|
HC RPR TITER
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.25 |
| 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 |
$3.41
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| 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: 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: Mclaren Medicaid |
$3.25
|
| Rate for Payer: Meridian Medicaid |
$3.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| 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 Choice Medicaid |
$3.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| 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 Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC RPR TITER
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| 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 Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| 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 RSV DNA/RNA AMP PROBE
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.91
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: BCBS MAPPO |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$59.48
|
| Rate for Payer: BCN Commercial |
$59.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$51.81
|
| Rate for Payer: Meridian Medicaid |
$54.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Senior Care Partners |
$18.17
|
| Rate for Payer: PACE SWMI |
$19.12
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$19.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Medicare |
$19.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: Railroad Medicare Medicare |
$19.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.12
|
| Rate for Payer: UHC Medicare Advantage |
$19.70
|
| Rate for Payer: VA VA |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: BCBS Trust/PPO |
$59.12
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.29 |
| Max. Negotiated Rate |
$1,149.30 |
| Rate for Payer: Aetna Commercial |
$1,085.45
|
| Rate for Payer: Aetna Medicare |
$332.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.06
|
| Rate for Payer: BCBS Complete |
$510.80
|
| Rate for Payer: BCBS MAPPO |
$319.25
|
| Rate for Payer: BCBS Trust/PPO |
$992.87
|
| Rate for Payer: BCN Commercial |
$992.87
|
| Rate for Payer: BCN Medicare Advantage |
$319.25
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cofinity Commercial |
$1,098.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.25
|
| Rate for Payer: Healthscope Commercial |
$1,149.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.45
|
| Rate for Payer: PACE Senior Care Partners |
$303.29
|
| Rate for Payer: PACE SWMI |
$319.25
|
| Rate for Payer: PHP Commercial |
$1,085.45
|
| Rate for Payer: PHP Medicare Advantage |
$319.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.99
|
| Rate for Payer: Priority Health Medicare |
$319.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$778.84
|
| Rate for Payer: Railroad Medicare Medicare |
$319.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.76
|
| Rate for Payer: UHC Core |
$1,066.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.25
|
| Rate for Payer: UHC Medicare Advantage |
$328.83
|
| Rate for Payer: VA VA |
$319.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.75
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$778.84 |
| Max. Negotiated Rate |
$1,149.30 |
| Rate for Payer: Aetna Commercial |
$1,085.45
|
| Rate for Payer: BCBS Trust/PPO |
$986.87
|
| Rate for Payer: BCN Commercial |
$986.87
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cofinity Commercial |
$1,098.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.60
|
| Rate for Payer: Healthscope Commercial |
$1,149.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.45
|
| Rate for Payer: PHP Commercial |
$1,085.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$778.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.76
|
| Rate for Payer: UHC Core |
$1,066.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.75
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$778.84 |
| Max. Negotiated Rate |
$1,149.30 |
| Rate for Payer: Aetna Commercial |
$1,085.45
|
| Rate for Payer: BCBS Trust/PPO |
$986.87
|
| Rate for Payer: BCN Commercial |
$986.87
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cofinity Commercial |
$1,098.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.60
|
| Rate for Payer: Healthscope Commercial |
$1,149.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.45
|
| Rate for Payer: PHP Commercial |
$1,085.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$778.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.76
|
| Rate for Payer: UHC Core |
$1,066.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.75
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.29 |
| Max. Negotiated Rate |
$1,149.30 |
| Rate for Payer: Aetna Commercial |
$1,085.45
|
| Rate for Payer: Aetna Medicare |
$332.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.06
|
| Rate for Payer: BCBS Complete |
$510.80
|
| Rate for Payer: BCBS MAPPO |
$319.25
|
| Rate for Payer: BCBS Trust/PPO |
$992.87
|
| Rate for Payer: BCN Commercial |
$992.87
|
| Rate for Payer: BCN Medicare Advantage |
$319.25
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cofinity Commercial |
