|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
OP
|
$3,622.26
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$638.60 |
| Max. Negotiated Rate |
$3,260.03 |
| Rate for Payer: Aetna Commercial |
$3,078.92
|
| Rate for Payer: Aetna Medicare |
$941.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,131.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,131.96
|
| Rate for Payer: BCBS Complete |
$670.48
|
| Rate for Payer: BCBS MAPPO |
$905.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,977.86
|
| Rate for Payer: BCN Commercial |
$2,977.86
|
| Rate for Payer: BCN Medicare Advantage |
$905.57
|
| Rate for Payer: Cash Price |
$2,897.81
|
| Rate for Payer: Cofinity Commercial |
$3,115.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,897.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$905.57
|
| Rate for Payer: Healthscope Commercial |
$3,260.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,716.70
|
| Rate for Payer: Mclaren Medicaid |
$638.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$950.84
|
| Rate for Payer: Meridian Medicaid |
$670.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,041.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$996.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,078.92
|
| Rate for Payer: Nomi Health Commercial |
$2,970.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,716.70
|
| Rate for Payer: PACE Senior Care Partners |
$860.29
|
| Rate for Payer: PACE SWMI |
$905.57
|
| Rate for Payer: PHP Commercial |
$3,078.92
|
| Rate for Payer: PHP Medicare Advantage |
$905.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$638.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,151.37
|
| Rate for Payer: Priority Health Medicare |
$914.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,521.09
|
| Rate for Payer: Railroad Medicare Medicare |
$905.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,187.59
|
| Rate for Payer: UHC Core |
$3,024.59
|
| Rate for Payer: UHC Exchange |
$905.57
|
| Rate for Payer: UHC Medicaid |
$638.60
|
| Rate for Payer: UHC Medicare Advantage |
$905.57
|
| Rate for Payer: UHCCP Medicaid |
$638.60
|
| Rate for Payer: VA VA |
$905.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,716.70
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
OP
|
$133.38
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.51 |
| Max. Negotiated Rate |
$120.04 |
| Rate for Payer: Aetna Commercial |
$113.37
|
| Rate for Payer: Aetna Medicare |
$34.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.68
|
| Rate for Payer: BCBS Complete |
$24.69
|
| Rate for Payer: BCBS MAPPO |
$33.34
|
| Rate for Payer: BCBS Trust/PPO |
$109.65
|
| Rate for Payer: BCN Commercial |
$109.65
|
| Rate for Payer: BCN Medicare Advantage |
$33.34
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Cofinity Commercial |
$114.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.34
|
| Rate for Payer: Healthscope Commercial |
$120.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.03
|
| Rate for Payer: Mclaren Medicaid |
$23.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.01
|
| Rate for Payer: Meridian Medicaid |
$24.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.37
|
| Rate for Payer: Nomi Health Commercial |
$109.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.03
|
| Rate for Payer: PACE Senior Care Partners |
$31.68
|
| Rate for Payer: PACE SWMI |
$33.34
|
| Rate for Payer: PHP Commercial |
$113.37
|
| Rate for Payer: PHP Medicare Advantage |
$33.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$116.04
|
| Rate for Payer: Priority Health Medicare |
$33.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.83
|
| Rate for Payer: Railroad Medicare Medicare |
$33.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.37
|
| Rate for Payer: UHC Core |
$111.37
|
| Rate for Payer: UHC Exchange |
$33.34
|
| Rate for Payer: UHC Medicaid |
$23.51
|
| Rate for Payer: UHC Medicare Advantage |
$33.34
|
| Rate for Payer: UHCCP Medicaid |
$23.51
|
| Rate for Payer: VA VA |
$33.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.03
|
|
|
HC HEPATITIS A ANTIBODY IGM
|
Facility
|
IP
|
$133.38
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
30200299
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$92.83 |
| Max. Negotiated Rate |
$120.04 |
| Rate for Payer: Aetna Commercial |
$113.37
|
| Rate for Payer: BCBS Trust/PPO |
$110.16
|
| Rate for Payer: BCN Commercial |
$110.16
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Cofinity Commercial |
$114.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.70
