|
HC VAP CHOLESTEROL CMPT
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Mclaren Medicaid |
$4.24
|
| Rate for Payer: Meridian Medicaid |
$4.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC VAP CHOLESTEROL CMPT
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ
|
Facility
|
IP
|
$216.24
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
63600084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.88 |
| Max. Negotiated Rate |
$194.62 |
| Rate for Payer: Aetna Commercial |
$183.80
|
| Rate for Payer: BCBS Trust/PPO |
$167.11
|
| Rate for Payer: BCN Commercial |
$167.11
|
| Rate for Payer: Cash Price |
$172.99
|
| Rate for Payer: Cofinity Commercial |
$185.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.99
|
| Rate for Payer: Healthscope Commercial |
$194.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.80
|
| Rate for Payer: PHP Commercial |
$183.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.29
|
| Rate for Payer: UHC Core |
$180.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.18
|
|
|
HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ
|
Facility
|
OP
|
$216.24
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
63600084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.36 |
| Max. Negotiated Rate |
$194.62 |
| Rate for Payer: Aetna Commercial |
$183.80
|
| Rate for Payer: Aetna Medicare |
$56.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.58
|
| Rate for Payer: BCBS Complete |
$86.50
|
| Rate for Payer: BCBS MAPPO |
$54.06
|
| Rate for Payer: BCBS Trust/PPO |
$168.13
|
| Rate for Payer: BCN Commercial |
$168.13
|
| Rate for Payer: BCN Medicare Advantage |
$54.06
|
| Rate for Payer: Cash Price |
$172.99
|
| Rate for Payer: Cofinity Commercial |
$185.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.06
|
| Rate for Payer: Healthscope Commercial |
$194.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.80
|
| Rate for Payer: PACE Senior Care Partners |
$51.36
|
| Rate for Payer: PACE SWMI |
$54.06
|
| Rate for Payer: PHP Commercial |
$183.80
|
| Rate for Payer: PHP Medicare Advantage |
$54.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.13
|
| Rate for Payer: Priority Health Medicare |
$54.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.88
|
| Rate for Payer: Railroad Medicare Medicare |
$54.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.29
|
| Rate for Payer: UHC Core |
$180.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.06
|
| Rate for Payer: UHC Medicare Advantage |
$55.68
|
| Rate for Payer: VA VA |
$54.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.18
|
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200327
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: BCBS Trust/PPO |
$33.90
|
| Rate for Payer: BCN Commercial |
$33.90
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200327
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna Medicare |
$11.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.71
|
| Rate for Payer: BCBS Complete |
$9.98
|
| Rate for Payer: BCBS MAPPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$34.10
|
| Rate for Payer: BCN Commercial |
$34.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.96
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.96
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Mclaren Medicaid |
$9.51
|
| Rate for Payer: Meridian Medicaid |
$9.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PACE Senior Care Partners |
$10.42
|
| Rate for Payer: PACE SWMI |
$10.96
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: PHP Medicare Advantage |
$10.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.16
|
| Rate for Payer: Priority Health Medicare |
$10.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.75
|
| Rate for Payer: Railroad Medicare Medicare |
$10.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$36.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.96
|
| Rate for Payer: UHC Medicare Advantage |
$11.29
|
| Rate for Payer: VA VA |
$10.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Aetna Commercial |
$67.15
|
| Rate for Payer: Aetna Medicare |
$20.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.69
|
| Rate for Payer: BCBS Complete |
$9.98
|
| Rate for Payer: BCBS MAPPO |
$19.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.42
|
| Rate for Payer: BCN Commercial |
$61.42
|
| Rate for Payer: BCN Medicare Advantage |
$19.75
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$67.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.75
|
| Rate for Payer: Healthscope Commercial |
$71.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.25
|
| Rate for Payer: Mclaren Medicaid |
$9.51
|
| Rate for Payer: Meridian Medicaid |
$9.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.15
|
| Rate for Payer: PACE Senior Care Partners |
$18.76
|
| Rate for Payer: PACE SWMI |
$19.75
|
| Rate for Payer: PHP Commercial |
$67.15
|
| Rate for Payer: PHP Medicare Advantage |
$19.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.73
|
| Rate for Payer: Priority Health Medicare |
$19.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.18
|
| Rate for Payer: Railroad Medicare Medicare |
$19.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.52
|
| Rate for Payer: UHC Core |
$65.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.75
|
| Rate for Payer: UHC Medicare Advantage |
$20.34
|
| Rate for Payer: VA VA |
$19.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.25
