|
HC IGG SYNTHESIS RATE CSF
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$6.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$7.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$6.72
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC IGG SYNTHESIS RATE CSF
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100212
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC IGG SYNTHESIS RATE CSF ALBUMIN
|
Facility
|
IP
|
$16.65
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$13.59
|
| Rate for Payer: BCN Commercial |
$12.87
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health HMO/PPO |
$14.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.65
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
|
|
HC IGG SYNTHESIS RATE CSF ALBUMIN
|
Facility
|
OP
|
$16.65
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100074
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Medicare |
$4.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.20
|
| Rate for Payer: BCBS Complete |
$5.91
|
| Rate for Payer: BCBS MAPPO |
$4.16
|
| Rate for Payer: BCBS Trust/PPO |
$13.69
|
| Rate for Payer: BCN Commercial |
$12.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.16
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.16
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.49
|
| Rate for Payer: Mclaren Medicaid |
$5.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.37
|
| Rate for Payer: Meridian Medicaid |
$5.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$13.65
|
| Rate for Payer: PACE Senior Care Partners |
$3.95
|
| Rate for Payer: PACE SWMI |
$4.16
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Medicare Advantage |
$4.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health HMO/PPO |
$14.49
|
| Rate for Payer: Priority Health Medicare |
$4.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.16
|
| Rate for Payer: Railroad Medicare Medicare |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.65
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UHC Medicare Advantage |
$4.16
|
| Rate for Payer: UHCCP Medicaid |
$5.62
|
| Rate for Payer: VA VA |
$4.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.49
|
|
|
HC IGG SYNTHESIS RATE CSF-IGG
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$7.06
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$6.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$7.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$6.72
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC IGG SYNTHESIS RATE CSF-IGG
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
30100210
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: BCBS Trust/PPO |
$8.49
|
| Rate for Payer: BCN Commercial |
$8.04
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO |
$9.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC IGG SYNTHESIS RATE CSF-PROTEIN
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
30100073
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$2.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.25
|
| Rate for Payer: BCBS Complete |
$3.76
|
| Rate for Payer: BCBS MAPPO |
$2.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.55
|
| Rate for Payer: BCN Commercial |
$8.09
|
| Rate for Payer: BCN Medicare Advantage |
$2.60
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Mclaren Medicaid |
$3.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.73
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: PACE Senior Care Partners |
$2.47
|
| Rate for Payer: PACE SWMI |
$2.60
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: PHP Medicare Advantage |
$2.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO |
$9.05
|
| Rate for Payer: Priority Health Medicare |
$2.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.97
|
| Rate for Payer: Railroad Medicare Medicare |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.60
|
| Rate for Payer: UHC Exchange |
$2.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.60
|
| Rate for Payer: UHCCP Medicaid |
$3.58
|
| Rate for Payer: VA VA |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
HC IGH IN BCLL
|
Facility
|
IP
|
$481.76
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$313.14 |
| Max. Negotiated Rate |
$433.58 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: BCBS Trust/PPO |
$393.26
|
| Rate for Payer: BCN Commercial |
$372.30
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: PHP Commercial |
$409.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health HMO/PPO |
$419.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$322.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.95
|
| Rate for Payer: UHC Core |
$402.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.32
|
|
|
HC IGH IN BCLL
|
Facility
|
OP
|
$481.76
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
31000146