|
| Rate for Payer: Healthscope Commercial |
$120.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.37
|
| Rate for Payer: Nomi Health Commercial |
$109.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.03
|
| Rate for Payer: PHP Commercial |
$113.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$116.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.37
|
| Rate for Payer: UHC Core |
$111.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.03
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$217.24 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: BCBS Trust/PPO |
$257.78
|
| Rate for Payer: BCN Commercial |
$257.78
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.67
|
| Rate for Payer: UHC Core |
$260.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
HC HEPATITIS ABC PANEL
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
30100017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: Aetna Medicare |
$81.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.54
|
| Rate for Payer: BCBS Complete |
$57.77
|
| Rate for Payer: BCBS MAPPO |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$256.59
|
| Rate for Payer: BCN Commercial |
$256.59
|
| Rate for Payer: BCN Medicare Advantage |
$78.03
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.03
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: Mclaren Medicaid |
$55.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.93
|
| Rate for Payer: Meridian Medicaid |
$57.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.09
|
| Rate for Payer: PACE Senior Care Partners |
$74.13
|
| Rate for Payer: PACE SWMI |
$78.03
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: PHP Medicare Advantage |
$78.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.54
|
| Rate for Payer: Priority Health Medicare |
$78.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.24
|
| Rate for Payer: Railroad Medicare Medicare |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.67
|
| Rate for Payer: UHC Core |
$260.62
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Medicaid |
$55.03
|
| Rate for Payer: UHC Medicare Advantage |
$78.03
|
| Rate for Payer: UHCCP Medicaid |
$55.03
|
| Rate for Payer: VA VA |
$78.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
HC HEPATITIS A IGG
|
Facility
|
OP
|
$44.57
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$40.11 |
| Rate for Payer: Aetna Commercial |
$37.88
|
| Rate for Payer: Aetna Medicare |
$11.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.93
|
| Rate for Payer: BCBS Complete |
$8.25
|
| Rate for Payer: BCBS MAPPO |
$11.14
|
| Rate for Payer: BCBS Trust/PPO |
$36.64
|
| Rate for Payer: BCN Commercial |
$36.64
|
| Rate for Payer: BCN Medicare Advantage |
$11.14
|
| Rate for Payer: Cash Price |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$38.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.14
|
| Rate for Payer: Healthscope Commercial |
$40.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.43
|
| Rate for Payer: Mclaren Medicaid |
$7.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.70
|
| Rate for Payer: Meridian Medicaid |
$8.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.88
|
| Rate for Payer: Nomi Health Commercial |
$36.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.43
|
| Rate for Payer: PACE Senior Care Partners |
$10.59
|
| Rate for Payer: PACE SWMI |
$11.14
|
| Rate for Payer: PHP Commercial |
$37.88
|
| Rate for Payer: PHP Medicare Advantage |
$11.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.78
|
| Rate for Payer: Priority Health Medicare |
$11.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.02
|
| Rate for Payer: Railroad Medicare Medicare |
$11.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.22
|
| Rate for Payer: UHC Core |
$37.22
|
| Rate for Payer: UHC Exchange |
$11.14
|
| Rate for Payer: UHC Medicaid |
$7.86
|
| Rate for Payer: UHC Medicare Advantage |
$11.14
|
| Rate for Payer: UHCCP Medicaid |
$7.86
|
| Rate for Payer: VA VA |
$11.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.43
|
|
|
HC HEPATITIS A IGG
|
Facility
|
IP
|
$44.57
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200408
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$40.11 |
| Rate for Payer: Aetna Commercial |
$37.88
|
| Rate for Payer: BCBS Trust/PPO |
$36.81
|
| Rate for Payer: BCN Commercial |
$36.81
|
| Rate for Payer: Cash Price |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$38.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.66
|
| Rate for Payer: Healthscope Commercial |
