Commercial |
$51.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.97
|
| Rate for Payer: Healthscope Commercial |
$53.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.90
|
| Rate for Payer: Mclaren Medicaid |
$26.38
|
| Rate for Payer: Meridian Medicaid |
$27.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.89
|
| Rate for Payer: PACE Senior Care Partners |
$14.22
|
| Rate for Payer: PACE SWMI |
$14.97
|
| Rate for Payer: PHP Commercial |
$50.89
|
| Rate for Payer: PHP Medicare Advantage |
$14.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.09
|
| Rate for Payer: Priority Health Medicare |
$14.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.51
|
| Rate for Payer: Railroad Medicare Medicare |
$14.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.69
|
| Rate for Payer: UHC Core |
$49.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.97
|
| Rate for Payer: UHC Medicare Advantage |
$15.42
|
| Rate for Payer: VA VA |
$14.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.90
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$59.87
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$53.88 |
| Rate for Payer: Aetna Commercial |
$50.89
|
| Rate for Payer: BCBS Trust/PPO |
$46.27
|
| Rate for Payer: BCN Commercial |
$46.27
|
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Cofinity Commercial |
$51.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.90
|
| Rate for Payer: Healthscope Commercial |
$53.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.89
|
| Rate for Payer: PHP Commercial |
$50.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.69
|
| Rate for Payer: UHC Core |
$49.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.90
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$23.18
|
| Rate for Payer: BCN Commercial |
$23.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.40
|
| Rate for Payer: UHC Core |
$25.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.38
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$7.50
|
| Rate for Payer: BCBS Trust/PPO |
$23.32
|
| Rate for Payer: BCN Commercial |
$23.32
|
| Rate for Payer: BCN Medicare Advantage |
$7.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PACE Senior Care Partners |
$7.12
|
| Rate for Payer: PACE SWMI |
$7.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: PHP Medicare Advantage |
$7.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.10
|
| Rate for Payer: Priority Health Medicare |
$7.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.30
|
| Rate for Payer: Railroad Medicare Medicare |
$7.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.40
|
| Rate for Payer: UHC Core |
$25.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.50
|
| Rate for Payer: UHC Medicare Advantage |
$7.72
|
| Rate for Payer: VA VA |
$7.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.13 |
| Max. Negotiated Rate |
$29.70 |
| Rate for Payer: Aetna Commercial |
$28.05
|
| Rate for Payer: BCBS Trust/PPO |
$25.50
|
| Rate for Payer: BCN Commercial |
$25.50
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$28.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.40
|
| Rate for Payer: Healthscope Commercial |
$29.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.05
|
| Rate for Payer: PHP Commercial |
$28.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.04
|
| Rate for Payer: UHC Core |
$27.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.75
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$48.52 |
| Rate for Payer: Aetna Commercial |
$28.05
|
| Rate for Payer: Aetna Medicare |
$8.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.31
|
| Rate for Payer: BCBS Complete |
$48.52
|
| Rate for Payer: BCBS MAPPO |
$8.25
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$25.66
|
| Rate for Payer: BCN Medicare Advantage |
$8.25
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$28.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.25
|
| Rate for Payer: Healthscope Commercial |
$29.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.75
|
| Rate for Payer: Mclaren Medicaid |
$46.21
|
| Rate for Payer: Meridian Medicaid |
$48.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.05
|
| Rate for Payer: PACE Senior Care Partners |
$7.84
|
| Rate for Payer: PACE SWMI |
$8.25
|
| Rate for Payer: PHP Commercial |
$28.05
|
| Rate for Payer: PHP Medicare Advantage |
$8.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.71
|
| Rate for Payer: Priority Health Medicare |
$8.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.13
|
| Rate for Payer: Railroad Medicare Medicare |
$8.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.04
|
| Rate for Payer: UHC Core |
$27.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.25
|
| Rate for Payer: UHC Medicare Advantage |
$8.50
|
| Rate for Payer: VA VA |
$8.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.75
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
IP
|
$33.45
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$30.10 |
| Rate for Payer: Aetna Commercial |
$28.43
|
| Rate for Payer: BCBS Trust/PPO |
$25.85
|
| Rate for Payer: BCN Commercial |
$25.85
|
| Rate for Payer: Cash Price |
$26.76
|
| Rate for Payer: Cofinity Commercial |
$28.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.76
|
| Rate for Payer: Healthscope Commercial |
$30.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.43
|
| Rate for Payer: PHP Commercial |
$28.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.44
|
| Rate for Payer: UHC Core |
$27.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.09
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
OP
|
$33.45
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$30.10 |
| Rate for Payer: Aetna Commercial |
$28.43
|
| Rate for Payer: Aetna Medicare |
$8.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.45
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$8.36
|
| Rate for Payer: BCBS Trust/PPO |
$26.01
|
| Rate for Payer: BCN Commercial |
$26.01
|
| Rate for Payer: BCN Medicare Advantage |
$8.36
|
| Rate for Payer: Cash Price |
$26.76
|
| Rate for Payer: Cofinity Commercial |
$28.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.36
|
| Rate for Payer: Healthscope Commercial |
$30.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.43
|
| Rate for Payer: PACE Senior Care Partners |
$7.94
|
| Rate for Payer: PACE SWMI |
$8.36
|
| Rate for Payer: PHP Commercial |
$28.43
|
| Rate for Payer: PHP Medicare Advantage |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.10
|
| Rate for Payer: Priority Health Medicare |
$8.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.40
|
| Rate for Payer: Railroad Medicare Medicare |
$8.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.44
|
| Rate for Payer: UHC Core |
$27.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.36
|
| Rate for Payer: UHC Medicare Advantage |
$8.61
|
| Rate for Payer: VA VA |
$8.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.09
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.81
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$6.25
|
| Rate for Payer: BCBS Trust/PPO |
$19.44
|
| Rate for Payer: BCN Commercial |
$19.44
|
| Rate for Payer: BCN Medicare Advantage |
$6.25
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PACE Senior Care Partners |
$5.94
|
| Rate for Payer: PACE SWMI |
$6.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Medicare Advantage |
$6.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.75
|
| Rate for Payer: Priority Health Medicare |
$6.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.00
|
| Rate for Payer: UHC Core |
$20.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.25
|
| Rate for Payer: UHC Medicare Advantage |
$6.44
|
| Rate for Payer: VA VA |
$6.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