$1,098.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.25
|
| Rate for Payer: Healthscope Commercial |
$1,149.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.45
|
| Rate for Payer: PACE Senior Care Partners |
$303.29
|
| Rate for Payer: PACE SWMI |
$319.25
|
| Rate for Payer: PHP Commercial |
$1,085.45
|
| Rate for Payer: PHP Medicare Advantage |
$319.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.99
|
| Rate for Payer: Priority Health Medicare |
$319.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$778.84
|
| Rate for Payer: Railroad Medicare Medicare |
$319.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.76
|
| Rate for Payer: UHC Core |
$1,066.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.25
|
| Rate for Payer: UHC Medicare Advantage |
$328.83
|
| Rate for Payer: VA VA |
$319.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.75
|
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
OP
|
$69.30
|
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$62.37 |
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna Medicare |
$18.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.66
|
| Rate for Payer: BCBS Complete |
$27.72
|
| Rate for Payer: BCBS MAPPO |
$17.32
|
| Rate for Payer: BCBS Trust/PPO |
$53.88
|
| Rate for Payer: BCN Commercial |
$53.88
|
| Rate for Payer: BCN Medicare Advantage |
$17.32
|
| Rate for Payer: Cash Price |
$55.44
|
| Rate for Payer: Cofinity Commercial |
$59.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$62.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.90
|
| Rate for Payer: PACE Senior Care Partners |
$16.46
|
| Rate for Payer: PACE SWMI |
$17.32
|
| Rate for Payer: PHP Commercial |
$58.90
|
| Rate for Payer: PHP Medicare Advantage |
$17.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.29
|
| Rate for Payer: Priority Health Medicare |
$17.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.27
|
| Rate for Payer: Railroad Medicare Medicare |
$17.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.98
|
| Rate for Payer: UHC Core |
$57.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.32
|
| Rate for Payer: UHC Medicare Advantage |
$17.84
|
| Rate for Payer: VA VA |
$17.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.98
|
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
IP
|
$69.30
|
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.27 |
| Max. Negotiated Rate |
$62.37 |
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: BCBS Trust/PPO |
$53.56
|
| Rate for Payer: BCN Commercial |
$53.56
|
| Rate for Payer: Cash Price |
$55.44
|
| Rate for Payer: Cofinity Commercial |
$59.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.44
|
| Rate for Payer: Healthscope Commercial |
$62.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.90
|
| Rate for Payer: PHP Commercial |
$58.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.98
|
| Rate for Payer: UHC Core |
$57.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.98
|
|
|
HC RUBELLA ANTIBODY IGC
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.75
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS MAPPO |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.72
|
| Rate for Payer: BCN Commercial |
$31.72
|
| Rate for Payer: BCN Medicare Advantage |
$10.20
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.20
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Mclaren Medicaid |
$10.62
|
| Rate for Payer: Meridian Medicaid |
$11.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Senior Care Partners |
$9.69
|
| Rate for Payer: PACE SWMI |
$10.20
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$10.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$10.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: Railroad Medicare Medicare |
$10.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.20
|
| Rate for Payer: UHC Medicare Advantage |
$10.51
|
| Rate for Payer: VA VA |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC RUBELLA ANTIBODY IGC
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$31.53
|
| Rate for Payer: BCN Commercial |
$31.53
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC RUBELLA ANTIBODY IGM
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$31.53
|
| Rate for Payer: BCN Commercial |
$31.53
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC RUBELLA ANTIBODY IGM
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.75
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS MAPPO |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.72
|
| Rate for Payer: BCN Commercial |
$31.72
|
| Rate for Payer: BCN Medicare Advantage |
$10.20
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.20
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Mclaren Medicaid |
$10.62
|
| Rate for Payer: Meridian Medicaid |
$11.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Senior Care Partners |
$9.69
|
| Rate for Payer: PACE SWMI |
$10.20
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$10.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$10.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: Railroad Medicare Medicare |
$10.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.20
|