$40.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.88
|
| Rate for Payer: Nomi Health Commercial |
$36.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.43
|
| Rate for Payer: PHP Commercial |
$37.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.22
|
| Rate for Payer: UHC Core |
$37.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.43
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
OP
|
$48.82
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$43.94 |
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: Aetna Medicare |
$12.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.26
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$12.21
|
| Rate for Payer: BCBS Trust/PPO |
$40.13
|
| Rate for Payer: BCN Commercial |
$40.13
|
| Rate for Payer: BCN Medicare Advantage |
$12.21
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.21
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.82
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Nomi Health Commercial |
$40.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PACE Senior Care Partners |
$11.59
|
| Rate for Payer: PACE SWMI |
$12.21
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.47
|
| Rate for Payer: Priority Health Medicare |
$12.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.98
|
| Rate for Payer: Railroad Medicare Medicare |
$12.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.96
|
| Rate for Payer: UHC Core |
$40.76
|
| Rate for Payer: UHC Exchange |
$12.21
|
| Rate for Payer: UHC Medicaid |
$8.61
|
| Rate for Payer: UHC Medicare Advantage |
$12.21
|
| Rate for Payer: UHCCP Medicaid |
$8.61
|
| Rate for Payer: VA VA |
$12.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
|
|
HC HEPATITIS A TOTAL ANTIBODY
|
Facility
|
IP
|
$48.82
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
30200298
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.98 |
| Max. Negotiated Rate |
$43.94 |
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: BCBS Trust/PPO |
$40.32
|
| Rate for Payer: BCN Commercial |
$40.32
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Nomi Health Commercial |
$40.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.96
|
| Rate for Payer: UHC Core |
$40.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
IP
|
$93.39
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: BCBS Trust/PPO |
$77.13
|
| Rate for Payer: BCN Commercial |
$77.13
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.18
|
| Rate for Payer: UHC Core |
$77.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC HEPATITIS A VACCINE (HEPA) ADULT IM
|
Facility
|
OP
|
$93.39
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
63600067
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: Aetna Medicare |
$24.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.18
|
| Rate for Payer: BCBS Complete |
$17.29
|
| Rate for Payer: BCBS MAPPO |
$23.35
|
| Rate for Payer: BCBS Trust/PPO |
$76.78
|
| Rate for Payer: BCN Commercial |
$76.78
|
| Rate for Payer: BCN Medicare Advantage |
$23.35
|
| Rate for Payer: Cash Price |
$74.71
|
| Rate for Payer: Cofinity Commercial |
$80.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.35
|
| Rate for Payer: Healthscope Commercial |
$84.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.04
|
| Rate for Payer: Mclaren Medicaid |
$16.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.51
|
| Rate for Payer: Meridian Medicaid |
$17.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.38
|
| Rate for Payer: Nomi Health Commercial |
$76.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.04
|
| Rate for Payer: PACE Senior Care Partners |
$22.18
|
| Rate for Payer: PACE SWMI |
$23.35
|
| Rate for Payer: PHP Commercial |
$79.38
|
| Rate for Payer: PHP Medicare Advantage |
$23.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$23.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.00
|
| Rate for Payer: Railroad Medicare Medicare |
$23.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.18
|
| Rate for Payer: UHC Core |
$77.98
|
| Rate for Payer: UHC Exchange |
$23.35
|
| Rate for Payer: UHC Medicaid |
$16.46
|
| Rate for Payer: UHC Medicare Advantage |
$23.35
|
| Rate for Payer: UHCCP Medicaid |
$16.46
|
| Rate for Payer: VA VA |
$23.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.04
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.93 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$43.82
|
| Rate for Payer: BCN Commercial |
$43.82
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC HEPATITIS A VAC (HEPA) PEDI/ADOLESCENT DOSAGE-2 DOSE SCHEDULE IM
