|
HC PLT PHER LEUKO REDUCED
|
Facility
|
OP
|
$2,204.30
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$345.05 |
| Max. Negotiated Rate |
$1,983.87 |
| Rate for Payer: Aetna Commercial |
$1,873.66
|
| Rate for Payer: Aetna Medicare |
$573.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.84
|
| Rate for Payer: BCBS Complete |
$362.33
|
| Rate for Payer: BCBS MAPPO |
$551.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,812.16
|
| Rate for Payer: BCN Commercial |
$1,713.84
|
| Rate for Payer: BCN Medicare Advantage |
$551.08
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cofinity Commercial |
$1,895.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$1,983.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,653.22
|
| Rate for Payer: Mclaren Medicaid |
$345.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.63
|
| Rate for Payer: Meridian Medicaid |
$362.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.66
|
| Rate for Payer: Nomi Health Commercial |
$1,807.53
|
| Rate for Payer: PACE Senior Care Partners |
$523.52
|
| Rate for Payer: PACE SWMI |
$551.08
|
| Rate for Payer: PHP Commercial |
$1,873.66
|
| Rate for Payer: PHP Medicare Advantage |
$551.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$345.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,917.74
|
| Rate for Payer: Priority Health Medicare |
$556.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.88
|
| Rate for Payer: Railroad Medicare Medicare |
$551.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,939.78
|
| Rate for Payer: UHC Core |
$1,840.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$551.08
|
| Rate for Payer: UHC Exchange |
$551.08
|
| Rate for Payer: UHC Medicare Advantage |
$551.08
|
| Rate for Payer: UHCCP Medicaid |
$345.05
|
| Rate for Payer: VA VA |
$551.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,653.22
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
IP
|
$2,204.30
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,432.80 |
| Max. Negotiated Rate |
$1,983.87 |
| Rate for Payer: Aetna Commercial |
$1,873.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.37
|
| Rate for Payer: BCN Commercial |
$1,703.48
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cofinity Commercial |
$1,895.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.44
|
| Rate for Payer: Healthscope Commercial |
$1,983.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,653.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.66
|
| Rate for Payer: Nomi Health Commercial |
$1,807.53
|
| Rate for Payer: PHP Commercial |
$1,873.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,917.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,939.78
|
| Rate for Payer: UHC Core |
$1,840.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,653.22
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$2,886.67
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,876.34 |
| Max. Negotiated Rate |
$2,598.00 |
| Rate for Payer: Aetna Commercial |
$2,453.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,356.39
|
| Rate for Payer: BCN Commercial |
$2,230.82
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cofinity Commercial |
$2,482.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,309.34
|
| Rate for Payer: Healthscope Commercial |
$2,598.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,165.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,453.67
|
| Rate for Payer: Nomi Health Commercial |
$2,367.07
|
| Rate for Payer: PHP Commercial |
$2,453.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,511.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,934.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,540.27
|
| Rate for Payer: UHC Core |
$2,410.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,165.00
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$2,886.67
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$478.63 |
| Max. Negotiated Rate |
$2,598.00 |
| Rate for Payer: Aetna Commercial |
$2,453.67
|
| Rate for Payer: Aetna Medicare |
$750.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$902.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$902.08
|
| Rate for Payer: BCBS Complete |
$502.59
|
| Rate for Payer: BCBS MAPPO |
$721.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,373.13
|
| Rate for Payer: BCN Commercial |
$2,244.39
|
| Rate for Payer: BCN Medicare Advantage |
$721.67
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cofinity Commercial |
$2,482.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,309.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$721.67
|
| Rate for Payer: Healthscope Commercial |
$2,598.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,165.00
|
| Rate for Payer: Mclaren Medicaid |
$478.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$757.75
|
| Rate for Payer: Meridian Medicaid |
$502.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$829.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,453.67
|
| Rate for Payer: Nomi Health Commercial |
$2,367.07
|
| Rate for Payer: PACE Senior Care Partners |
$685.58
|
| Rate for Payer: PACE SWMI |
$721.67
|
| Rate for Payer: PHP Commercial |
$2,453.67
|
| Rate for Payer: PHP Medicare Advantage |
$721.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,511.40
|