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$114.42 |
| Max. Negotiated Rate |
$433.58 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna Medicare |
$125.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.55
|
| Rate for Payer: BCBS Complete |
$223.60
|
| Rate for Payer: BCBS MAPPO |
$120.44
|
| Rate for Payer: BCBS Trust/PPO |
$396.05
|
| Rate for Payer: BCN Commercial |
$374.57
|
| Rate for Payer: BCN Medicare Advantage |
$120.44
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.44
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.32
|
| Rate for Payer: Mclaren Medicaid |
$212.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.46
|
| Rate for Payer: Meridian Medicaid |
$223.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: PACE Senior Care Partners |
$114.42
|
| Rate for Payer: PACE SWMI |
$120.44
|
| Rate for Payer: PHP Commercial |
$409.50
|
| Rate for Payer: PHP Medicare Advantage |
$120.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health HMO/PPO |
$419.13
|
| Rate for Payer: Priority Health Medicare |
$121.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$322.78
|
| Rate for Payer: Railroad Medicare Medicare |
$120.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.95
|
| Rate for Payer: UHC Core |
$402.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.44
|
| Rate for Payer: UHC Exchange |
$120.44
|
| Rate for Payer: UHC Medicare Advantage |
$120.44
|
| Rate for Payer: UHCCP Medicaid |
$212.94
|
| Rate for Payer: VA VA |
$120.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.32
|
|
|
HC ILEOSCOPY
|
Facility
|
IP
|
$2,308.81
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,500.73 |
| Max. Negotiated Rate |
$2,077.93 |
| Rate for Payer: Aetna Commercial |
$1,962.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,884.68
|
| Rate for Payer: BCN Commercial |
$1,784.25
|
| Rate for Payer: Cash Price |
$1,847.05
|
| Rate for Payer: Cofinity Commercial |
$1,985.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,847.05
|
| Rate for Payer: Healthscope Commercial |
$2,077.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,731.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,962.49
|
| Rate for Payer: Nomi Health Commercial |
$1,893.22
|
| Rate for Payer: PHP Commercial |
$1,962.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,500.73
|
| Rate for Payer: Priority Health HMO/PPO |
$2,008.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,546.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,031.75
|
| Rate for Payer: UHC Core |
$1,927.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,731.61
|
|
|
HC ILEOSCOPY
|
Facility
|
OP
|
$2,308.81
|
|
| Hospital Charge Code |
36000055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$548.34 |
| Max. Negotiated Rate |
$2,077.93 |
| Rate for Payer: Aetna Commercial |
$1,962.49
|
| Rate for Payer: Aetna Medicare |
$600.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$721.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$721.50
|
| Rate for Payer: BCBS Complete |
$923.52
|
| Rate for Payer: BCBS MAPPO |
$577.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.07
|
| Rate for Payer: BCN Commercial |
$1,795.10
|
| Rate for Payer: BCN Medicare Advantage |
$577.20
|
| Rate for Payer: Cash Price |
$1,847.05
|
| Rate for Payer: Cofinity Commercial |
$1,985.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,847.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$577.20
|
| Rate for Payer: Healthscope Commercial |
$2,077.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,731.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$606.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$663.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,962.49
|
| Rate for Payer: Nomi Health Commercial |
$1,893.22
|
| Rate for Payer: PACE Senior Care Partners |
$548.34
|
| Rate for Payer: PACE SWMI |
$577.20
|
| Rate for Payer: PHP Commercial |
$1,962.49
|
| Rate for Payer: PHP Medicare Advantage |
$577.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,500.73
|
| Rate for Payer: Priority Health HMO/PPO |
$2,008.66
|
| Rate for Payer: Priority Health Medicare |
$582.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,546.90
|
| Rate for Payer: Railroad Medicare Medicare |
$577.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,031.75
|
| Rate for Payer: UHC Core |
$1,927.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$577.20
|
| Rate for Payer: UHC Exchange |
$577.20
|
| Rate for Payer: UHC Medicare Advantage |
$577.20
|
| Rate for Payer: VA VA |
$577.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,731.61
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
OP
|
$2,755.73
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$654.49 |
| Max. Negotiated Rate |
$2,480.16 |
| Rate for Payer: Aetna Commercial |
$2,342.37
|
| Rate for Payer: Aetna Medicare |
