|
HC PLATELET LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$394.64
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
39000064
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$240.69 |
| Max. Negotiated Rate |
$355.18 |
| Rate for Payer: Aetna Commercial |
$335.44
|
| Rate for Payer: BCBS Trust/PPO |
$304.98
|
| Rate for Payer: BCN Commercial |
$304.98
|
| Rate for Payer: Cash Price |
$315.71
|
| Rate for Payer: Cofinity Commercial |
$339.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.71
|
| Rate for Payer: Healthscope Commercial |
$355.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.44
|
| Rate for Payer: PHP Commercial |
$335.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.28
|
| Rate for Payer: UHC Core |
$329.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.98
|
|
|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
OP
|
$95.37
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$85.83 |
| Rate for Payer: Aetna Commercial |
$81.06
|
| Rate for Payer: Aetna Medicare |
$24.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.80
|
| Rate for Payer: BCBS Complete |
$19.30
|
| Rate for Payer: BCBS MAPPO |
$23.84
|
| Rate for Payer: BCBS Trust/PPO |
$74.15
|
| Rate for Payer: BCN Commercial |
$74.15
|
| Rate for Payer: BCN Medicare Advantage |
$23.84
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$82.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.84
|
| Rate for Payer: Healthscope Commercial |
$85.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.53
|
| Rate for Payer: Mclaren Medicaid |
$18.38
|
| Rate for Payer: Meridian Medicaid |
$19.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.06
|
| Rate for Payer: PACE Senior Care Partners |
$22.65
|
| Rate for Payer: PACE SWMI |
$23.84
|
| Rate for Payer: PHP Commercial |
$81.06
|
| Rate for Payer: PHP Medicare Advantage |
$23.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.97
|
| Rate for Payer: Priority Health Medicare |
$23.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.17
|
| Rate for Payer: Railroad Medicare Medicare |
$23.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.93
|
| Rate for Payer: UHC Core |
$79.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.84
|
| Rate for Payer: UHC Medicare Advantage |
$24.56
|
| Rate for Payer: VA VA |
$23.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.53
|
|
|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
IP
|
$95.37
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.17 |
| Max. Negotiated Rate |
$85.83 |
| Rate for Payer: Aetna Commercial |
$81.06
|
| Rate for Payer: BCBS Trust/PPO |
$73.70
|
| Rate for Payer: BCN Commercial |
$73.70
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$82.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.30
|
| Rate for Payer: Healthscope Commercial |
$85.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.06
|
| Rate for Payer: PHP Commercial |
$81.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.93
|
| Rate for Payer: UHC Core |
$79.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.53
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
OP
|
$90.78
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$77.16
|
| Rate for Payer: Aetna Medicare |
$23.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.37
|
| Rate for Payer: BCBS Complete |
$19.30
|
| Rate for Payer: BCBS MAPPO |
$22.70
|
| Rate for Payer: BCBS Trust/PPO |
$70.58
|
| Rate for Payer: BCN Commercial |
$70.58
|
| Rate for Payer: BCN Medicare Advantage |
$22.70
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$78.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.70
|
| Rate for Payer: Healthscope Commercial |
$81.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.08
|
| Rate for Payer: Mclaren Medicaid |
$18.38
|
| Rate for Payer: Meridian Medicaid |
$19.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: PACE Senior Care Partners |
$21.56
|
| Rate for Payer: PACE SWMI |
$22.70
|
| Rate for Payer: PHP Commercial |
$77.16
|
| Rate for Payer: PHP Medicare Advantage |
$22.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.98
|
| Rate for Payer: Priority Health Medicare |
$22.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.37
|
| Rate for Payer: Railroad Medicare Medicare |
$22.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.89
|
| Rate for Payer: UHC Core |
$75.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.70
|
| Rate for Payer: UHC Medicare Advantage |
$23.38
|
| Rate for Payer: VA VA |
$22.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.08
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
IP
|
$90.78
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$77.16
|
| Rate for Payer: BCBS Trust/PPO |
$70.15
|
| Rate for Payer: BCN Commercial |
$70.15
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$78.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$81.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: PHP Commercial |
$77.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.89
|
| Rate for Payer: UHC Core |
$75.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.08
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
OP
|
$1,904.34
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.28 |
| Max. Negotiated Rate |
$1,713.91 |
| Rate for Payer: Aetna Commercial |
$1,618.69
|
| Rate for Payer: Aetna Medicare |
$495.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.11
|
| Rate for Payer: BCBS Complete |
$954.41
|
| Rate for Payer: BCBS MAPPO |
$476.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,480.62
|
| Rate for Payer: BCN Commercial |
$1,480.62
|
| Rate for Payer: BCN Medicare Advantage |
