|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
IP
|
$10.61
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Aetna Commercial |
$9.02
|
| Rate for Payer: BCBS Trust/PPO |
$8.76
|
| Rate for Payer: BCN Commercial |
$8.76
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$9.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.02
|
| Rate for Payer: Nomi Health Commercial |
$8.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.96
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.34
|
| Rate for Payer: UHC Core |
$8.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
HC IGH IN BCLL
|
Facility
|
IP
|
$527.22
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$366.95 |
| Max. Negotiated Rate |
$474.50 |
| Rate for Payer: Aetna Commercial |
$448.14
|
| Rate for Payer: BCBS Trust/PPO |
$435.43
|
| Rate for Payer: BCN Commercial |
$435.43
|
| Rate for Payer: Cash Price |
$421.78
|
| Rate for Payer: Cofinity Commercial |
$453.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.78
|
| Rate for Payer: Healthscope Commercial |
$474.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.14
|
| Rate for Payer: Nomi Health Commercial |
$432.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.42
|
| Rate for Payer: PHP Commercial |
$448.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$458.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$366.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.95
|
| Rate for Payer: UHC Core |
$440.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.42
|
|
|
HC IGH IN BCLL
|
Facility
|
OP
|
$527.22
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$474.50 |
| Rate for Payer: Aetna Commercial |
$448.14
|
| Rate for Payer: Aetna Medicare |
$137.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$164.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$164.76
|
| Rate for Payer: BCBS Complete |
$97.59
|
| Rate for Payer: BCBS MAPPO |
$131.81
|
| Rate for Payer: BCBS Trust/PPO |
$433.43
|
| Rate for Payer: BCN Commercial |
$433.43
|
| Rate for Payer: BCN Medicare Advantage |
$131.81
|
| Rate for Payer: Cash Price |
$421.78
|
| Rate for Payer: Cofinity Commercial |
$453.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.81
|
| Rate for Payer: Healthscope Commercial |
$474.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.42
|
| Rate for Payer: Mclaren Medicaid |
$92.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.40
|
| Rate for Payer: Meridian Medicaid |
$97.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$144.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.14
|
| Rate for Payer: Nomi Health Commercial |
$432.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.42
|
| Rate for Payer: PACE Senior Care Partners |
$125.21
|
| Rate for Payer: PACE SWMI |
$131.81
|
| Rate for Payer: PHP Commercial |
$448.14
|
| Rate for Payer: PHP Medicare Advantage |
$131.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$458.68
|
| Rate for Payer: Priority Health Medicare |
$133.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$366.95
|
| Rate for Payer: Railroad Medicare Medicare |
$131.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.95
|
| Rate for Payer: UHC Core |
$440.23
|
| Rate for Payer: UHC Exchange |
$131.81
|
| Rate for Payer: UHC Medicaid |
$92.95
|
| Rate for Payer: UHC Medicare Advantage |
$131.81
|
| Rate for Payer: UHCCP Medicaid |
$92.95
|
| Rate for Payer: VA VA |
$131.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.42
|
|
|
HC ILEOSCOPY
|
Facility
|
OP
|
$2,354.99
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$415.18 |
| Max. Negotiated Rate |
$2,119.49 |
| Rate for Payer: Aetna Commercial |
$2,001.74
|
| Rate for Payer: Aetna Medicare |
$612.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$735.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$735.93
|
| Rate for Payer: BCBS Complete |
$435.91
|
| Rate for Payer: BCBS MAPPO |
$588.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,936.04
|
| Rate for Payer: BCN Commercial |
$1,936.04
|
| Rate for Payer: BCN Medicare Advantage |
$588.75
|
| Rate for Payer: Cash Price |
$1,883.99
|
| Rate for Payer: Cofinity Commercial |
$2,025.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.75
|
| Rate for Payer: Healthscope Commercial |
$2,119.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,766.24
|
| Rate for Payer: Mclaren Medicaid |
$415.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.18
|
| Rate for Payer: Meridian Medicaid |
$435.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$677.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$647.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,001.74
|
| Rate for Payer: Nomi Health Commercial |
$1,931.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,766.24
|
| Rate for Payer: PACE Senior Care Partners |
$559.31
|
| Rate for Payer: PACE SWMI |
$588.75
|
| Rate for Payer: PHP Commercial |
$2,001.74
|
| Rate for Payer: PHP Medicare Advantage |
$588.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$415.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,048.84
|
| Rate for Payer: Priority Health Medicare |
$594.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,639.07
|
| Rate for Payer: Railroad Medicare Medicare |
$588.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,072.39
|
| Rate for Payer: UHC Core |
$1,966.42
|
| Rate for Payer: UHC Exchange |
$588.75
|
| Rate for Payer: UHC Medicaid |
$415.18
|
| Rate for Payer: UHC Medicare Advantage |
$588.75
|
| Rate for Payer: UHCCP Medicaid |
$415.18
|
| Rate for Payer: VA VA |
$588.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,766.24
|
|
|
HC ILEOSCOPY
|
Facility
|
IP
|
$2,354.99