|
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.18 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Aetna Commercial |
$67.15
|
| Rate for Payer: BCBS Trust/PPO |
$61.05
|
| Rate for Payer: BCN Commercial |
$61.05
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$67.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.20
|
| Rate for Payer: Healthscope Commercial |
$71.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.15
|
| Rate for Payer: PHP Commercial |
$67.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.52
|
| Rate for Payer: UHC Core |
$65.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.25
|
|
|
HC VARICELLA ZOSTER PCR CSF
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600167
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.32 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: BCBS Trust/PPO |
$82.77
|
| Rate for Payer: BCN Commercial |
$82.77
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC VARICELLA ZOSTER PCR CSF
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600167
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna Medicare |
$27.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.47
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$26.78
|
| Rate for Payer: BCBS Trust/PPO |
$83.27
|
| Rate for Payer: BCN Commercial |
$83.27
|
| Rate for Payer: BCN Medicare Advantage |
$26.78
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PACE Senior Care Partners |
$25.44
|
| Rate for Payer: PACE SWMI |
$26.78
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: PHP Medicare Advantage |
$26.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.18
|
| Rate for Payer: Priority Health Medicare |
$26.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.32
|
| Rate for Payer: Railroad Medicare Medicare |
$26.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.78
|
| Rate for Payer: UHC Medicare Advantage |
$27.58
|
| Rate for Payer: VA VA |
$26.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC VARICELLA ZOSTER VIRUS (VZV)
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Aetna Medicare |
$14.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.19
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$13.75
|
| Rate for Payer: BCBS Trust/PPO |
$42.76
|
| Rate for Payer: BCN Commercial |
$42.76
|
| Rate for Payer: BCN Medicare Advantage |
$13.75
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$47.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.75
|
| Rate for Payer: Healthscope Commercial |
$49.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.25
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
| Rate for Payer: PACE Senior Care Partners |
$13.06
|
| Rate for Payer: PACE SWMI |
$13.75
|
| Rate for Payer: PHP Commercial |
$46.75
|
| Rate for Payer: PHP Medicare Advantage |
$13.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.85
|
| Rate for Payer: Priority Health Medicare |
$13.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.54
|
| Rate for Payer: Railroad Medicare Medicare |
$13.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.40
|
| Rate for Payer: UHC Core |
$45.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.75
|
| Rate for Payer: UHC Medicare Advantage |
$14.16
|
| Rate for Payer: VA VA |
$13.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.25
|
|
|
HC VARICELLA ZOSTER VIRUS (VZV)
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: BCBS Trust/PPO |
$42.50
|
| Rate for Payer: BCN Commercial |
$42.50
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$47.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.00
|
| Rate for Payer: Healthscope Commercial |
$49.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
| Rate for Payer: PHP Commercial |
$46.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.40
|
| Rate for Payer: UHC Core |
$45.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.25
|
|
|
HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$200.40
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
36100533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$180.36 |
| Rate for Payer: Aetna Commercial |
$170.34
|
| Rate for Payer: Aetna Medicare |
$52.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.62
|
| Rate for Payer: BCBS Complete |
$80.16
|
| Rate for Payer: BCBS MAPPO |
$50.10
|
| Rate for Payer: BCBS Trust/PPO |
$155.81
|
| Rate for Payer: BCN Commercial |
$155.81
|
| Rate for Payer: BCN Medicare Advantage |
$50.10
|
| Rate for Payer: Cash Price |
$160.32
|
| Rate for Payer: Cofinity Commercial |
$172.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.10
|
| Rate for Payer: Healthscope Commercial |
$180.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.34
|
| Rate for Payer: PACE Senior Care Partners |
$47.60
|
| Rate for Payer: PACE SWMI |
$50.10
|
| Rate for Payer: PHP Commercial |
$170.34
|
| Rate for Payer: PHP Medicare Advantage |
$50.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.35
|
| Rate for Payer: Priority Health Medicare |
$50.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.22
|
| Rate for Payer: Railroad Medicare Medicare |
$50.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.35
|
| Rate for Payer: UHC Core |
$167.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.10
|
| Rate for Payer: UHC Medicare Advantage |
$51.60
|
| Rate for Payer: VA VA |
$50.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.30
|
|
|
HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$200.40