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
63600068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.58
|
| Rate for Payer: BCBS Complete |
$9.82
|
| Rate for Payer: BCBS MAPPO |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$43.62
|
| Rate for Payer: BCN Commercial |
$43.62
|
| Rate for Payer: BCN Medicare Advantage |
$13.27
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.27
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Mclaren Medicaid |
$9.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.93
|
| Rate for Payer: Meridian Medicaid |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Senior Care Partners |
$12.60
|
| Rate for Payer: PACE SWMI |
$13.27
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Medicare |
$13.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: UHC Exchange |
$13.27
|
| Rate for Payer: UHC Medicaid |
$9.35
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: UHCCP Medicaid |
$9.35
|
| Rate for Payer: VA VA |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$26.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.86
|
| Rate for Payer: BCBS Complete |
$18.87
|
| Rate for Payer: BCBS MAPPO |
$25.49
|
| Rate for Payer: BCBS Trust/PPO |
$83.82
|
| Rate for Payer: BCN Commercial |
$83.82
|
| Rate for Payer: BCN Medicare Advantage |
$25.49
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.47
|
| Rate for Payer: Mclaren Medicaid |
$17.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.76
|
| Rate for Payer: Meridian Medicaid |
$18.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PACE Senior Care Partners |
$24.22
|
| Rate for Payer: PACE SWMI |
$25.49
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: PHP Medicare Advantage |
$25.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.71
|
| Rate for Payer: Priority Health Medicare |
$25.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.96
|
| Rate for Payer: Railroad Medicare Medicare |
$25.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.72
|
| Rate for Payer: UHC Core |
$85.14
|
| Rate for Payer: UHC Exchange |
$25.49
|
| Rate for Payer: UHC Medicaid |
$17.98
|
| Rate for Payer: UHC Medicare Advantage |
$25.49
|
| Rate for Payer: UHCCP Medicaid |
$17.98
|
| Rate for Payer: VA VA |
$25.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.47
|
|
|
HC HEPATITIS B CORE AB IGM
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200295
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.96 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: BCBS Trust/PPO |
$84.21
|
| Rate for Payer: BCN Commercial |
$84.21
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.72
|
| Rate for Payer: UHC Core |
$85.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.47
|
|
|
HC HEPATITIS B CORE AB TOTAL.
|
Facility
|
OP
|
$49.78
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$44.80 |
| Rate for Payer: Aetna Commercial |
$42.31
|
| Rate for Payer: Aetna Medicare |
$12.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.56
|
| Rate for Payer: BCBS Complete |
$9.21
|
| Rate for Payer: BCBS MAPPO |
$12.45
|
| Rate for Payer: BCBS Trust/PPO |
$40.92
|
| Rate for Payer: BCN Commercial |
$40.92
|
| Rate for Payer: BCN Medicare Advantage |
$12.45
|
| Rate for Payer: Cash Price |
$39.82
|
| Rate for Payer: Cofinity Commercial |
$42.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.45
|
| Rate for Payer: Healthscope Commercial |
$44.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.34
|
| Rate for Payer: Mclaren Medicaid |
$8.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.07
|
| Rate for Payer: Meridian Medicaid |
$9.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.31
|
| Rate for Payer: Nomi Health Commercial |
$40.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.34
|
| Rate for Payer: PACE Senior Care Partners |
$11.82
|
| Rate for Payer: PACE SWMI |
$12.45
|
| Rate for Payer: PHP Commercial |
$42.31
|
| Rate for Payer: PHP Medicare Advantage |
$12.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.31
|
| Rate for Payer: Priority Health Medicare |
$12.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.65
|
| Rate for Payer: Railroad Medicare Medicare |
$12.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.81
|
| Rate for Payer: UHC Core |
$41.57
|
| Rate for Payer: UHC Exchange |
$12.45
|
| Rate for Payer: UHC Medicaid |
$8.78
|
| Rate for Payer: UHC Medicare Advantage |
$12.45
|
| Rate for Payer: UHCCP Medicaid |
$8.78
|
| Rate for Payer: VA VA |
$12.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.34
|
|
|
HC HEPATITIS B CORE AB TOTAL.