$476.08
|
| Rate for Payer: Cash Price |
$1,523.47
|
| Rate for Payer: Cash Price |
$1,523.47
|
| Rate for Payer: Cofinity Commercial |
$1,637.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.08
|
| Rate for Payer: Healthscope Commercial |
$1,713.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,428.26
|
| Rate for Payer: Mclaren Medicaid |
$908.96
|
| Rate for Payer: Meridian Medicaid |
$954.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$499.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,618.69
|
| Rate for Payer: PACE Senior Care Partners |
$452.28
|
| Rate for Payer: PACE SWMI |
$476.08
|
| Rate for Payer: PHP Commercial |
$1,618.69
|
| Rate for Payer: PHP Medicare Advantage |
$476.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$908.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,656.78
|
| Rate for Payer: Priority Health Medicare |
$476.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,161.46
|
| Rate for Payer: Railroad Medicare Medicare |
$476.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,675.82
|
| Rate for Payer: UHC Core |
$1,590.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.08
|
| Rate for Payer: UHC Medicare Advantage |
$490.37
|
| Rate for Payer: VA VA |
$476.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,428.26
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
IP
|
$1,904.34
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,161.46 |
| Max. Negotiated Rate |
$1,713.91 |
| Rate for Payer: Aetna Commercial |
$1,618.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,471.67
|
| Rate for Payer: BCN Commercial |
$1,471.67
|
| Rate for Payer: Cash Price |
$1,523.47
|
| Rate for Payer: Cofinity Commercial |
$1,637.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.47
|
| Rate for Payer: Healthscope Commercial |
$1,713.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,428.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,618.69
|
| Rate for Payer: PHP Commercial |
$1,618.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,656.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,161.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,675.82
|
| Rate for Payer: UHC Core |
$1,590.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,428.26
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
IP
|
$2,161.08
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,318.04 |
| Max. Negotiated Rate |
$1,944.97 |
| Rate for Payer: Aetna Commercial |
$1,836.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,670.08
|
| Rate for Payer: BCN Commercial |
$1,670.08
|
| Rate for Payer: Cash Price |
$1,728.86
|
| Rate for Payer: Cofinity Commercial |
$1,858.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,728.86
|
| Rate for Payer: Healthscope Commercial |
$1,944.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,620.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,836.92
|
| Rate for Payer: PHP Commercial |
$1,836.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,318.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.75
|
| Rate for Payer: UHC Core |
$1,804.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,620.81
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
OP
|
$2,161.08
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$325.20 |
| Max. Negotiated Rate |
$1,944.97 |
| Rate for Payer: Aetna Commercial |
$1,836.92
|
| Rate for Payer: Aetna Medicare |
$561.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$675.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$675.34
|
| Rate for Payer: BCBS Complete |
$341.46
|
| Rate for Payer: BCBS MAPPO |
$540.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,680.24
|
| Rate for Payer: BCN Commercial |
$1,680.24
|
| Rate for Payer: BCN Medicare Advantage |
$540.27
|
| Rate for Payer: Cash Price |
$1,728.86
|
| Rate for Payer: Cash Price |
$1,728.86
|
| Rate for Payer: Cofinity Commercial |
$1,858.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,728.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.27
|
| Rate for Payer: Healthscope Commercial |
$1,944.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,620.81
|
| Rate for Payer: Mclaren Medicaid |
$325.20
|
| Rate for Payer: Meridian Medicaid |
$341.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$567.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$621.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,836.92
|
| Rate for Payer: PACE Senior Care Partners |
$513.26
|
| Rate for Payer: PACE SWMI |
$540.27
|
| Rate for Payer: PHP Commercial |
$1,836.92
|
| Rate for Payer: PHP Medicare Advantage |
$540.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.14
|
| Rate for Payer: Priority Health Medicare |
$540.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,318.04
|
| Rate for Payer: Railroad Medicare Medicare |
$540.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.75
|
| Rate for Payer: UHC Core |
$1,804.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.27
|
| Rate for Payer: UHC Medicare Advantage |
$556.48
|
| Rate for Payer: VA VA |
$540.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,620.81
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$2,830.07
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$463.00 |
| Max. Negotiated Rate |
$2,547.06 |
| Rate for Payer: Aetna Commercial |
$2,405.56
|
| Rate for Payer: Aetna Medicare |
$735.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$884.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$884.40
|
| Rate for Payer: BCBS Complete |
$486.15
|
| Rate for Payer: BCBS MAPPO |
$707.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,200.38
