|
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
|
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 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 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
|
OP
|
$33.66
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
77100003
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$52.94 |
| 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 |
$52.94
|
| Rate for Payer: BCBS MAPPO |
$8.42
|
| Rate for Payer: BCBS Trust/PPO |
$27.67
|
| Rate for Payer: BCN Commercial |
$26.17
|
| Rate for Payer: BCN Medicare Advantage |
$8.42
|
| 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 |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$30.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.24
|
| Rate for Payer: Mclaren Medicaid |
$50.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.84
|
| Rate for Payer: Meridian Medicaid |
$52.94
|
| 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 |
$8.42
|
| Rate for Payer: PHP Commercial |
$28.61
|
| Rate for Payer: PHP Medicare Advantage |
$8.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.41
|
| 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 |
$8.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.62
|
| Rate for Payer: UHC Core |
$28.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.42
|
| Rate for Payer: UHC Exchange |
$8.42
|
| Rate for Payer: UHC Medicare Advantage |
$8.42
|
| Rate for Payer: UHCCP Medicaid |
$50.41
|
| Rate for Payer: VA VA |
$8.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.24
|
|
|
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 |
$25.24
|
| 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 |
$25.24
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE
|
Facility
|
OP
|
$34.12
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
77100004
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$30.71 |
| Rate for Payer: Aetna Commercial |
$29.00
|
| Rate for Payer: Aetna Medicare |
$8.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.66
|
| Rate for Payer: BCBS Complete |
$13.65
|
| Rate for Payer: BCBS MAPPO |
$8.53
|
| Rate for Payer: BCBS Trust/PPO |
$28.05
|
| Rate for Payer: BCN Commercial |
$26.53
|
| Rate for Payer: BCN Medicare Advantage |
$8.53
|
| 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: Health Alliance Plan Medicare Advantage |
$8.53
|
| Rate for Payer: Healthscope Commercial |
$30.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.00
|
| Rate for Payer: Nomi Health Commercial |
$27.98
|
| Rate for Payer: PACE Senior Care Partners |
$8.10
|
| Rate for Payer: PACE SWMI |
$8.53
|
| Rate for Payer: PHP Commercial |
$29.00
|
| Rate for Payer: PHP Medicare Advantage |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.18
|
| Rate for Payer: Priority Health HMO/PPO |
$29.68
|
| Rate for Payer: Priority Health Medicare |
$8.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.86
|
| Rate for Payer: Railroad Medicare Medicare |
$8.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.03
|
| Rate for Payer: UHC Core |
$28.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.53
|
| Rate for Payer: UHC Exchange |
$8.53
|
| Rate for Payer: UHC Medicare Advantage |
$8.53
|
| Rate for Payer: VA VA |
$8.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.59
|
|
|
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
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$20.96
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health HMO/PPO |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.08
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Exchange |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.38
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC IMMUNIZATION EACH ADDL VACCINE 18 YEARS OR YOUNGER
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 90461
|
| Hospital Charge Code |
77100002
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$20.82
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Nomi Health Commercial |
$20.91
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health HMO/PPO |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC IMMUNIZATION NASAL ORAL 1ST
|
Facility
|
OP
|
$37.54
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
77100005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$52.94 |
| Rate for Payer: Aetna Commercial |
$31.91
|
| Rate for Payer: Aetna Medicare |
$9.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.73
|
| Rate for Payer: BCBS Complete |
$52.94
|
| Rate for Payer: BCBS MAPPO |
$9.38
|
| Rate for Payer: BCBS Trust/PPO |
$30.86
|
| Rate for Payer: BCN Commercial |
$29.19
|
| Rate for Payer: BCN Medicare Advantage |
$9.38