$716.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.17
|
| Rate for Payer: BCBS Complete |
$1,102.29
|
| Rate for Payer: BCBS MAPPO |
$688.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,265.49
|
| Rate for Payer: BCN Commercial |
$2,142.58
|
| Rate for Payer: BCN Medicare Advantage |
$688.93
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cofinity Commercial |
$2,369.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$688.93
|
| Rate for Payer: Healthscope Commercial |
$2,480.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,066.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.37
|
| Rate for Payer: Nomi Health Commercial |
$2,259.70
|
| Rate for Payer: PACE Senior Care Partners |
$654.49
|
| Rate for Payer: PACE SWMI |
$688.93
|
| Rate for Payer: PHP Commercial |
$2,342.37
|
| Rate for Payer: PHP Medicare Advantage |
$688.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.22
|
| Rate for Payer: Priority Health HMO/PPO |
$2,397.49
|
| Rate for Payer: Priority Health Medicare |
$695.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,846.34
|
| Rate for Payer: Railroad Medicare Medicare |
$688.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,425.04
|
| Rate for Payer: UHC Core |
$2,301.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$688.93
|
| Rate for Payer: UHC Exchange |
$688.93
|
| Rate for Payer: UHC Medicare Advantage |
$688.93
|
| Rate for Payer: VA VA |
$688.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,066.80
|
|
|
HC ILIAC ANGIOGRAPHY W/HEART CATH
|
Facility
|
IP
|
$2,755.73
|
|
|
Service Code
|
HCPCS G0278
|
| Hospital Charge Code |
48100053
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,791.22 |
| Max. Negotiated Rate |
$2,480.16 |
| Rate for Payer: Aetna Commercial |
$2,342.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,249.50
|
| Rate for Payer: BCN Commercial |
$2,129.63
|
| Rate for Payer: Cash Price |
$2,204.58
|
| Rate for Payer: Cofinity Commercial |
$2,369.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,204.58
|
| Rate for Payer: Healthscope Commercial |
$2,480.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,066.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,342.37
|
| Rate for Payer: Nomi Health Commercial |
$2,259.70
|
| Rate for Payer: PHP Commercial |
$2,342.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,791.22
|
| Rate for Payer: Priority Health HMO/PPO |
$2,397.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,846.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,425.04
|
| Rate for Payer: UHC Core |
$2,301.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,066.80
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$139.38
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.10 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna Commercial |
$118.47
|
| Rate for Payer: Aetna Medicare |
$36.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.56
|
| Rate for Payer: BCBS Complete |
$130.10
|
| Rate for Payer: BCBS MAPPO |
$34.84
|
| Rate for Payer: BCBS Trust/PPO |
$114.58
|
| Rate for Payer: BCN Commercial |
$108.37
|
| Rate for Payer: BCN Medicare Advantage |
$34.84
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cofinity Commercial |
$119.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.84
|
| Rate for Payer: Healthscope Commercial |
$125.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.53
|
| Rate for Payer: Mclaren Medicaid |
$123.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.59
|
| Rate for Payer: Meridian Medicaid |
$130.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.47
|
| Rate for Payer: Nomi Health Commercial |
$114.29
|
| Rate for Payer: PACE Senior Care Partners |
$33.10
|
| Rate for Payer: PACE SWMI |
$34.84
|
| Rate for Payer: PHP Commercial |
$118.47
|
| Rate for Payer: PHP Medicare Advantage |
$34.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.60
|
| Rate for Payer: Priority Health HMO/PPO |
$121.26
|
| Rate for Payer: Priority Health Medicare |
$35.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.38
|
| Rate for Payer: Railroad Medicare Medicare |
$34.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.65
|
| Rate for Payer: UHC Core |
$116.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.84
|
| Rate for Payer: UHC Exchange |
$34.84
|
| Rate for Payer: UHC Medicare Advantage |
$34.84
|
| Rate for Payer: UHCCP Medicaid |
$123.89
|
| Rate for Payer: VA VA |
$34.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.53
|
|
|
HC IMFLUOR 1ST AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$139.38
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
31000086
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.60 |
| Max. Negotiated Rate |
$125.44 |
| Rate for Payer: Aetna Commercial |
$118.47
|
| Rate for Payer: BCBS Trust/PPO |
$113.78
|
| Rate for Payer: BCN Commercial |
$107.71