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
36100533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$122.22 |
| Max. Negotiated Rate |
$180.36 |
| Rate for Payer: Aetna Commercial |
$170.34
|
| Rate for Payer: BCBS Trust/PPO |
$154.87
|
| Rate for Payer: BCN Commercial |
$154.87
|
| Rate for Payer: Cash Price |
$160.32
|
| Rate for Payer: Cofinity Commercial |
$172.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.32
|
| Rate for Payer: Healthscope Commercial |
$180.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.34
|
| Rate for Payer: PHP Commercial |
$170.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.35
|
| Rate for Payer: UHC Core |
$167.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.30
|
|
|
HC VASCULAR GRAFT
|
Facility
|
IP
|
$2,269.02
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27800033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,383.88 |
| Max. Negotiated Rate |
$2,042.12 |
| Rate for Payer: Aetna Commercial |
$1,928.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.50
|
| Rate for Payer: BCN Commercial |
$1,753.50
|
| Rate for Payer: Cash Price |
$1,815.22
|
| Rate for Payer: Cofinity Commercial |
$1,951.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,815.22
|
| Rate for Payer: Healthscope Commercial |
$2,042.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,701.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,928.67
|
| Rate for Payer: PHP Commercial |
$1,928.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,974.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,383.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,996.74
|
| Rate for Payer: UHC Core |
$1,894.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,701.76
|
|
|
HC VASCULAR GRAFT
|
Facility
|
OP
|
$2,269.02
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27800033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.89 |
| Max. Negotiated Rate |
$2,042.12 |
| Rate for Payer: Aetna Commercial |
$1,928.67
|
| Rate for Payer: Aetna Medicare |
$589.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$709.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$709.07
|
| Rate for Payer: BCBS Complete |
$907.61
|
| Rate for Payer: BCBS MAPPO |
$567.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,764.16
|
| Rate for Payer: BCN Commercial |
$1,764.16
|
| Rate for Payer: BCN Medicare Advantage |
$567.26
|
| Rate for Payer: Cash Price |
$1,815.22
|
| Rate for Payer: Cofinity Commercial |
$1,951.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,815.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.26
|
| Rate for Payer: Healthscope Commercial |
$2,042.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,701.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$595.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$652.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,928.67
|
| Rate for Payer: PACE Senior Care Partners |
$538.89
|
| Rate for Payer: PACE SWMI |
$567.26
|
| Rate for Payer: PHP Commercial |
$1,928.67
|
| Rate for Payer: PHP Medicare Advantage |
$567.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,974.05
|
| Rate for Payer: Priority Health Medicare |
$567.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,383.88
|
| Rate for Payer: Railroad Medicare Medicare |
$567.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,996.74
|
| Rate for Payer: UHC Core |
$1,894.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$567.26
|
| Rate for Payer: UHC Medicare Advantage |
$584.27
|
| Rate for Payer: VA VA |
$567.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,701.76
|
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
30100456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: BCBS Trust/PPO |
$63.85
|
| Rate for Payer: BCN Commercial |
$63.85
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.71
|
| Rate for Payer: UHC Core |
$68.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.96
|
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
30100456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$21.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.82
|
| Rate for Payer: BCBS Complete |
$27.38
|
| Rate for Payer: BCBS MAPPO |
$20.66
|
| Rate for Payer: BCBS Trust/PPO |
$64.24
|
| Rate for Payer: BCN Commercial |
$64.24
|
| Rate for Payer: BCN Medicare Advantage |
$20.66
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.66
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.96
|
| Rate for Payer: Mclaren Medicaid |
$26.07
|
| Rate for Payer: Meridian Medicaid |
$27.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: PACE Senior Care Partners |
$19.62
|
| Rate for Payer: PACE SWMI |
$20.66
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: PHP Medicare Advantage |
$20.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.88
|
| Rate for Payer: Priority Health Medicare |
$20.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.39
|
| Rate for Payer: Railroad Medicare Medicare |
$20.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.71
|
| Rate for Payer: UHC Core |
$68.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.66
|
| Rate for Payer: UHC Medicare Advantage |
$21.27
|
| Rate for Payer: VA VA |
$20.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.96
|
|
|
HC VASOPNEUMATIC TREATMENT
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$19.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.95
|
