|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
OP
|
$701.23
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$166.54 |
| Max. Negotiated Rate |
$631.11 |
| Rate for Payer: Aetna Commercial |
$596.05
|
| Rate for Payer: Aetna Medicare |
$182.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$219.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$219.13
|
| Rate for Payer: BCBS Complete |
$195.62
|
| Rate for Payer: BCBS MAPPO |
$175.31
|
| Rate for Payer: BCBS Trust/PPO |
$576.48
|
| Rate for Payer: BCN Commercial |
$545.21
|
| Rate for Payer: BCN Medicare Advantage |
$175.31
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cash Price |
$560.98
|
| Rate for Payer: Cofinity Commercial |
$603.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.31
|
| Rate for Payer: Healthscope Commercial |
$631.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.92
|
| Rate for Payer: Mclaren Medicaid |
$186.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.07
|
| Rate for Payer: Meridian Medicaid |
$195.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.05
|
| Rate for Payer: Nomi Health Commercial |
$575.01
|
| Rate for Payer: PACE Senior Care Partners |
$166.54
|
| Rate for Payer: PACE SWMI |
$175.31
|
| Rate for Payer: PHP Commercial |
$596.05
|
| Rate for Payer: PHP Medicare Advantage |
$175.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.80
|
| Rate for Payer: Priority Health HMO/PPO |
$610.07
|
| Rate for Payer: Priority Health Medicare |
$177.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$469.82
|
| Rate for Payer: Railroad Medicare Medicare |
$175.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.08
|
| Rate for Payer: UHC Core |
$585.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.31
|
| Rate for Payer: UHC Exchange |
$175.31
|
| Rate for Payer: UHC Medicare Advantage |
$175.31
|
| Rate for Payer: UHCCP Medicaid |
$186.29
|
| Rate for Payer: VA VA |
$175.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.92
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
OP
|
$421.54
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$100.12 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna Commercial |
$358.31
|
| Rate for Payer: Aetna Medicare |
$109.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.73
|
| Rate for Payer: BCBS Complete |
$195.62
|
| Rate for Payer: BCBS MAPPO |
$105.38
|
| Rate for Payer: BCBS Trust/PPO |
$346.55
|
| Rate for Payer: BCN Commercial |
$327.75
|
| Rate for Payer: BCN Medicare Advantage |
$105.38
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$362.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.38
|
| Rate for Payer: Healthscope Commercial |
$379.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.16
|
| Rate for Payer: Mclaren Medicaid |
$186.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.65
|
| Rate for Payer: Meridian Medicaid |
$195.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: Nomi Health Commercial |
$345.66
|
| Rate for Payer: PACE Senior Care Partners |
$100.12
|
| Rate for Payer: PACE SWMI |
$105.38
|
| Rate for Payer: PHP Commercial |
$358.31
|
| Rate for Payer: PHP Medicare Advantage |
$105.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: Priority Health HMO/PPO |
$366.74
|
| Rate for Payer: Priority Health Medicare |
$106.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.43
|
| Rate for Payer: Railroad Medicare Medicare |
$105.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.96
|
| Rate for Payer: UHC Core |
$351.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.38
|
| Rate for Payer: UHC Exchange |
$105.38
|
| Rate for Payer: UHC Medicare Advantage |
$105.38
|
| Rate for Payer: UHCCP Medicaid |
$186.29
|
| Rate for Payer: VA VA |
$105.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.16
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
IP
|
$421.54
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$274.00 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna Commercial |
$358.31
|
| Rate for Payer: BCBS Trust/PPO |
$344.10
|
| Rate for Payer: BCN Commercial |
$325.77
|
| Rate for Payer: Cash Price |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$362.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.23
|
| Rate for Payer: Healthscope Commercial |
$379.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.31
|
| Rate for Payer: Nomi Health Commercial |
$345.66
|
| Rate for Payer: PHP Commercial |
$358.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.00
|
| Rate for Payer: Priority Health HMO/PPO |
$366.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.96
|
| Rate for Payer: UHC Core |
$351.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.16
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
OP
|
$231.24
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$54.92 |
| Max. Negotiated Rate |
$208.12 |
| Rate for Payer: Aetna Commercial |
$196.55
|
| Rate for Payer: Aetna Medicare |
$60.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.26
|
| Rate for Payer: BCBS Complete |
$81.45
|