| Rate for Payer: Priority Health Medicare |
$728.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,934.07
|
| Rate for Payer: Railroad Medicare Medicare |
$721.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,540.27
|
| Rate for Payer: UHC Core |
$2,410.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$721.67
|
| Rate for Payer: UHC Exchange |
$721.67
|
| Rate for Payer: UHC Medicare Advantage |
$721.67
|
| Rate for Payer: UHCCP Medicaid |
$478.63
|
| Rate for Payer: VA VA |
$721.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,165.00
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
OP
|
$1,345.24
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$319.49 |
| Max. Negotiated Rate |
$1,210.72 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Aetna Medicare |
$349.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$420.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$420.39
|
| Rate for Payer: BCBS Complete |
$502.59
|
| Rate for Payer: BCBS MAPPO |
$336.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,105.92
|
| Rate for Payer: BCN Commercial |
$1,045.92
|
| Rate for Payer: BCN Medicare Advantage |
$336.31
|
| Rate for Payer: Cash Price |
$1,076.19
|
| Rate for Payer: Cash Price |
$1,076.19
|
| Rate for Payer: Cofinity Commercial |
$1,156.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,076.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$336.31
|
| Rate for Payer: Healthscope Commercial |
$1,210.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.93
|
| Rate for Payer: Mclaren Medicaid |
$478.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$353.13
|
| Rate for Payer: Meridian Medicaid |
$502.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$386.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,143.45
|
| Rate for Payer: Nomi Health Commercial |
$1,103.10
|
| Rate for Payer: PACE Senior Care Partners |
$319.49
|
| Rate for Payer: PACE SWMI |
$336.31
|
| Rate for Payer: PHP Commercial |
$1,143.45
|
| Rate for Payer: PHP Medicare Advantage |
$336.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,170.36
|
| Rate for Payer: Priority Health Medicare |
$339.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$901.31
|
| Rate for Payer: Railroad Medicare Medicare |
$336.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,183.81
|
| Rate for Payer: UHC Core |
$1,123.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$336.31
|
| Rate for Payer: UHC Exchange |
$336.31
|
| Rate for Payer: UHC Medicare Advantage |
$336.31
|
| Rate for Payer: UHCCP Medicaid |
$478.63
|
| Rate for Payer: VA VA |
$336.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.93
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
IP
|
$1,345.24
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$874.41 |
| Max. Negotiated Rate |
$1,210.72 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.12
|
| Rate for Payer: BCN Commercial |
$1,039.60
|
| Rate for Payer: Cash Price |
$1,076.19
|
| Rate for Payer: Cofinity Commercial |
$1,156.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,076.19
|
| Rate for Payer: Healthscope Commercial |
$1,210.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,143.45
|
| Rate for Payer: Nomi Health Commercial |
$1,103.10
|
| Rate for Payer: PHP Commercial |
$1,143.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,170.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$901.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,183.81
|
| Rate for Payer: UHC Core |
$1,123.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.93
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
OP
|
$295.47
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.17 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$251.15
|
| Rate for Payer: Aetna Medicare |
$76.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.33
|
| Rate for Payer: BCBS Complete |
$118.19
|
| Rate for Payer: BCBS MAPPO |
$73.87
|
| Rate for Payer: BCBS Trust/PPO |
$242.91
|
| Rate for Payer: BCN Commercial |
$229.73
|
| Rate for Payer: BCN Medicare Advantage |
$73.87
|
| Rate for Payer: Cash Price |
$236.38
|
| Rate for Payer: Cofinity Commercial |
$254.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.87
|
| Rate for Payer: Healthscope Commercial |
$265.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.15
|
| Rate for Payer: Nomi Health Commercial |
$242.29
|
| Rate for Payer: PACE Senior Care Partners |
$70.17
|
| Rate for Payer: PACE SWMI |
$73.87
|
| Rate for Payer: PHP Commercial |
$251.15
|
| Rate for Payer: PHP Medicare Advantage |
$73.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.06
|
| Rate for Payer: Priority Health HMO/PPO |
$257.06
|
| Rate for Payer: Priority Health Medicare |
$74.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.96
|
| Rate for Payer: Railroad Medicare Medicare |
$73.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.01
|
| Rate for Payer: UHC Core |
$246.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.87
|
| Rate for Payer: UHC Exchange |
$73.87
|
| Rate for Payer: UHC Medicare Advantage |
$73.87
|
| Rate for Payer: VA VA |
$73.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.60
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
IP
|
$295.47
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.06 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$251.15