| Rate for Payer: BCBS Complete |
$29.38
|
| Rate for Payer: BCBS MAPPO |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$57.10
|
| Rate for Payer: BCN Commercial |
$57.10
|
| Rate for Payer: BCN Medicare Advantage |
$18.36
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
| Rate for Payer: PACE Senior Care Partners |
$17.44
|
| Rate for Payer: PACE SWMI |
$18.36
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$18.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.89
|
| Rate for Payer: Priority Health Medicare |
$18.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.79
|
| Rate for Payer: Railroad Medicare Medicare |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.36
|
| Rate for Payer: UHC Medicare Advantage |
$18.91
|
| Rate for Payer: VA VA |
$18.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
HC VASOPNEUMATIC TREATMENT
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$56.75
|
| Rate for Payer: BCN Commercial |
$56.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
HC VDRL SPINAL FLUID
|
Facility
|
IP
|
$34.68
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.15 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: BCBS Trust/PPO |
$26.80
|
| Rate for Payer: BCN Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.48
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.52
|
| Rate for Payer: UHC Core |
$28.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.01
|
|
|
HC VDRL SPINAL FLUID
|
Facility
|
OP
|
$34.68
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200216
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.84
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS MAPPO |
$8.67
|
| Rate for Payer: BCBS Trust/PPO |
$26.96
|
| Rate for Payer: BCN Commercial |
$26.96
|
| Rate for Payer: BCN Medicare Advantage |
$8.67
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.67
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.01
|
| Rate for Payer: Mclaren Medicaid |
$3.15
|
| Rate for Payer: Meridian Medicaid |
$3.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.48
|
| Rate for Payer: PACE Senior Care Partners |
$8.24
|
| Rate for Payer: PACE SWMI |
$8.67
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: PHP Medicare Advantage |
$8.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.17
|
| Rate for Payer: Priority Health Medicare |
$8.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.15
|
| Rate for Payer: Railroad Medicare Medicare |
$8.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.52
|
| Rate for Payer: UHC Core |
$28.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.67
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
| Rate for Payer: VA VA |
$8.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.01
|
|
|
HC VDRL TITER CSF
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200397
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.13 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: BCBS Trust/PPO |
$57.19
|
| Rate for Payer: BCN Commercial |
$57.19
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.20
|
| Rate for Payer: Healthscope Commercial |
$66.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: PHP Commercial |
$62.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.12
|
| Rate for Payer: UHC Core |
$61.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.50
|
|
|
HC VDRL TITER CSF
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200397
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna Medicare |
$19.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.12
|
| Rate for Payer: BCBS Complete |
$3.41
|
| Rate for Payer: BCBS MAPPO |
$18.50
|
| Rate for Payer: BCBS Trust/PPO |
$57.54
|
| Rate for Payer: BCN Commercial |
$57.54
|
| Rate for Payer: BCN Medicare Advantage |
$18.50
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.50
|
| Rate for Payer: Healthscope Commercial |
$66.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.50
|
| Rate for Payer: Mclaren Medicaid |
$3.25
|
| Rate for Payer: Meridian Medicaid |
$3.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: PACE Senior Care Partners |
$17.58
|
| Rate for Payer: PACE SWMI |
$18.50
|
| Rate for Payer: PHP Commercial |
$62.90
|
| Rate for Payer: PHP Medicare Advantage |
$18.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.38
|
| Rate for Payer: Priority Health Medicare |
$18.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.13
|
| Rate for Payer: Railroad Medicare Medicare |
$18.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.12
|
| Rate for Payer: UHC Core |
$61.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.50
|
| Rate for Payer: UHC Medicare Advantage |
$19.06
|
| Rate for Payer: VA VA |
$18.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.50
|
|
|
HC VEDOLIZUMAB
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100671
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.41 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna Commercial |
$138.55
|
| Rate for Payer: BCBS Trust/PPO |
$125.97
|
| Rate for Payer: BCN Commercial |
$125.97
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$140.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.40
|
| Rate for Payer: Healthscope Commercial |
$146.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.55
|
| Rate for Payer: PHP Commercial |
$138.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.44
|
| Rate for Payer: UHC Core |
$136.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.25
|
|