| Rate for Payer: BCBS MAPPO |
$57.81
|
| Rate for Payer: BCBS Trust/PPO |
$190.10
|
| Rate for Payer: BCN Commercial |
$179.79
|
| Rate for Payer: BCN Medicare Advantage |
$57.81
|
| Rate for Payer: Cash Price |
$184.99
|
| Rate for Payer: Cash Price |
$184.99
|
| Rate for Payer: Cofinity Commercial |
$198.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.81
|
| Rate for Payer: Healthscope Commercial |
$208.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.43
|
| Rate for Payer: Mclaren Medicaid |
$77.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.70
|
| Rate for Payer: Meridian Medicaid |
$81.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.55
|
| Rate for Payer: Nomi Health Commercial |
$189.62
|
| Rate for Payer: PACE Senior Care Partners |
$54.92
|
| Rate for Payer: PACE SWMI |
$57.81
|
| Rate for Payer: PHP Commercial |
$196.55
|
| Rate for Payer: PHP Medicare Advantage |
$57.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.31
|
| Rate for Payer: Priority Health HMO/PPO |
$201.18
|
| Rate for Payer: Priority Health Medicare |
$58.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.93
|
| Rate for Payer: Railroad Medicare Medicare |
$57.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.49
|
| Rate for Payer: UHC Core |
$193.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.81
|
| Rate for Payer: UHC Exchange |
$57.81
|
| Rate for Payer: UHC Medicare Advantage |
$57.81
|
| Rate for Payer: UHCCP Medicaid |
$77.57
|
| Rate for Payer: VA VA |
$57.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.43
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
IP
|
$231.24
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$150.31 |
| Max. Negotiated Rate |
$208.12 |
| Rate for Payer: Aetna Commercial |
$196.55
|
| Rate for Payer: BCBS Trust/PPO |
$188.76
|
| Rate for Payer: BCN Commercial |
$178.70
|
| Rate for Payer: Cash Price |
$184.99
|
| Rate for Payer: Cofinity Commercial |
$198.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.99
|
| Rate for Payer: Healthscope Commercial |
$208.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.55
|
| Rate for Payer: Nomi Health Commercial |
$189.62
|
| Rate for Payer: PHP Commercial |
$196.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.31
|
| Rate for Payer: Priority Health HMO/PPO |
$201.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.49
|
| Rate for Payer: UHC Core |
$193.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.43
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Facility
|
OP
|
$15,380.00
|
|
|
Service Code
|
CPT 35266
|
| Hospital Charge Code |
36000124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,652.75 |
| Max. Negotiated Rate |
$13,842.00 |
| Rate for Payer: Aetna Commercial |
$13,073.00
|
| Rate for Payer: Aetna Medicare |
$3,998.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,806.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,806.25
|
| Rate for Payer: BCBS Complete |
$4,021.03
|
| Rate for Payer: BCBS MAPPO |
$3,845.00
|
| Rate for Payer: BCBS Trust/PPO |
$12,643.90
|
| Rate for Payer: BCN Commercial |
$11,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$3,845.00
|
| Rate for Payer: Cash Price |
$12,304.00
|
| Rate for Payer: Cash Price |
$12,304.00
|
| Rate for Payer: Cofinity Commercial |
$13,226.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,304.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,845.00
|
| Rate for Payer: Healthscope Commercial |
$13,842.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,535.00
|
| Rate for Payer: Mclaren Medicaid |
$3,829.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,037.25
|
| Rate for Payer: Meridian Medicaid |
$4,021.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,421.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,073.00
|
| Rate for Payer: Nomi Health Commercial |
$12,611.60
|
| Rate for Payer: PACE Senior Care Partners |
$3,652.75
|
| Rate for Payer: PACE SWMI |
$3,845.00
|
| Rate for Payer: PHP Commercial |
$13,073.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,845.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,829.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,997.00
|
| Rate for Payer: Priority Health HMO/PPO |
$13,380.60
|
| Rate for Payer: Priority Health Medicare |
$3,883.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,304.60
|
| Rate for Payer: Railroad Medicare Medicare |
$3,845.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,534.40
|
| Rate for Payer: UHC Core |
$12,842.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,845.00
|
| Rate for Payer: UHC Exchange |
$3,845.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,845.00
|
| Rate for Payer: UHCCP Medicaid |
$3,829.30
|
| Rate for Payer: VA VA |
$3,845.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,535.00
|
|
|
HC RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY
|
Facility
|
IP
|
$15,380.00
|
|
|
Service Code
|
CPT 35266
|
| Hospital Charge Code |
36000124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,997.00 |
| Max. Negotiated Rate |
$13,842.00 |