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cofinity Commercial |
$119.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.50
|
| Rate for Payer: Healthscope Commercial |
$125.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.47
|
| Rate for Payer: Nomi Health Commercial |
$114.29
|
| Rate for Payer: PHP Commercial |
$118.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.60
|
| Rate for Payer: Priority Health HMO/PPO |
$121.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.65
|
| Rate for Payer: UHC Core |
$116.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.53
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
OP
|
$105.99
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$95.39 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Aetna Medicare |
$27.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.12
|
| Rate for Payer: BCBS Complete |
$42.40
|
| Rate for Payer: BCBS MAPPO |
$26.50
|
| Rate for Payer: BCBS Trust/PPO |
$87.13
|
| Rate for Payer: BCN Commercial |
$82.41
|
| Rate for Payer: BCN Medicare Advantage |
$26.50
|
| Rate for Payer: Cash Price |
$84.79
|
| Rate for Payer: Cofinity Commercial |
$91.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.50
|
| Rate for Payer: Healthscope Commercial |
$95.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.09
|
| Rate for Payer: Nomi Health Commercial |
$86.91
|
| Rate for Payer: PACE Senior Care Partners |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.50
|
| Rate for Payer: PHP Commercial |
$90.09
|
| Rate for Payer: PHP Medicare Advantage |
$26.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.89
|
| Rate for Payer: Priority Health HMO/PPO |
$92.21
|
| Rate for Payer: Priority Health Medicare |
$26.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.01
|
| Rate for Payer: Railroad Medicare Medicare |
$26.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.27
|
| Rate for Payer: UHC Core |
$88.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.50
|
| Rate for Payer: UHC Exchange |
$26.50
|
| Rate for Payer: UHC Medicare Advantage |
$26.50
|
| Rate for Payer: VA VA |
$26.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.49
|
|
|
HC IMFLUOR EACH ADDL AB STAIN (BILL ONLY)
|
Facility
|
IP
|
$105.99
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
31000085
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.89 |
| Max. Negotiated Rate |
$95.39 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: BCBS Trust/PPO |
$86.52
|
| Rate for Payer: BCN Commercial |
$81.91
|
| Rate for Payer: Cash Price |
$84.79
|
| Rate for Payer: Cofinity Commercial |
$91.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.79
|
| Rate for Payer: Healthscope Commercial |
$95.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.09
|
| Rate for Payer: Nomi Health Commercial |
$86.91
|
| Rate for Payer: PHP Commercial |
$90.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.89
|
| Rate for Payer: Priority Health HMO/PPO |
$92.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.27
|
| Rate for Payer: UHC Core |
$88.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.49
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
IP
|
$61.07
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$39.70 |
| Max. Negotiated Rate |
$54.96 |
| Rate for Payer: Aetna Commercial |
$51.91
|
| Rate for Payer: BCBS Trust/PPO |
$49.85
|
| Rate for Payer: BCN Commercial |
$47.19
|
| Rate for Payer: Cash Price |
$48.86
|
| Rate for Payer: Cofinity Commercial |
$52.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.86
|
| Rate for Payer: Healthscope Commercial |
$54.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.91
|
| Rate for Payer: Nomi Health Commercial |
$50.08
|
| Rate for Payer: PHP Commercial |
$51.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.70
|
| Rate for Payer: Priority Health HMO/PPO |
$53.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.74
|
| Rate for Payer: UHC Core |
$50.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.80
|
|
|
HC IMMATURE PLATELET FRACTION
|
Facility
|
OP
|
$61.07
|
|
|
Service Code
|
CPT 85055
|
| Hospital Charge Code |
30500013
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$54.96 |
| Rate for Payer: Aetna Commercial |
$51.91
|
| Rate for Payer: Aetna Medicare |
$15.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.08
|
| Rate for Payer: BCBS Complete |
$27.13
|
| Rate for Payer: BCBS MAPPO |
$15.27
|
| Rate for Payer: BCBS Trust/PPO |
$50.21
|
| Rate for Payer: BCN Commercial |
$47.48
|
| Rate for Payer: BCN Medicare Advantage |
$15.27
|
| Rate for Payer: Cash Price |
$48.86
|
| Rate for Payer: Cash Price |
$48.86
|
| Rate for Payer: Cofinity Commercial |
$52.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.27
|
| Rate for Payer: Healthscope Commercial |
$54.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.80
|