|
| Rate for Payer: BCN Commercial |
$2,200.38
|
| Rate for Payer: BCN Medicare Advantage |
$707.52
|
| Rate for Payer: Cash Price |
$2,264.06
|
| Rate for Payer: Cash Price |
$2,264.06
|
| Rate for Payer: Cofinity Commercial |
$2,433.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,264.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$707.52
|
| Rate for Payer: Healthscope Commercial |
$2,547.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,122.55
|
| Rate for Payer: Mclaren Medicaid |
$463.00
|
| Rate for Payer: Meridian Medicaid |
$486.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$742.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$813.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,405.56
|
| Rate for Payer: PACE Senior Care Partners |
$672.14
|
| Rate for Payer: PACE SWMI |
$707.52
|
| Rate for Payer: PHP Commercial |
$2,405.56
|
| Rate for Payer: PHP Medicare Advantage |
$707.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$463.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,462.16
|
| Rate for Payer: Priority Health Medicare |
$707.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,726.06
|
| Rate for Payer: Railroad Medicare Medicare |
$707.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,490.46
|
| Rate for Payer: UHC Core |
$2,363.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$707.52
|
| Rate for Payer: UHC Medicare Advantage |
$728.74
|
| Rate for Payer: VA VA |
$707.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,122.55
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$2,830.07
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,726.06 |
| Max. Negotiated Rate |
$2,547.06 |
| Rate for Payer: Aetna Commercial |
$2,405.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,187.08
|
| Rate for Payer: BCN Commercial |
$2,187.08
|
| Rate for Payer: Cash Price |
$2,264.06
|
| Rate for Payer: Cofinity Commercial |
$2,433.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,264.06
|
| Rate for Payer: Healthscope Commercial |
$2,547.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,122.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,405.56
|
| Rate for Payer: PHP Commercial |
$2,405.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,462.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,726.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,490.46
|
| Rate for Payer: UHC Core |
$2,363.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,122.55
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
IP
|
$1,318.86
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$804.37 |
| Max. Negotiated Rate |
$1,186.97 |
| Rate for Payer: Aetna Commercial |
$1,121.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,019.22
|
| Rate for Payer: BCN Commercial |
$1,019.22
|
| Rate for Payer: Cash Price |
$1,055.09
|
| Rate for Payer: Cofinity Commercial |
$1,134.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,055.09
|
| Rate for Payer: Healthscope Commercial |
$1,186.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$989.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,121.03
|
| Rate for Payer: PHP Commercial |
$1,121.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,147.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$804.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,160.60
|
| Rate for Payer: UHC Core |
$1,101.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$989.14
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
OP
|
$1,318.86
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.23 |
| Max. Negotiated Rate |
$1,186.97 |
| Rate for Payer: Aetna Commercial |
$1,121.03
|
| Rate for Payer: Aetna Medicare |
$342.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$412.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$412.14
|
| Rate for Payer: BCBS Complete |
$486.15
|
| Rate for Payer: BCBS MAPPO |
$329.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.41
|
| Rate for Payer: BCN Commercial |
$1,025.41
|
| Rate for Payer: BCN Medicare Advantage |
$329.72
|
| Rate for Payer: Cash Price |
$1,055.09
|
| Rate for Payer: Cash Price |
$1,055.09
|
| Rate for Payer: Cofinity Commercial |
$1,134.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,055.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.72
|
| Rate for Payer: Healthscope Commercial |
$1,186.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$989.14
|
| Rate for Payer: Mclaren Medicaid |
$463.00
|
| Rate for Payer: Meridian Medicaid |
$486.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$346.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$379.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,121.03
|
| Rate for Payer: PACE Senior Care Partners |
$313.23
|
| Rate for Payer: PACE SWMI |
$329.72
|
| Rate for Payer: PHP Commercial |
$1,121.03
|
| Rate for Payer: PHP Medicare Advantage |
$329.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$463.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,147.41
|
| Rate for Payer: Priority Health Medicare |
$329.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$804.37
|
| Rate for Payer: Railroad Medicare Medicare |
$329.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,160.60
|
| Rate for Payer: UHC Core |
$1,101.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.72
|
| Rate for Payer: UHC Medicare Advantage |
$339.61
|
| Rate for Payer: VA VA |
$329.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$989.14
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
IP
|
$289.68
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$176.68 |
| Max. Negotiated Rate |