|
Facility
|
IP
|
$49.78
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200294
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$44.80 |
| Rate for Payer: Aetna Commercial |
$42.31
|
| Rate for Payer: BCBS Trust/PPO |
$41.11
|
| Rate for Payer: BCN Commercial |
$41.11
|
| Rate for Payer: Cash Price |
$39.82
|
| Rate for Payer: Cofinity Commercial |
$42.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.82
|
| Rate for Payer: Healthscope Commercial |
$44.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.31
|
| Rate for Payer: Nomi Health Commercial |
$40.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.34
|
| Rate for Payer: PHP Commercial |
$42.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.81
|
| Rate for Payer: UHC Core |
$41.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.34
|
|
|
HC HEPATITIS B CORE ANTIBODY TOTAL
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200511
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.99 |
| 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 |
$9.44
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$41.93
|
| Rate for Payer: BCN Commercial |
$41.93
|
| 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: Mclaren Medicaid |
$8.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: Meridian Medicaid |
$9.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| 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 |
$8.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: UHC Exchange |
$12.75
|
| Rate for Payer: UHC Medicaid |
$8.99
|
| Rate for Payer: UHC Medicare Advantage |
$12.75
|
| Rate for Payer: UHCCP Medicaid |
$8.99
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HEPATITIS B CORE ANTIBODY TOTAL
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
30200511
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$42.12
|
| Rate for Payer: BCN Commercial |
$42.12
|
| 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 Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HEPATITIS B DNA QUANTITATION
|
Facility
|
IP
|
$180.41
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
30600154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$125.57 |
| Max. Negotiated Rate |
$162.37 |
| Rate for Payer: Aetna Commercial |
$153.35
|
| Rate for Payer: BCBS Trust/PPO |
$149.00
|
| Rate for Payer: BCN Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$144.33
|
| Rate for Payer: Cofinity Commercial |
$155.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.33
|
| Rate for Payer: Healthscope Commercial |
$162.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.35
|
| Rate for Payer: Nomi Health Commercial |
$147.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.31
|
| Rate for Payer: PHP Commercial |
$153.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.76
|
| Rate for Payer: UHC Core |
$150.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.31
|
|
|
HC HEPATITIS B DNA QUANTITATION
|
Facility
|
OP
|
$180.41
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
30600154
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$162.37 |
| Rate for Payer: Aetna Commercial |
$153.35
|
| Rate for Payer: Aetna Medicare |
$46.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.38
|
| Rate for Payer: BCBS Complete |
$33.39
|
| Rate for Payer: BCBS MAPPO |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$148.32
|
| Rate for Payer: BCN Commercial |
$148.32
|
| Rate for Payer: BCN Medicare Advantage |
$45.10
|
| Rate for Payer: Cash Price |
$144.33
|
| Rate for Payer: Cofinity Commercial |
$155.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.10
|
| Rate for Payer: Healthscope Commercial |
$162.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.31
|
| Rate for Payer: Mclaren Medicaid |
$31.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.36
|
| Rate for Payer: Meridian Medicaid |
$33.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.35
|
| Rate for Payer: Nomi Health Commercial |
$147.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.31
|
| Rate for Payer: PACE Senior Care Partners |
$42.85
|
| Rate for Payer: PACE SWMI |
$45.10
|
| Rate for Payer: PHP Commercial |
$153.35
|
| Rate for Payer: PHP Medicare Advantage |
$45.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.96
|
| Rate for Payer: Priority Health Medicare |
$45.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.57
|
| Rate for Payer: Railroad Medicare Medicare |
$45.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.76
|
| Rate for Payer: UHC Core |