| Rate for Payer: UHC Medicare Advantage |
$10.51
|
| Rate for Payer: VA VA |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC RUBEOLA VIRUS IGG
|
Facility
|
OP
|
$86.10
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200318
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$77.49 |
| Rate for Payer: Aetna Commercial |
$73.18
|
| Rate for Payer: Aetna Medicare |
$22.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.91
|
| Rate for Payer: BCBS Complete |
$9.98
|
| Rate for Payer: BCBS MAPPO |
$21.52
|
| Rate for Payer: BCBS Trust/PPO |
$66.94
|
| Rate for Payer: BCN Commercial |
$66.94
|
| Rate for Payer: BCN Medicare Advantage |
$21.52
|
| Rate for Payer: Cash Price |
$68.88
|
| Rate for Payer: Cash Price |
$68.88
|
| Rate for Payer: Cofinity Commercial |
$74.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.52
|
| Rate for Payer: Healthscope Commercial |
$77.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.58
|
| Rate for Payer: Mclaren Medicaid |
$9.51
|
| Rate for Payer: Meridian Medicaid |
$9.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.18
|
| Rate for Payer: PACE Senior Care Partners |
$20.45
|
| Rate for Payer: PACE SWMI |
$21.52
|
| Rate for Payer: PHP Commercial |
$73.18
|
| Rate for Payer: PHP Medicare Advantage |
$21.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.91
|
| Rate for Payer: Priority Health Medicare |
$21.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.51
|
| Rate for Payer: Railroad Medicare Medicare |
$21.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.77
|
| Rate for Payer: UHC Core |
$71.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.52
|
| Rate for Payer: UHC Medicare Advantage |
$22.17
|
| Rate for Payer: VA VA |
$21.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.58
|
|
|
HC RUBEOLA VIRUS IGG
|
Facility
|
IP
|
$86.10
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200318
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.51 |
| Max. Negotiated Rate |
$77.49 |
| Rate for Payer: Aetna Commercial |
$73.18
|
| Rate for Payer: BCBS Trust/PPO |
$66.54
|
| Rate for Payer: BCN Commercial |
$66.54
|
| Rate for Payer: Cash Price |
$68.88
|
| Rate for Payer: Cofinity Commercial |
$74.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.88
|
| Rate for Payer: Healthscope Commercial |
$77.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.18
|
| Rate for Payer: PHP Commercial |
$73.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.77
|
| Rate for Payer: UHC Core |
$71.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.58
|
|
|
HC RUSSELL VIPER VENOM TIME DILUTED
|
Facility
|
OP
|
$60.40
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
30500059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$54.36 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Aetna Medicare |
$15.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.88
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$15.10
|
| Rate for Payer: BCBS Trust/PPO |
$46.96
|
| Rate for Payer: BCN Commercial |
$46.96
|
| Rate for Payer: BCN Medicare Advantage |
$15.10
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cofinity Commercial |
$51.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$54.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.30
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.34
|
| Rate for Payer: PACE Senior Care Partners |
$14.34
|
| Rate for Payer: PACE SWMI |
$15.10
|
| Rate for Payer: PHP Commercial |
$51.34
|
| Rate for Payer: PHP Medicare Advantage |
$15.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.55
|
| Rate for Payer: Priority Health Medicare |
$15.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.84
|
| Rate for Payer: Railroad Medicare Medicare |
$15.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.15
|
| Rate for Payer: UHC Core |
$50.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.10
|
| Rate for Payer: UHC Medicare Advantage |
$15.55
|
| Rate for Payer: VA VA |
$15.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.30
|
|
|
HC RUSSELL VIPER VENOM TIME DILUTED
|
Facility
|
IP
|
$60.40
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
30500059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$36.84 |
| Max. Negotiated Rate |
$54.36 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: BCBS Trust/PPO |
$46.68
|
| Rate for Payer: BCN Commercial |
$46.68
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cofinity Commercial |
$51.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.32
|
| Rate for Payer: Healthscope Commercial |
$54.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.34
|
| Rate for Payer: PHP Commercial |
$51.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.15
|
| Rate for Payer: UHC Core |
$50.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.30
|
|
|
HC RUSSIAN THISTLE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200100
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC RUSSIAN THISTLE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200100
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC SACRAL NERVE STIM, TEST LEAD, EACH
|
Facility
|
IP
|