$260.71 |
| Rate for Payer: Aetna Commercial |
$246.23
|
| Rate for Payer: BCBS Trust/PPO |
$223.86
|
| Rate for Payer: BCN Commercial |
$223.86
|
| Rate for Payer: Cash Price |
$231.74
|
| Rate for Payer: Cofinity Commercial |
$249.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.74
|
| Rate for Payer: Healthscope Commercial |
$260.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.23
|
| Rate for Payer: PHP Commercial |
$246.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.92
|
| Rate for Payer: UHC Core |
$241.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.26
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
OP
|
$289.68
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$260.71 |
| Rate for Payer: Aetna Commercial |
$246.23
|
| Rate for Payer: Aetna Medicare |
$75.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.52
|
| Rate for Payer: BCBS Complete |
$115.87
|
| Rate for Payer: BCBS MAPPO |
$72.42
|
| Rate for Payer: BCBS Trust/PPO |
$225.23
|
| Rate for Payer: BCN Commercial |
$225.23
|
| Rate for Payer: BCN Medicare Advantage |
$72.42
|
| Rate for Payer: Cash Price |
$231.74
|
| Rate for Payer: Cofinity Commercial |
$249.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.42
|
| Rate for Payer: Healthscope Commercial |
$260.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.23
|
| Rate for Payer: PACE Senior Care Partners |
$68.80
|
| Rate for Payer: PACE SWMI |
$72.42
|
| Rate for Payer: PHP Commercial |
$246.23
|
| Rate for Payer: PHP Medicare Advantage |
$72.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$252.02
|
| Rate for Payer: Priority Health Medicare |
$72.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.68
|
| Rate for Payer: Railroad Medicare Medicare |
$72.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.92
|
| Rate for Payer: UHC Core |
$241.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.42
|
| Rate for Payer: UHC Medicare Advantage |
$74.59
|
| Rate for Payer: VA VA |
$72.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.26
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
IP
|
$23.67
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$21.30 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCN Commercial |
$18.29
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$21.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: PHP Commercial |
$20.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.83
|
| Rate for Payer: UHC Core |
$19.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.75
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
OP
|
$23.67
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$21.30 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: Aetna Medicare |
$6.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.40
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS MAPPO |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$18.40
|
| Rate for Payer: BCN Commercial |
$18.40
|
| Rate for Payer: BCN Medicare Advantage |
$5.92
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.92
|
| Rate for Payer: Healthscope Commercial |
$21.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.75
|
| Rate for Payer: Mclaren Medicaid |
$11.06
|
| Rate for Payer: Meridian Medicaid |
$11.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: PACE Senior Care Partners |
$5.62
|
| Rate for Payer: PACE SWMI |
$5.92
|
| Rate for Payer: PHP Commercial |
$20.12
|
| Rate for Payer: PHP Medicare Advantage |
$5.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.59
|
| Rate for Payer: Priority Health Medicare |
$5.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.83
|
| Rate for Payer: UHC Core |
$19.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.92
|
| Rate for Payer: UHC Medicare Advantage |
$6.10
|
| Rate for Payer: VA VA |
$5.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.75
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
OP
|
$23.67
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$21.30 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: Aetna Medicare |
$6.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.40
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS MAPPO |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$18.40
|
| Rate for Payer: BCN Commercial |
$18.40
|
| Rate for Payer: BCN Medicare Advantage |
$5.92
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.92
|
| Rate for Payer: Healthscope Commercial |
$21.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.75
|
| Rate for Payer: Mclaren Medicaid |
$11.06
|
| Rate for Payer: Meridian Medicaid |
$11.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: PACE Senior Care Partners |
$5.62
|
| Rate for Payer: PACE SWMI |
$5.92
|
| Rate for Payer: PHP Commercial |
$20.12
|
| Rate for Payer: PHP Medicare Advantage |
$5.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.59
|
| Rate for Payer: Priority Health Medicare |
$5.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.83
|
| Rate for Payer: UHC Core |
$19.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.92
|
| Rate for Payer: UHC Medicare Advantage |
$6.10
|
| Rate for Payer: VA VA |
$5.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.75
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
IP
|
$23.67
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$21.30 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCN Commercial |
$18.29
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$20.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Healthscope Commercial |
$21.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: PHP Commercial |