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cofinity Commercial |
$32.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.38
|
| Rate for Payer: Healthscope Commercial |
$33.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.16
|
| Rate for Payer: Mclaren Medicaid |
$50.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.85
|
| Rate for Payer: Meridian Medicaid |
$52.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.91
|
| Rate for Payer: Nomi Health Commercial |
$30.78
|
| Rate for Payer: PACE Senior Care Partners |
$8.92
|
| Rate for Payer: PACE SWMI |
$9.38
|
| Rate for Payer: PHP Commercial |
$31.91
|
| Rate for Payer: PHP Medicare Advantage |
$9.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.40
|
| Rate for Payer: Priority Health HMO/PPO |
$32.66
|
| Rate for Payer: Priority Health Medicare |
$9.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.15
|
| Rate for Payer: Railroad Medicare Medicare |
$9.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.04
|
| Rate for Payer: UHC Core |
$31.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.38
|
| Rate for Payer: UHC Exchange |
$9.38
|
| Rate for Payer: UHC Medicare Advantage |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$50.41
|
| Rate for Payer: VA VA |
$9.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.16
|
|
|
HC IMMUNIZATION NASAL ORAL 1ST
|
Facility
|
IP
|
$37.54
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
77100005
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$33.79 |
| Rate for Payer: Aetna Commercial |
$31.91
|
| Rate for Payer: BCBS Trust/PPO |
$30.64
|
| Rate for Payer: BCN Commercial |
$29.01
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cofinity Commercial |
$32.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.03
|
| Rate for Payer: Healthscope Commercial |
$33.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.91
|
| Rate for Payer: Nomi Health Commercial |
$30.78
|
| Rate for Payer: PHP Commercial |
$31.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.40
|
| Rate for Payer: Priority Health HMO/PPO |
$32.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.04
|
| Rate for Payer: UHC Core |
$31.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.16
|
|
|
HC IMMUNIZATION ORAL/NASL EA ADD
|
Facility
|
OP
|
$27.54
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
77100006
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$7.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.61
|
| Rate for Payer: BCBS Complete |
$11.02
|
| Rate for Payer: BCBS MAPPO |
$6.88
|
| Rate for Payer: BCBS Trust/PPO |
$22.64
|
| Rate for Payer: BCN Commercial |
$21.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.88
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.88
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.41
|
| Rate for Payer: Nomi Health Commercial |
$22.58
|
| Rate for Payer: PACE Senior Care Partners |
$6.54
|
| Rate for Payer: PACE SWMI |
$6.88
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: PHP Medicare Advantage |
$6.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.90
|
| Rate for Payer: Priority Health HMO/PPO |
$23.96
|
| Rate for Payer: Priority Health Medicare |
$6.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.45
|
| Rate for Payer: Railroad Medicare Medicare |
$6.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.24
|
| Rate for Payer: UHC Core |
$23.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.88
|
| Rate for Payer: UHC Exchange |
$6.88
|
| Rate for Payer: UHC Medicare Advantage |
$6.88
|
| Rate for Payer: VA VA |
$6.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.66
|
|
|
HC IMMUNIZATION ORAL/NASL EA ADD
|
Facility
|
IP
|
$27.54
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
77100006
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$22.48
|
| Rate for Payer: BCN Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.03
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.41
|
| Rate for Payer: Nomi Health Commercial |
$22.58
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.90
|
| Rate for Payer: Priority Health HMO/PPO |
$23.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.24
|
| Rate for Payer: UHC Core |
$23.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.66
|
|
|
HC IMMUNOASSAY MULTI STEP
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.38
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
HC IMMUNOASSAY MULTI STEP
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100659
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$6.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.80
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS MAPPO |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$20.53