$1,326.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27200315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$808.73 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Commercial |
$1,127.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,024.73
|
| Rate for Payer: BCN Commercial |
$1,024.73
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$1,140.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,060.80
|
| Rate for Payer: Healthscope Commercial |
$1,193.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$994.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,127.10
|
| Rate for Payer: PHP Commercial |
$1,127.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,153.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$808.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,166.88
|
| Rate for Payer: UHC Core |
$1,107.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$994.50
|
|
|
HC SACRAL NERVE STIM, TEST LEAD, EACH
|
Facility
|
OP
|
$1,326.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27200315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$314.92 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Commercial |
$1,127.10
|
| Rate for Payer: Aetna Medicare |
$344.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$414.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$414.38
|
| Rate for Payer: BCBS Complete |
$530.40
|
| Rate for Payer: BCBS MAPPO |
$331.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.96
|
| Rate for Payer: BCN Commercial |
$1,030.96
|
| Rate for Payer: BCN Medicare Advantage |
$331.50
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$1,140.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,060.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$331.50
|
| Rate for Payer: Healthscope Commercial |
$1,193.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$994.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$348.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$381.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,127.10
|
| Rate for Payer: PACE Senior Care Partners |
$314.92
|
| Rate for Payer: PACE SWMI |
$331.50
|
| Rate for Payer: PHP Commercial |
$1,127.10
|
| Rate for Payer: PHP Medicare Advantage |
$331.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,153.62
|
| Rate for Payer: Priority Health Medicare |
$331.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$808.73
|
| Rate for Payer: Railroad Medicare Medicare |
$331.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,166.88
|
| Rate for Payer: UHC Core |
$1,107.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$331.50
|
| Rate for Payer: UHC Medicare Advantage |
$341.44
|
| Rate for Payer: VA VA |
$331.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$994.50
|
|
|
HC SALICYLATE LVL.
|
Facility
|
OP
|
$100.43
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$90.39 |
| Rate for Payer: Aetna Commercial |
$85.37
|
| Rate for Payer: Aetna Medicare |
$26.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.38
|
| Rate for Payer: BCBS Complete |
$48.15
|
| Rate for Payer: BCBS MAPPO |
$25.11
|
| Rate for Payer: BCBS Trust/PPO |
$78.08
|
| Rate for Payer: BCN Commercial |
$78.08
|
| Rate for Payer: BCN Medicare Advantage |
$25.11
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cofinity Commercial |
$86.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.11
|
| Rate for Payer: Healthscope Commercial |
$90.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.32
|
| Rate for Payer: Mclaren Medicaid |
$45.86
|
| Rate for Payer: Meridian Medicaid |
$48.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.37
|
| Rate for Payer: PACE Senior Care Partners |
$23.85
|
| Rate for Payer: PACE SWMI |
$25.11
|
| Rate for Payer: PHP Commercial |
$85.37
|
| Rate for Payer: PHP Medicare Advantage |
$25.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.37
|
| Rate for Payer: Priority Health Medicare |
$25.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.25
|
| Rate for Payer: Railroad Medicare Medicare |
$25.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.38
|
| Rate for Payer: UHC Core |
$83.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.11
|
| Rate for Payer: UHC Medicare Advantage |
$25.86
|
| Rate for Payer: VA VA |
$25.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.32
|
|
|
HC SALICYLATE LVL.
|
Facility
|
IP
|
$100.43
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$90.39 |
| Rate for Payer: Aetna Commercial |
$85.37
|
| Rate for Payer: BCBS Trust/PPO |
$77.61
|
| Rate for Payer: BCN Commercial |
$77.61
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cofinity Commercial |
$86.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.34
|
| Rate for Payer: Healthscope Commercial |
$90.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.37
|
| Rate for Payer: PHP Commercial |
$85.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.38
|
| Rate for Payer: UHC Core |
$83.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.32
|
|
|
HC SALICYLATE THERAPEUTIC DRUG ASSAY
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80179
|
| Hospital Charge Code |
30100730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$31.53
|
| Rate for Payer: BCN Commercial |
$31.53
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