|
| Rate for Payer: BCBS Trust/PPO |
$241.19
|
| Rate for Payer: BCN Commercial |
$228.34
|
| Rate for Payer: Cash Price |
$236.38
|
| Rate for Payer: Cofinity Commercial |
$254.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.38
|
| Rate for Payer: Healthscope Commercial |
$265.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.15
|
| Rate for Payer: Nomi Health Commercial |
$242.29
|
| Rate for Payer: PHP Commercial |
$251.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.06
|
| Rate for Payer: Priority Health HMO/PPO |
$257.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.01
|
| Rate for Payer: UHC Core |
$246.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.60
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
IP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: BCBS Trust/PPO |
$20.01
|
| Rate for Payer: BCN Commercial |
$18.94
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: Nomi Health Commercial |
$20.10
|
| Rate for Payer: PHP Commercial |
$20.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health HMO/PPO |
$21.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.57
|
| Rate for Payer: UHC Core |
$20.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.38
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
OP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: Aetna Medicare |
$6.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.66
|
| Rate for Payer: BCBS Complete |
$11.38
|
| Rate for Payer: BCBS MAPPO |
$6.13
|
| Rate for Payer: BCBS Trust/PPO |
$20.15
|
| Rate for Payer: BCN Commercial |
$19.06
|
| Rate for Payer: BCN Medicare Advantage |
$6.13
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.13
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.38
|
| Rate for Payer: Mclaren Medicaid |
$10.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.43
|
| Rate for Payer: Meridian Medicaid |
$11.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: Nomi Health Commercial |
$20.10
|
| Rate for Payer: PACE Senior Care Partners |
$5.82
|
| Rate for Payer: PACE SWMI |
$6.13
|
| Rate for Payer: PHP Commercial |
$20.83
|
| Rate for Payer: PHP Medicare Advantage |
$6.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health HMO/PPO |
$21.32
|
| Rate for Payer: Priority Health Medicare |
$6.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.42
|
| Rate for Payer: Railroad Medicare Medicare |
$6.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.57
|
| Rate for Payer: UHC Core |
$20.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.13
|
| Rate for Payer: UHC Exchange |
$6.13
|
| Rate for Payer: UHC Medicare Advantage |
$6.13
|
| Rate for Payer: UHCCP Medicaid |
$10.84
|
| Rate for Payer: VA VA |
$6.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.38
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
IP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: BCBS Trust/PPO |
$20.01
|
| Rate for Payer: BCN Commercial |
$18.94
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: Nomi Health Commercial |
$20.10
|
| Rate for Payer: PHP Commercial |
$20.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health HMO/PPO |
$21.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.57
|
| Rate for Payer: UHC Core |
$20.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.38
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
OP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: Aetna Medicare |
$6.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.66
|
| Rate for Payer: BCBS Complete |
$11.38
|
| Rate for Payer: BCBS MAPPO |
$6.13
|
| Rate for Payer: BCBS Trust/PPO |
$20.15
|
| Rate for Payer: BCN Commercial |
$19.06
|
| Rate for Payer: BCN Medicare Advantage |
$6.13
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.13
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.38
|
| Rate for Payer: Mclaren Medicaid |
$10.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.43
|
| Rate for Payer: Meridian Medicaid |
$11.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: Nomi Health Commercial |
$20.10
|
| Rate for Payer: PACE Senior Care Partners |
$5.82
|
| Rate for Payer: PACE SWMI |
$6.13
|
| Rate for Payer: PHP Commercial |
$20.83
|
| Rate for Payer: PHP Medicare Advantage |
$6.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health HMO/PPO |
$21.32
|
| Rate for Payer: Priority Health Medicare |
$6.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.42
|
| Rate for Payer: Railroad Medicare Medicare |
$6.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.57
|
| Rate for Payer: UHC Core |
$20.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.13
|
| Rate for Payer: UHC Exchange |
$6.13
|
| Rate for Payer: UHC Medicare Advantage |
$6.13
|
| Rate for Payer: UHCCP Medicaid |
$10.84
|
| Rate for Payer: VA VA |
$6.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.38
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
OP
|
$8.32
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$9.78 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna Medicare |
$2.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.60
|
| Rate for Payer: BCBS Complete |
$9.78
|
| Rate for Payer: BCBS MAPPO |
$2.08
|
| Rate for Payer: BCBS Trust/PPO |
$6.84
|
| Rate for Payer: BCN Commercial |
$6.47
|
| Rate for Payer: BCN Medicare Advantage |