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.24
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$8.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.55
|
| Rate for Payer: Meridian Medicaid |
$8.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: PACE Senior Care Partners |
$5.93
|
| Rate for Payer: PACE SWMI |
$6.24
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Medicare |
$6.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.24
|
| Rate for Payer: UHC Exchange |
$6.24
|
| Rate for Payer: UHC Medicare Advantage |
$6.24
|
| Rate for Payer: UHCCP Medicaid |
$8.34
|
| Rate for Payer: VA VA |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
HC IMMUNOASSAY MULTI STEP ADDITIONAL
|
Facility
|
OP
|
$39.02
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: Aetna Commercial |
$33.17
|
| Rate for Payer: Aetna Medicare |
$10.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.19
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS MAPPO |
$9.76
|
| Rate for Payer: BCBS Trust/PPO |
$32.08
|
| Rate for Payer: BCN Commercial |
$30.34
|
| Rate for Payer: BCN Medicare Advantage |
$9.76
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.76
|
| Rate for Payer: Healthscope Commercial |
$35.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.26
|
| Rate for Payer: Mclaren Medicaid |
$8.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.24
|
| Rate for Payer: Meridian Medicaid |
$8.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.17
|
| Rate for Payer: Nomi Health Commercial |
$32.00
|
| Rate for Payer: PACE Senior Care Partners |
$9.27
|
| Rate for Payer: PACE SWMI |
$9.76
|
| Rate for Payer: PHP Commercial |
$33.17
|
| Rate for Payer: PHP Medicare Advantage |
$9.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.36
|
| Rate for Payer: Priority Health HMO/PPO |
$33.95
|
| Rate for Payer: Priority Health Medicare |
$9.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.14
|
| Rate for Payer: Railroad Medicare Medicare |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.34
|
| Rate for Payer: UHC Core |
$32.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.76
|
| Rate for Payer: UHC Exchange |
$9.76
|
| Rate for Payer: UHC Medicare Advantage |
$9.76
|
| Rate for Payer: UHCCP Medicaid |
$8.34
|
| Rate for Payer: VA VA |
$9.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.26
|
|
|
HC IMMUNOASSAY MULTI STEP ADDITIONAL
|
Facility
|
IP
|
$39.02
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100658
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: Aetna Commercial |
$33.17
|
| Rate for Payer: BCBS Trust/PPO |
$31.85
|
| Rate for Payer: BCN Commercial |
$30.15
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$35.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.17
|
| Rate for Payer: Nomi Health Commercial |
$32.00
|
| Rate for Payer: PHP Commercial |
$33.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.36
|
| Rate for Payer: Priority Health HMO/PPO |
$33.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.34
|
| Rate for Payer: UHC Core |
$32.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.26
|
|
|
HC IMMUNOASSAY MULTI STEP FIRST
|
Facility
|
OP
|
$39.02
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: Aetna Commercial |
$33.17
|
| Rate for Payer: Aetna Medicare |
$10.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.19
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS MAPPO |
$9.76
|
| Rate for Payer: BCBS Trust/PPO |
$32.08
|
| Rate for Payer: BCN Commercial |
$30.34
|
| Rate for Payer: BCN Medicare Advantage |
$9.76
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.76
|
| Rate for Payer: Healthscope Commercial |
$35.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.26
|
| Rate for Payer: Mclaren Medicaid |
$8.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.24
|
| Rate for Payer: Meridian Medicaid |
$8.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.17
|
| Rate for Payer: Nomi Health Commercial |
$32.00
|
| Rate for Payer: PACE Senior Care Partners |
$9.27
|
| Rate for Payer: PACE SWMI |
$9.76
|
| Rate for Payer: PHP Commercial |
$33.17
|
| Rate for Payer: PHP Medicare Advantage |
$9.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.36
|
| Rate for Payer: Priority Health HMO/PPO |
$33.95
|
| Rate for Payer: Priority Health Medicare |
$9.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.14
|
| Rate for Payer: Railroad Medicare Medicare |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.34
|
| Rate for Payer: UHC Core |
$32.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.76
|
| Rate for Payer: UHC Exchange |
$9.76
|
| Rate for Payer: UHC Medicare Advantage |