| Rate for Payer: Aetna Commercial |
$13,073.00
|
| Rate for Payer: BCBS Trust/PPO |
$12,554.69
|
| Rate for Payer: BCN Commercial |
$11,885.66
|
| Rate for Payer: Cash Price |
$12,304.00
|
| Rate for Payer: Cofinity Commercial |
$13,226.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,304.00
|
| Rate for Payer: Healthscope Commercial |
$13,842.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,535.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,073.00
|
| Rate for Payer: Nomi Health Commercial |
$12,611.60
|
| Rate for Payer: PHP Commercial |
$13,073.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,997.00
|
| Rate for Payer: Priority Health HMO/PPO |
$13,380.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10,304.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,534.40
|
| Rate for Payer: UHC Core |
$12,842.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,535.00
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$3.24
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Meridian Medicaid |
$3.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$3.09
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC RPR TITER
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$3.34
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$3.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Meridian Medicaid |
$3.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$3.18
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC RPR TITER
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: BCBS Trust/PPO |
$63.70
|
| Rate for Payer: BCN Commercial |
$60.30
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$53.30
|
| Rate for Payer: BCBS MAPPO |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.15
|
| Rate for Payer: BCN Commercial |
$60.67
|
| Rate for Payer: BCN Medicare Advantage |
$19.51
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$50.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: Meridian Medicaid |
$53.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Senior Care Partners |
$18.53
|
| Rate for Payer: PACE SWMI |
$19.51
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: Railroad Medicare Medicare |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.51
|
| Rate for Payer: UHC Exchange |
$19.51
|
| Rate for Payer: UHC Medicare Advantage |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: VA VA |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
OP
|
$1,302.54
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$309.35 |
| Max. Negotiated Rate |
$1,172.29 |
| Rate for Payer: Aetna Commercial |
$1,107.16
|
| Rate for Payer: Aetna Medicare |
$338.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$407.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$407.04
|
| Rate for Payer: BCBS Complete |
$521.02
|
| Rate for Payer: BCBS MAPPO |
$325.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,070.82
|
| Rate for Payer: BCN Commercial |
$1,012.72
|
| Rate for Payer: BCN Medicare Advantage |
$325.64
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cofinity Commercial |
$1,120.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.64
|
| Rate for Payer: Healthscope Commercial |
$1,172.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.16
|
| Rate for Payer: Nomi Health Commercial |
$1,068.08
|
| Rate for Payer: PACE Senior Care Partners |
$309.35
|
| Rate for Payer: PACE SWMI |
$325.64
|
| Rate for Payer: PHP Commercial |
$1,107.16
|
| Rate for Payer: PHP Medicare Advantage |
$325.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,133.21
|
| Rate for Payer: Priority Health Medicare |
$328.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$872.70
|
| Rate for Payer: Railroad Medicare Medicare |
$325.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,146.24
|
| Rate for Payer: UHC Core |
$1,087.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$325.64
|
| Rate for Payer: UHC Exchange |
$325.64
|
| Rate for Payer: UHC Medicare Advantage |
$325.64
|
| Rate for Payer: VA VA |
$325.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.90
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
IP
|
$1,302.54
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$846.65 |
| Max. Negotiated Rate |
$1,172.29 |
| Rate for Payer: Aetna Commercial |
$1,107.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,063.26
|
| Rate for Payer: BCN Commercial |
$1,006.60
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cofinity Commercial |
$1,120.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.03
|
| Rate for Payer: Healthscope Commercial |
$1,172.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.16
|
| Rate for Payer: Nomi Health Commercial |
$1,068.08
|
| Rate for Payer: PHP Commercial |
$1,107.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,133.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$872.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,146.24
|
| Rate for Payer: UHC Core |
$1,087.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.90
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