$2.08
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.24
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.18
|
| Rate for Payer: Meridian Medicaid |
$9.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Nomi Health Commercial |
$6.82
|
| Rate for Payer: PACE Senior Care Partners |
$1.98
|
| Rate for Payer: PACE SWMI |
$2.08
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: PHP Medicare Advantage |
$2.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.41
|
| Rate for Payer: Priority Health HMO/PPO |
$7.24
|
| Rate for Payer: Priority Health Medicare |
$2.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.57
|
| Rate for Payer: Railroad Medicare Medicare |
$2.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.32
|
| Rate for Payer: UHC Core |
$6.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.08
|
| Rate for Payer: UHC Exchange |
$2.08
|
| Rate for Payer: UHC Medicare Advantage |
$2.08
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$2.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.24
|
|
|
HC PNEUMOCOCCAL IGG ABS PRE & POST
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
30200226
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: BCBS Trust/PPO |
$6.79
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.07
|
| Rate for Payer: Nomi Health Commercial |
$6.82
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.41
|
| Rate for Payer: Priority Health HMO/PPO |
$7.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.32
|
| Rate for Payer: UHC Core |
$6.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.24
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$24.98
|
| Rate for Payer: BCN Commercial |
$23.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO |
$26.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC PNEUMOCOCCAL INJECTION
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
HCPCS G0009
|
| Hospital Charge Code |
77100010
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$34.32 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.56
|
| Rate for Payer: BCBS Complete |
$34.32
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$25.16
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: BCN Medicare Advantage |
$7.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$32.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: Meridian Medicaid |
$34.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PACE Senior Care Partners |
$7.27
|
| Rate for Payer: PACE SWMI |
$7.65
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO |
$26.62
|
| Rate for Payer: Priority Health Medicare |
$7.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.50
|
| Rate for Payer: Railroad Medicare Medicare |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.65
|
| Rate for Payer: UHC Exchange |
$7.65
|
| Rate for Payer: UHC Medicare Advantage |
$7.65
|
| Rate for Payer: UHCCP Medicaid |
$32.69
|
| Rate for Payer: VA VA |
$7.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
OP
|
$148.78
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$133.90 |
| Rate for Payer: Aetna Commercial |
$126.46
|
| Rate for Payer: Aetna Medicare |
$38.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.49
|
| Rate for Payer: BCBS Complete |
$59.51
|
| Rate for Payer: BCBS MAPPO |
$37.20
|
| Rate for Payer: BCBS Trust/PPO |
$122.31
|
| Rate for Payer: BCN Commercial |
$115.68
|
| Rate for Payer: BCN Medicare Advantage |
$37.20
|
| Rate for Payer: Cash Price |
$119.02
|
| Rate for Payer: Cofinity Commercial |
$127.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.20
|
| Rate for Payer: Healthscope Commercial |
$133.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.46
|
| Rate for Payer: Nomi Health Commercial |
$122.00
|
| Rate for Payer: PACE Senior Care Partners |
$35.34
|
| Rate for Payer: PACE SWMI |
$37.20
|
| Rate for Payer: PHP Commercial |
$126.46
|
| Rate for Payer: PHP Medicare Advantage |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.71
|
| Rate for Payer: Priority Health HMO/PPO |
$129.44
|
| Rate for Payer: Priority Health Medicare |
$37.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.68
|
| Rate for Payer: Railroad Medicare Medicare |
$37.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.93
|
| Rate for Payer: UHC Core |
$124.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.20
|
| Rate for Payer: UHC Exchange |
$37.20
|
| Rate for Payer: UHC Medicare Advantage |
$37.20
|
| Rate for Payer: VA VA |
$37.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.58
|
|
|
HC PNEUMOCOCCAL VACCINE
|
Facility
|
IP
|
$148.78
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
63600029
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.71 |
| Max. Negotiated Rate |
$133.90 |
| Rate for Payer: Aetna Commercial |
$126.46
|
| Rate for Payer: BCBS Trust/PPO |
$121.45
|
| Rate for Payer: BCN Commercial |
$114.98
|
| Rate for Payer: Cash Price |
$119.02
|
| Rate for Payer: Cofinity Commercial |
$127.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.02
|
| Rate for Payer: Healthscope Commercial |
$133.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.46
|
| Rate for Payer: Nomi Health Commercial |
$122.00
|
| Rate for Payer: PHP Commercial |
$126.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.71
|
| Rate for Payer: Priority Health HMO/PPO |