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,639.07 |
| Max. Negotiated Rate |
$2,119.49 |
| Rate for Payer: Aetna Commercial |
$2,001.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,944.99
|
| Rate for Payer: BCN Commercial |
$1,944.99
|
| Rate for Payer: Cash Price |
$1,883.99
|
| Rate for Payer: Cofinity Commercial |
$2,025.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,883.99
|
| Rate for Payer: Healthscope Commercial |
$2,119.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,766.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,001.74
|
| Rate for Payer: Nomi Health Commercial |
$1,931.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,766.24
|
| Rate for Payer: PHP Commercial |
$2,001.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,048.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,639.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,072.39
|
| Rate for Payer: UHC Core |
$1,966.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,766.24
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
OP
|
$2,810.84
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$495.55 |
| Max. Negotiated Rate |
$2,529.76 |
| Rate for Payer: Aetna Commercial |
$2,389.21
|
| Rate for Payer: Aetna Medicare |
$730.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$878.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$878.39
|
| Rate for Payer: BCBS Complete |
$520.29
|
| Rate for Payer: BCBS MAPPO |
$702.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,310.79
|
| Rate for Payer: BCN Commercial |
$2,310.79
|
| Rate for Payer: BCN Medicare Advantage |
$702.71
|
| Rate for Payer: Cash Price |
$2,248.67
|
| Rate for Payer: Cofinity Commercial |
$2,417.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,248.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$702.71
|
| Rate for Payer: Healthscope Commercial |
$2,529.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,108.13
|
| Rate for Payer: Mclaren Medicaid |
$495.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.85
|
| Rate for Payer: Meridian Medicaid |
$520.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$772.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,389.21
|
| Rate for Payer: Nomi Health Commercial |
$2,304.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,108.13
|
| Rate for Payer: PACE Senior Care Partners |
$667.57
|
| Rate for Payer: PACE SWMI |
$702.71
|
| Rate for Payer: PHP Commercial |
$2,389.21
|
| Rate for Payer: PHP Medicare Advantage |
$702.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$495.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,445.43
|
| Rate for Payer: Priority Health Medicare |
$709.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,956.34
|
| Rate for Payer: Railroad Medicare Medicare |
$702.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,473.54
|
| Rate for Payer: UHC Core |
$2,347.05
|
| Rate for Payer: UHC Exchange |
$702.71
|
| Rate for Payer: UHC Medicaid |
$495.55
|
| Rate for Payer: UHC Medicare Advantage |
$702.71
|
| Rate for Payer: UHCCP Medicaid |
$495.55
|
| Rate for Payer: VA VA |
$702.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,108.13
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
IP
|
$2,810.84
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,956.34 |
| Max. Negotiated Rate |
$2,529.76 |
| Rate for Payer: Aetna Commercial |
$2,389.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,321.47
|
| Rate for Payer: BCN Commercial |
$2,321.47
|
| Rate for Payer: Cash Price |
$2,248.67
|
| Rate for Payer: Cofinity Commercial |
$2,417.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,248.67
|
| Rate for Payer: Healthscope Commercial |
$2,529.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,108.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,389.21
|
| Rate for Payer: Nomi Health Commercial |
$2,304.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,108.13
|
| Rate for Payer: PHP Commercial |
$2,389.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,445.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,956.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,473.54
|
| Rate for Payer: UHC Core |
$2,347.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,108.13
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$142.17
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.06 |
| Max. Negotiated Rate |
$127.95 |
| Rate for Payer: Aetna Commercial |
$120.84
|
| Rate for Payer: Aetna Medicare |
$36.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.43
|
| Rate for Payer: BCBS Complete |
$26.32
|
| Rate for Payer: BCBS MAPPO |
$35.54
|
| Rate for Payer: BCBS Trust/PPO |
$116.88
|
| Rate for Payer: BCN Commercial |
$116.88
|
| Rate for Payer: BCN Medicare Advantage |
$35.54
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cofinity Commercial |
$122.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.54
|
| Rate for Payer: Healthscope Commercial |
$127.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.63
|
| Rate for Payer: Mclaren Medicaid |
$25.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.32
|
| Rate for Payer: Meridian Medicaid |
$26.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.84
|
| Rate for Payer: Nomi Health Commercial |
$116.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.63
|
| Rate for Payer: PACE Senior Care Partners |
$33.77
|
| Rate for Payer: PACE SWMI |
$35.54
|
| Rate for Payer: PHP Commercial |
$120.84
|
| Rate for Payer: PHP Medicare Advantage |
$35.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$123.69
|
| Rate for Payer: Priority Health Medicare |
$35.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.95
|