| Rate for Payer: Mclaren Medicaid |
$25.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.03
|
| Rate for Payer: Meridian Medicaid |
$27.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.91
|
| Rate for Payer: Nomi Health Commercial |
$50.08
|
| Rate for Payer: PACE Senior Care Partners |
$14.50
|
| Rate for Payer: PACE SWMI |
$15.27
|
| Rate for Payer: PHP Commercial |
$51.91
|
| Rate for Payer: PHP Medicare Advantage |
$15.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.70
|
| Rate for Payer: Priority Health HMO/PPO |
$53.13
|
| Rate for Payer: Priority Health Medicare |
$15.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.92
|
| Rate for Payer: Railroad Medicare Medicare |
$15.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.74
|
| Rate for Payer: UHC Core |
$50.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.27
|
| Rate for Payer: UHC Exchange |
$15.27
|
| Rate for Payer: UHC Medicare Advantage |
$15.27
|
| Rate for Payer: UHCCP Medicaid |
$25.84
|
| Rate for Payer: VA VA |
$15.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.80
|
|
|
HC IMMUNIZATION 18YEARS OR YOUNGER
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
77100001
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.27 |
| 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 |
$12.24
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$25.16
|
| Rate for Payer: BCN Commercial |
$23.79
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| 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 Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO |
$26.62
|
| Rate for Payer: Priority Health Medicare |
$7.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.50
|
| 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 Dual Complete DSNP |
$7.65
|
| Rate for Payer: UHC Exchange |
$7.65
|
| Rate for Payer: UHC Medicare Advantage |
$7.65
|
| 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 |
$19.89 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$24.98
|
| Rate for Payer: BCN Commercial |
$23.65
|
| 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: 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: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO |
$26.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.50
|
| 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
|
IP
|
$33.66
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$30.29 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Commercial |
$26.01
|
| 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: PHP Commercial |
$28.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.88
|
| Rate for Payer: Priority Health HMO/PPO |
$29.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.55
|
| 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
|
|
|
HC IMMUNIZATION 1ST VACCINE
|
Facility
|
OP
|
$33.66
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$54.03 |
| 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 |
$54.03
|
| Rate for Payer: BCBS MAPPO |
$8.41
|
| Rate for Payer: BCBS Trust/PPO |
$27.67
|
| Rate for Payer: BCN Commercial |
$26.17
|
| Rate for Payer: BCN Medicare Advantage |
$8.41
|
| Rate for Payer: Cash Price |
$26.93
|
| 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 |
$51.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.84
|
| Rate for Payer: Meridian Medicaid |
$54.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.61
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| 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 |
$51.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.88
|
| Rate for Payer: Priority Health HMO/PPO |
$29.28
|
| Rate for Payer: Priority Health Medicare |
$8.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.55
|
| 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 Dual Complete DSNP |
$8.41
|
| Rate for Payer: UHC Exchange |
$8.41
|
| Rate for Payer: UHC Medicare Advantage |
$8.41
|
| Rate for Payer: UHCCP Medicaid |
$51.46
|
| Rate for Payer: VA VA |
$8.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.25
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
IP
|
$34.12
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.18 |
| Max. Negotiated Rate |
$30.71 |
| Rate for Payer: Aetna Commercial |
$29.00
|
| Rate for Payer: BCBS Trust/PPO |
$27.85
|
| Rate for Payer: BCN Commercial |
$26.37
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cofinity Commercial |
$29.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$30.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.00
|
| Rate for Payer: Nomi Health Commercial |
$27.98
|
| Rate for Payer: PHP Commercial |
$29.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.18
|
| Rate for Payer: Priority Health HMO/PPO |
$29.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.03
|
| Rate for Payer: UHC Core |
$28.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.59
|
|