$129.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.93
|
| Rate for Payer: UHC Core |
$124.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.58
|
|
|
HC PNEUMOCYSTIS BY RAPID PCR
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600170
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.37 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.81
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$125.78
|
| Rate for Payer: BCN Commercial |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PACE Senior Care Partners |
$36.34
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: Railroad Medicare Medicare |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Exchange |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC PNEUMOCYSTIS BY RAPID PCR
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600170
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$124.89
|
| Rate for Payer: BCN Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC PNEUMONIAE AB IGM BY IFA
|
Facility
|
IP
|
$148.92
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$134.03 |
| Rate for Payer: Aetna Commercial |
$126.58
|
| Rate for Payer: BCBS Trust/PPO |
$121.56
|
| Rate for Payer: BCN Commercial |
$115.09
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cofinity Commercial |
$128.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.14
|
| Rate for Payer: Healthscope Commercial |
$134.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: Nomi Health Commercial |
$122.11
|
| Rate for Payer: PHP Commercial |
$126.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.80
|
| Rate for Payer: Priority Health HMO/PPO |
$129.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.05
|
| Rate for Payer: UHC Core |
$124.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.69
|
|
|
HC PNEUMONIAE AB IGM BY IFA
|
Facility
|
OP
|
$148.92
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200309
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$134.03 |
| Rate for Payer: Aetna Commercial |
$126.58
|
| Rate for Payer: Aetna Medicare |
$38.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.54
|
| Rate for Payer: BCBS Complete |
$10.05
|
| Rate for Payer: BCBS MAPPO |
$37.23
|
| Rate for Payer: BCBS Trust/PPO |
$122.43
|
| Rate for Payer: BCN Commercial |
$115.79
|
| Rate for Payer: BCN Medicare Advantage |
$37.23
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cash Price |
$119.14
|
| Rate for Payer: Cofinity Commercial |
$128.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.23
|
| Rate for Payer: Healthscope Commercial |
$134.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.69
|
| Rate for Payer: Mclaren Medicaid |
$9.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.09
|
| Rate for Payer: Meridian Medicaid |
$10.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.58
|
| Rate for Payer: Nomi Health Commercial |
$122.11
|
| Rate for Payer: PACE Senior Care Partners |
$35.37
|
| Rate for Payer: PACE SWMI |
$37.23
|
| Rate for Payer: PHP Commercial |
$126.58
|
| Rate for Payer: PHP Medicare Advantage |
$37.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.80
|
| Rate for Payer: Priority Health HMO/PPO |
$129.56
|
| Rate for Payer: Priority Health Medicare |
$37.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.78
|
| Rate for Payer: Railroad Medicare Medicare |
$37.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.05
|
| Rate for Payer: UHC Core |
$124.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.23
|
| Rate for Payer: UHC Exchange |
$37.23
|
| Rate for Payer: UHC Medicare Advantage |
$37.23
|
| Rate for Payer: UHCCP Medicaid |
$9.57
|
| Rate for Payer: VA VA |
$37.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.69
|
|
|
HC POC BASIC METABOLIC PANEL W/ICAL
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
30100696
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.00
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.00
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.00
|
| Rate for Payer: UHC Exchange |
$13.00
|
| Rate for Payer: UHC Medicare Advantage |
$13.00
|
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| Rate for Payer: VA VA |
$13.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC POC BASIC METABOLIC PANEL W/ICAL
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
30100696
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC POC BLOOD GAS
|
Facility
|
IP
|
$165.22
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
30100499
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.39 |
| Max. Negotiated Rate |
$148.70 |
| Rate for Payer: Aetna Commercial |
$140.44
|
| Rate for Payer: BCBS Trust/PPO |
$134.87
|
| Rate for Payer: BCN Commercial |
$127.68
|
| Rate for Payer: Cash Price |
$132.18
|
| Rate for Payer: Cofinity Commercial |
$142.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.18
|
| Rate for Payer: Healthscope Commercial |
$148.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.44
|
| Rate for Payer: Nomi Health Commercial |
$135.48
|
| Rate for Payer: PHP Commercial |
$140.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.39
|
| Rate for Payer: Priority Health HMO/PPO |
$143.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.39
|
| Rate for Payer: UHC Core |
$137.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.92
|
|