| Rate for Payer: Railroad Medicare Medicare |
$35.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.11
|
| Rate for Payer: UHC Core |
$118.71
|
| Rate for Payer: UHC Exchange |
$35.54
|
| Rate for Payer: UHC Medicaid |
$25.06
|
| Rate for Payer: UHC Medicare Advantage |
$35.54
|
| Rate for Payer: UHCCP Medicaid |
$25.06
|
| Rate for Payer: VA VA |
$35.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.63
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$142.17
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.95 |
| Max. Negotiated Rate |
$127.95 |
| Rate for Payer: Aetna Commercial |
$120.84
|
| Rate for Payer: BCBS Trust/PPO |
$117.42
|
| Rate for Payer: BCN Commercial |
$117.42
|
| Rate for Payer: Cash Price |
$113.74
|
| Rate for Payer: Cofinity Commercial |
$122.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.74
|
| Rate for Payer: Healthscope Commercial |
$127.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.84
|
| Rate for Payer: Nomi Health Commercial |
$116.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.63
|
| Rate for Payer: PHP Commercial |
$120.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$123.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.11
|
| Rate for Payer: UHC Core |
$118.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.63
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$108.11
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$97.30 |
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna Medicare |
$28.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.78
|
| Rate for Payer: BCBS Complete |
$20.01
|
| Rate for Payer: BCBS MAPPO |
$27.03
|
| Rate for Payer: BCBS Trust/PPO |
$88.88
|
| Rate for Payer: BCN Commercial |
$88.88
|
| Rate for Payer: BCN Medicare Advantage |
$27.03
|
| Rate for Payer: Cash Price |
$86.49
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.03
|
| Rate for Payer: Healthscope Commercial |
$97.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: Mclaren Medicaid |
$19.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.38
|
| Rate for Payer: Meridian Medicaid |
$20.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Nomi Health Commercial |
$88.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: PACE Senior Care Partners |
$25.68
|
| Rate for Payer: PACE SWMI |
$27.03
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: PHP Medicare Advantage |
$27.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.06
|
| Rate for Payer: Priority Health Medicare |
$27.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.24
|
| Rate for Payer: Railroad Medicare Medicare |
$27.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.14
|
| Rate for Payer: UHC Core |
$90.27
|
| Rate for Payer: UHC Exchange |
$27.03
|
| Rate for Payer: UHC Medicaid |
$19.06
|
| Rate for Payer: UHC Medicare Advantage |
$27.03
|
| Rate for Payer: UHCCP Medicaid |
$19.06
|
| Rate for Payer: VA VA |
$27.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$108.11
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$97.30 |
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: BCBS Trust/PPO |
$89.29
|
| Rate for Payer: BCN Commercial |
$89.29
|
| Rate for Payer: Cash Price |
$86.49
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.49
|
| Rate for Payer: Healthscope Commercial |
$97.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Nomi Health Commercial |
$88.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.14
|
| Rate for Payer: UHC Core |
$90.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
HC IMG RETINA DETCN/MNTR DS POC AUTON A/R UNI/BI
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 92229
|
| Hospital Charge Code |
92000034
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$144.77 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: BCBS Trust/PPO |
$171.79
|
| Rate for Payer: BCN Commercial |
$171.79
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: Nomi Health Commercial |
$170.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$180.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.04
|
| Rate for Payer: UHC Core |
$173.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
HC IMG RETINA DETCN/MNTR DS POC AUTON A/R UNI/BI
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 92229
|
| Hospital Charge Code |
92000034
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$36.67 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna Medicare |
$54.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.00
|
| Rate for Payer: BCBS Complete |
$38.50
|
| Rate for Payer: BCBS MAPPO |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$171.00
|
| Rate for Payer: BCN Commercial |
$171.00
|
| Rate for Payer: BCN Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Mclaren Medicaid |
$36.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.60
|
| Rate for Payer: Meridian Medicaid |
$38.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: Nomi Health Commercial |
$170.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| Rate for Payer: PACE Senior Care Partners |
$49.40
|
| Rate for Payer: PACE SWMI |
$52.00
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: PHP Medicare Advantage |
$52.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$180.96
|
| Rate for Payer: Priority Health Medicare |
$52.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.77
|
| Rate for Payer: Railroad Medicare Medicare |
$52.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.04
|
| Rate for Payer: UHC Core |
$173.68
|
| Rate for Payer: UHC Exchange |
$52.00
|
| Rate for Payer: UHC Medicaid |
$36.67
|
| Rate for Payer: UHC Medicare Advantage |
$52.00
|
| Rate for Payer: UHCCP Medicaid |
$36.67
|
| Rate for Payer: VA VA |