$20.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.83
|
| Rate for Payer: UHC Core |
$19.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.75
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
IP
|
$8.16
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$7.34 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: BCBS Trust/PPO |
$6.31
|
| Rate for Payer: BCN Commercial |
$6.31
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.53
|
| Rate for Payer: Healthscope Commercial |
$7.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.94
|
| Rate for Payer: PHP Commercial |
$6.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.18
|
| Rate for Payer: UHC Core |
$6.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.12
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
OP
|
$8.16
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$9.98 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.55
|
| Rate for Payer: BCBS Complete |
$9.98
|
| Rate for Payer: BCBS MAPPO |
$2.04
|
| Rate for Payer: BCBS Trust/PPO |
$6.34
|
| Rate for Payer: BCN Commercial |
$6.34
|
| Rate for Payer: BCN Medicare Advantage |
$2.04
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cash Price |
$6.53
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$7.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.12
|
| Rate for Payer: Mclaren Medicaid |
$9.51
|
| Rate for Payer: Meridian Medicaid |
$9.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.94
|
| Rate for Payer: PACE Senior Care Partners |
$1.94
|
| Rate for Payer: PACE SWMI |
$2.04
|
| Rate for Payer: PHP Commercial |
$6.94
|
| Rate for Payer: PHP Medicare Advantage |
$2.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.10
|
| Rate for Payer: Priority Health Medicare |
$2.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.98
|
| Rate for Payer: Railroad Medicare Medicare |
$2.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.18
|
| Rate for Payer: UHC Core |
$6.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.04
|
| Rate for Payer: UHC Medicare Advantage |
$2.10
|
| Rate for Payer: VA VA |
$2.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.12
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$23.18
|
| Rate for Payer: BCN Commercial |
$23.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.40
|
| Rate for Payer: UHC Core |
$25.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$32.72 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.38
|
| Rate for Payer: BCBS Complete |
$32.72
|
| Rate for Payer: BCBS MAPPO |
$7.50
|
| Rate for Payer: BCBS Trust/PPO |
$23.32
|
| Rate for Payer: BCN Commercial |
$23.32
|
| Rate for Payer: BCN Medicare Advantage |
$7.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Mclaren Medicaid |
$31.16
|
| Rate for Payer: Meridian Medicaid |
$32.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PACE Senior Care Partners |
$7.12
|
| Rate for Payer: PACE SWMI |
$7.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: PHP Medicare Advantage |
$7.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.10
|
| Rate for Payer: Priority Health Medicare |
$7.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.30
|
| Rate for Payer: Railroad Medicare Medicare |
$7.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.40
|
| Rate for Payer: UHC Core |
$25.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.50
|
| Rate for Payer: UHC Medicare Advantage |
$7.72
|
| Rate for Payer: VA VA |
$7.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
IP
|
$145.86
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.96 |
| Max. Negotiated Rate |
$131.27 |
| Rate for Payer: Aetna Commercial |
$123.98
|
| Rate for Payer: BCBS Trust/PPO |
$112.72
|
| Rate for Payer: BCN Commercial |
$112.72
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cofinity Commercial |
$125.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.69
|
| Rate for Payer: Healthscope Commercial |
$131.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.98
|
| Rate for Payer: PHP Commercial |
$123.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.36
|
| Rate for Payer: UHC Core |
$121.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.40
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$145.86
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.64 |
| Max. Negotiated Rate |
$131.27 |
| Rate for Payer: Aetna Commercial |
$123.98
|
| Rate for Payer: Aetna Medicare |
$37.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.58
|
| Rate for Payer: BCBS Complete |
$58.34
|
| Rate for Payer: BCBS MAPPO |
$36.46
|
| Rate for Payer: BCBS Trust/PPO |
$113.41
|
| Rate for Payer: BCN Commercial |
$113.41
|
| Rate for Payer: BCN Medicare Advantage |
$36.46
|
| Rate for Payer: Cash Price |
$116.69
|
| Rate for Payer: Cofinity Commercial |
$125.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.46
|
| Rate for Payer: Healthscope Commercial |
$131.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.98
|
| Rate for Payer: PACE Senior Care Partners |
$34.64
|
| Rate for Payer: PACE SWMI |
$36.46
|
| Rate for Payer: PHP Commercial |
$123.98
|
| Rate for Payer: PHP Medicare Advantage |
$36.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.90
|
| Rate for Payer: Priority Health Medicare |
$36.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.96
|
| Rate for Payer: Railroad Medicare Medicare |
$36.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.36
|
| Rate for Payer: UHC Core |
$121.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.46
|
| Rate for Payer: UHC Medicare Advantage |
$37.56
|
| Rate for Payer: VA VA |
$36.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.40
|
|