$9.76
|
| Rate for Payer: UHCCP Medicaid |
$8.34
|
| Rate for Payer: VA VA |
$9.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.26
|
|
|
HC IMMUNOASSAY MULTI STEP FIRST
|
Facility
|
IP
|
$39.02
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30100657
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: Aetna Commercial |
$33.17
|
| Rate for Payer: BCBS Trust/PPO |
$31.85
|
| Rate for Payer: BCN Commercial |
$30.15
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$35.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.17
|
| Rate for Payer: Nomi Health Commercial |
$32.00
|
| Rate for Payer: PHP Commercial |
$33.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.36
|
| Rate for Payer: Priority Health HMO/PPO |
$33.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.34
|
| Rate for Payer: UHC Core |
$32.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.26
|
|
|
HC IMMUNODIFFUSION
|
Facility
|
IP
|
$125.46
|
|
|
Service Code
|
CPT 86329
|
| Hospital Charge Code |
30200191
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$112.91 |
| Rate for Payer: Aetna Commercial |
$106.64
|
| Rate for Payer: BCBS Trust/PPO |
$102.41
|
| Rate for Payer: BCN Commercial |
$96.96
|
| Rate for Payer: Cash Price |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$107.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.37
|
| Rate for Payer: Healthscope Commercial |
$112.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.64
|
| Rate for Payer: Nomi Health Commercial |
$102.88
|
| Rate for Payer: PHP Commercial |
$106.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.55
|
| Rate for Payer: Priority Health HMO/PPO |
$109.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.40
|
| Rate for Payer: UHC Core |
$104.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.10
|
|
|
HC IMMUNODIFFUSION
|
Facility
|
OP
|
$125.46
|
|
|
Service Code
|
CPT 86329
|
| Hospital Charge Code |
30200191
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$112.91 |
| Rate for Payer: Aetna Commercial |
$106.64
|
| Rate for Payer: Aetna Medicare |
$32.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.21
|
| Rate for Payer: BCBS Complete |
$10.67
|
| Rate for Payer: BCBS MAPPO |
$31.36
|
| Rate for Payer: BCBS Trust/PPO |
$103.14
|
| Rate for Payer: BCN Commercial |
$97.55
|
| Rate for Payer: BCN Medicare Advantage |
$31.36
|
| Rate for Payer: Cash Price |
$100.37
|
| Rate for Payer: Cash Price |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$107.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.36
|
| Rate for Payer: Healthscope Commercial |
$112.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.10
|
| Rate for Payer: Mclaren Medicaid |
$10.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.93
|
| Rate for Payer: Meridian Medicaid |
$10.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.64
|
| Rate for Payer: Nomi Health Commercial |
$102.88
|
| Rate for Payer: PACE Senior Care Partners |
$29.80
|
| Rate for Payer: PACE SWMI |
$31.36
|
| Rate for Payer: PHP Commercial |
$106.64
|
| Rate for Payer: PHP Medicare Advantage |
$31.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.55
|
| Rate for Payer: Priority Health HMO/PPO |
$109.15
|
| Rate for Payer: Priority Health Medicare |
$31.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.06
|
| Rate for Payer: Railroad Medicare Medicare |
$31.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.40
|
| Rate for Payer: UHC Core |
$104.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.36
|
| Rate for Payer: UHC Exchange |
$31.36
|
| Rate for Payer: UHC Medicare Advantage |
$31.36
|
| Rate for Payer: UHCCP Medicaid |
$10.16
|
| Rate for Payer: VA VA |
$31.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.10
|
|
|
HC IMMUNODIFFUSION AB OR AG ADDITIONAL
|
Facility
|
IP
|
$79.07
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
30200402
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$71.16 |
| Rate for Payer: Aetna Commercial |
$67.21
|
| Rate for Payer: BCBS Trust/PPO |
$64.54
|
| Rate for Payer: BCN Commercial |
$61.11
|
| Rate for Payer: Cash Price |
$63.26
|
| Rate for Payer: Cofinity Commercial |
$68.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.26
|
| Rate for Payer: Healthscope Commercial |
$71.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.21
|
| Rate for Payer: Nomi Health Commercial |
$64.84
|
| Rate for Payer: PHP Commercial |
$67.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.40
|
| Rate for Payer: Priority Health HMO/PPO |
$68.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.58
|
| Rate for Payer: UHC Core |
$66.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.30
|
|