$52.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$63.99
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Aetna Commercial |
$54.39
|
| Rate for Payer: Aetna Medicare |
$16.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.00
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS MAPPO |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$52.61
|
| Rate for Payer: BCN Commercial |
$52.61
|
| Rate for Payer: BCN Medicare Advantage |
$16.00
|
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Cofinity Commercial |
$55.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$57.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.99
|
| Rate for Payer: Mclaren Medicaid |
$11.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.80
|
| Rate for Payer: Meridian Medicaid |
$11.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.39
|
| Rate for Payer: Nomi Health Commercial |
$52.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.99
|
| Rate for Payer: PACE Senior Care Partners |
$15.20
|
| Rate for Payer: PACE SWMI |
$16.00
|
| Rate for Payer: PHP Commercial |
$54.39
|
| Rate for Payer: PHP Medicare Advantage |
$16.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.67
|
| Rate for Payer: Priority Health Medicare |
$16.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.54
|
| Rate for Payer: Railroad Medicare Medicare |
$16.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.31
|
| Rate for Payer: UHC Core |
$53.43
|
| Rate for Payer: UHC Exchange |
$16.00
|
| Rate for Payer: UHC Medicaid |
$11.28
|
| Rate for Payer: UHC Medicare Advantage |
$16.00
|
| Rate for Payer: UHCCP Medicaid |
$11.28
|
| Rate for Payer: VA VA |
$16.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.99
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$63.99
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.54 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Aetna Commercial |
$54.39
|
| Rate for Payer: BCBS Trust/PPO |
$52.85
|
| Rate for Payer: BCN Commercial |
$52.85
|
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Cofinity Commercial |
$55.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$57.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.39
|
| Rate for Payer: Nomi Health Commercial |
$52.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.99
|
| Rate for Payer: PHP Commercial |
$54.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.31
|
| Rate for Payer: UHC Core |
$53.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.99
|
|
|
HC IMM COUNSELING WO ADMIN, > 10 MIN UP TO 20 MIN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 90483
|
| Hospital Charge Code |
77100069
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.50
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$32.88
|
| Rate for Payer: BCN Commercial |
$32.88
|
| Rate for Payer: BCN Medicare Advantage |
$10.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Mclaren Medicaid |
$7.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.50
|
| Rate for Payer: Meridian Medicaid |
$7.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.00
|
| Rate for Payer: Nomi Health Commercial |
$32.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.00
|
| Rate for Payer: PACE Senior Care Partners |
$9.50
|
| Rate for Payer: PACE SWMI |
$10.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: PHP Medicare Advantage |
$10.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.80
|
| Rate for Payer: Priority Health Medicare |
$10.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.84
|
| Rate for Payer: Railroad Medicare Medicare |
$10.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.20
|
| Rate for Payer: UHC Core |
$33.40
|
| Rate for Payer: UHC Exchange |
$10.00
|
| Rate for Payer: UHC Medicaid |
$7.05
|
| Rate for Payer: UHC Medicare Advantage |
$10.00
|
| Rate for Payer: UHCCP Medicaid |
$7.05
|
| Rate for Payer: VA VA |
$10.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC IMM COUNSELING WO ADMIN, > 10 MIN UP TO 20 MIN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 90483
|
| Hospital Charge Code |
77100069
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$27.84 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$34.00
|
| Rate for Payer: BCBS Trust/PPO |
$33.04
|
| Rate for Payer: BCN Commercial |
$33.04
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$36.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.00
|
| Rate for Payer: Nomi Health Commercial |
$32.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.00
|
| Rate for Payer: PHP Commercial |
$34.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.20
|
| Rate for Payer: UHC Core |
$33.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.00
|
|
|
HC IMM COUNSELING WO ADMIN, > 20 MIN
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 90484
|
| Hospital Charge Code |
77100070
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.06
|
| Rate for Payer: BCBS Complete |
$8.33
|
| Rate for Payer: BCBS MAPPO |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$36.99
|
| Rate for Payer: BCN Commercial |
$36.99
|
| Rate for Payer: BCN Medicare Advantage |
$11.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.25
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Mclaren Medicaid |
$7.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.81
|
| Rate for Payer: Meridian Medicaid |
$8.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: Nomi Health Commercial |
$36.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.75
|
| Rate for Payer: PACE Senior Care Partners |
$10.69
|
| Rate for Payer: PACE SWMI |
$11.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.15
|
| Rate for Payer: Priority Health Medicare |