$150.64
|
| Rate for Payer: UHC Exchange |
$45.10
|
| Rate for Payer: UHC Medicaid |
$31.81
|
| Rate for Payer: UHC Medicare Advantage |
$45.10
|
| Rate for Payer: UHCCP Medicaid |
$31.81
|
| Rate for Payer: VA VA |
$45.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.31
|
|
|
HC HEPATITIS BE AG CMPT
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
30600349
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.01
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.78
|
| Rate for Payer: BCBS Complete |
$2.83
|
| Rate for Payer: BCBS MAPPO |
$3.83
|
| Rate for Payer: BCBS Trust/PPO |
$12.58
|
| Rate for Payer: BCN Commercial |
$12.58
|
| Rate for Payer: BCN Medicare Advantage |
$3.83
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.83
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.47
|
| Rate for Payer: Mclaren Medicaid |
$2.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.02
|
| Rate for Payer: Meridian Medicaid |
$2.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.01
|
| Rate for Payer: Nomi Health Commercial |
$12.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.47
|
| Rate for Payer: PACE Senior Care Partners |
$3.63
|
| Rate for Payer: PACE SWMI |
$3.83
|
| Rate for Payer: PHP Commercial |
$13.01
|
| Rate for Payer: PHP Medicare Advantage |
$3.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.31
|
| Rate for Payer: Priority Health Medicare |
$3.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$12.78
|
| Rate for Payer: UHC Exchange |
$3.83
|
| Rate for Payer: UHC Medicaid |
$2.70
|
| Rate for Payer: UHC Medicare Advantage |
$3.83
|
| Rate for Payer: UHCCP Medicaid |
$2.70
|
| Rate for Payer: VA VA |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.47
|
|
|
HC HEPATITIS BE AG CMPT
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
30600349
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$12.64
|
| Rate for Payer: BCN Commercial |
$12.64
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.01
|
| Rate for Payer: Nomi Health Commercial |
$12.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.47
|
| Rate for Payer: PHP Commercial |
$13.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$12.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.47
|
|
|
HC HEPATITIS BE ANTIBODY
|
Facility
|
IP
|
$48.82
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
30200297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.98 |
| Max. Negotiated Rate |
$43.94 |
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: BCBS Trust/PPO |
$40.32
|
| Rate for Payer: BCN Commercial |
$40.32
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Nomi Health Commercial |
$40.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.96
|
| Rate for Payer: UHC Core |
$40.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
|
|
HC HEPATITIS BE ANTIBODY
|
Facility
|
OP
|
$48.82
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
30200297
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$43.94 |
| Rate for Payer: Aetna Commercial |
$41.50
|
| Rate for Payer: Aetna Medicare |
$12.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.26
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$12.21
|
| Rate for Payer: BCBS Trust/PPO |
$40.13
|
| Rate for Payer: BCN Commercial |
$40.13
|
| Rate for Payer: BCN Medicare Advantage |
$12.21
|
| Rate for Payer: Cash Price |
$39.06
|
| Rate for Payer: Cofinity Commercial |
$41.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.21
|
| Rate for Payer: Healthscope Commercial |
$43.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.62
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.82
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.50
|
| Rate for Payer: Nomi Health Commercial |
$40.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.62
|
| Rate for Payer: PACE Senior Care Partners |
$11.59
|
| Rate for Payer: PACE SWMI |
$12.21
|
| Rate for Payer: PHP Commercial |
$41.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.47
|
| Rate for Payer: Priority Health Medicare |
$12.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.98
|
| Rate for Payer: Railroad Medicare Medicare |
$12.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.96
|
| Rate for Payer: UHC Core |
$40.76
|
| Rate for Payer: UHC Exchange |
$12.21
|
| Rate for Payer: UHC Medicaid |
$8.61
|
| Rate for Payer: UHC Medicare Advantage |
$12.21
|
| Rate for Payer: UHCCP Medicaid |
$8.61
|
| Rate for Payer: VA VA |
$12.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.62
|
|