$11.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.32
|
| Rate for Payer: Railroad Medicare Medicare |
$11.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: UHC Exchange |
$11.25
|
| Rate for Payer: UHC Medicaid |
$7.93
|
| Rate for Payer: UHC Medicare Advantage |
$11.25
|
| Rate for Payer: UHCCP Medicaid |
$7.93
|
| Rate for Payer: VA VA |
$11.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC IMM COUNSELING WO ADMIN, > 20 MIN
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 90484
|
| Hospital Charge Code |
77100070
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$37.17
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: Nomi Health Commercial |
$36.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.75
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC IMM COUNSELING WO ADMIN, 3 MIN UP TO 10 MIN
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 90482
|
| Hospital Charge Code |
77100068
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.91
|
| Rate for Payer: BCN Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$28.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
HC IMM COUNSELING WO ADMIN, 3 MIN UP TO 10 MIN
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 90482
|
| Hospital Charge Code |
77100068
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna Medicare |
$9.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.94
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS MAPPO |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.77
|
| Rate for Payer: BCN Commercial |
$28.77
|
| Rate for Payer: BCN Medicare Advantage |
$8.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.75
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Mclaren Medicaid |
$6.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.19
|
| Rate for Payer: Meridian Medicaid |
$6.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$28.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PACE Senior Care Partners |
$8.31
|
| Rate for Payer: PACE SWMI |
$8.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: PHP Medicare Advantage |
$8.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.45
|
| Rate for Payer: Priority Health Medicare |
$8.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.36
|
| Rate for Payer: Railroad Medicare Medicare |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.23
|
| Rate for Payer: UHC Exchange |
$8.75
|
| Rate for Payer: UHC Medicaid |
$6.17
|
| Rate for Payer: UHC Medicare Advantage |
$8.75
|
| Rate for Payer: UHCCP Medicaid |
$6.17
|
| Rate for Payer: VA VA |
$8.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.56
|
| Rate for Payer: BCBS Complete |
$5.66
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$25.16
|
| Rate for Payer: BCN Commercial |
$25.16
|
| Rate for Payer: BCN Medicare Advantage |
$7.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$5.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: Meridian Medicaid |
$5.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.95
|
| Rate for Payer: PACE Senior Care Partners |
$7.27
|
| Rate for Payer: PACE SWMI |
$7.65
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.62
|
| Rate for Payer: Priority Health Medicare |
$7.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.30
|
| Rate for Payer: Railroad Medicare Medicare |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: UHC Exchange |
$7.65
|
| Rate for Payer: UHC Medicaid |
$5.39
|
| Rate for Payer: UHC Medicare Advantage |
$7.65
|
| Rate for Payer: UHCCP Medicaid |
$5.39
|
| Rate for Payer: VA VA |
$7.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$25.27
|
| Rate for Payer: BCN Commercial |
$25.27
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.95
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
OP
|
$33.66
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Aetna Medicare |
$8.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.52
|
| Rate for Payer: BCBS Complete |
$6.23
|
| Rate for Payer: BCBS MAPPO |
$8.41
|
| Rate for Payer: BCBS Trust/PPO |
$27.67
|
| Rate for Payer: BCN Commercial |
$27.67
|
| Rate for Payer: BCN Medicare Advantage |
$8.41
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.41
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.25
|
| Rate for Payer: Mclaren Medicaid |
$5.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.84
|
| Rate for Payer: Meridian Medicaid |
$6.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: PACE Senior Care Partners |
$7.99
|
| Rate for Payer: PACE SWMI |
$8.41
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: PHP Medicare Advantage |
$8.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.28
|
| Rate for Payer: Priority Health Medicare |
$8.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.43
|
| Rate for Payer: Railroad Medicare Medicare |
$8.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.62
|
| Rate for Payer: UHC Core |
$28.11
|
| Rate for Payer: UHC Exchange |
$8.41
|
| Rate for Payer: UHC Medicaid |
$5.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.41
|
| Rate for Payer: UHCCP Medicaid |
$5.93
|
| Rate for Payer: VA VA |
$8.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.25
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
IP
|
$33.66
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: BCBS Trust/PPO |
$27.80
|
| Rate for Payer: BCN Commercial |
$27.80
|
| Rate for Payer: Cash Price |
$26.93
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.93
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.25
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.62
|
| Rate for Payer: UHC Core |
$28.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.25
|
|