IP
|
$1,302.54
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$846.65 |
| Max. Negotiated Rate |
$1,172.29 |
| Rate for Payer: Aetna Commercial |
$1,107.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,063.26
|
| Rate for Payer: BCN Commercial |
$1,006.60
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cofinity Commercial |
$1,120.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.03
|
| Rate for Payer: Healthscope Commercial |
$1,172.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.16
|
| Rate for Payer: Nomi Health Commercial |
$1,068.08
|
| Rate for Payer: PHP Commercial |
$1,107.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,133.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$872.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,146.24
|
| Rate for Payer: UHC Core |
$1,087.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.90
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
OP
|
$1,302.54
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$309.35 |
| Max. Negotiated Rate |
$1,172.29 |
| Rate for Payer: Aetna Commercial |
$1,107.16
|
| Rate for Payer: Aetna Medicare |
$338.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$407.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$407.04
|
| Rate for Payer: BCBS Complete |
$521.02
|
| Rate for Payer: BCBS MAPPO |
$325.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,070.82
|
| Rate for Payer: BCN Commercial |
$1,012.72
|
| Rate for Payer: BCN Medicare Advantage |
$325.64
|
| Rate for Payer: Cash Price |
$1,042.03
|
| Rate for Payer: Cofinity Commercial |
$1,120.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,042.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.64
|
| Rate for Payer: Healthscope Commercial |
$1,172.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.16
|
| Rate for Payer: Nomi Health Commercial |
$1,068.08
|
| Rate for Payer: PACE Senior Care Partners |
$309.35
|
| Rate for Payer: PACE SWMI |
$325.64
|
| Rate for Payer: PHP Commercial |
$1,107.16
|
| Rate for Payer: PHP Medicare Advantage |
$325.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,133.21
|
| Rate for Payer: Priority Health Medicare |
$328.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$872.70
|
| Rate for Payer: Railroad Medicare Medicare |
$325.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,146.24
|
| Rate for Payer: UHC Core |
$1,087.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$325.64
|
| Rate for Payer: UHC Exchange |
$325.64
|
| Rate for Payer: UHC Medicare Advantage |
$325.64
|
| Rate for Payer: VA VA |
$325.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.90
|
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
IP
|
$70.69
|
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$63.62 |
| Rate for Payer: Aetna Commercial |
$60.09
|
| Rate for Payer: BCBS Trust/PPO |
$57.70
|
| Rate for Payer: BCN Commercial |
$54.63
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cofinity Commercial |
$60.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.55
|
| Rate for Payer: Healthscope Commercial |
$63.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.09
|
| Rate for Payer: Nomi Health Commercial |
$57.97
|
| Rate for Payer: PHP Commercial |
$60.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.95
|
| Rate for Payer: Priority Health HMO/PPO |
$61.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.21
|
| Rate for Payer: UHC Core |
$59.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.02
|
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
OP
|
$70.69
|
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$63.62 |
| Rate for Payer: Aetna Commercial |
$60.09
|
| Rate for Payer: Aetna Medicare |
$18.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.09
|
| Rate for Payer: BCBS Complete |
$28.28
|
| Rate for Payer: BCBS MAPPO |
$17.67
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCN Commercial |
$54.96
|
| Rate for Payer: BCN Medicare Advantage |
$17.67
|
| Rate for Payer: Cash Price |
$56.55
|
| Rate for Payer: Cofinity Commercial |
$60.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.67
|
| Rate for Payer: Healthscope Commercial |
$63.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.09
|
| Rate for Payer: Nomi Health Commercial |
$57.97
|
| Rate for Payer: PACE Senior Care Partners |
$16.79
|
| Rate for Payer: PACE SWMI |
$17.67
|
| Rate for Payer: PHP Commercial |
$60.09
|
| Rate for Payer: PHP Medicare Advantage |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.95
|
| Rate for Payer: Priority Health HMO/PPO |
$61.50
|
| Rate for Payer: Priority Health Medicare |
$17.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.36
|
| Rate for Payer: Railroad Medicare Medicare |
$17.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.21
|
| Rate for Payer: UHC Core |
$59.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.67
|
| Rate for Payer: UHC Exchange |
$17.67
|
| Rate for Payer: UHC Medicare Advantage |
$17.67
|
| Rate for Payer: VA VA |
$17.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.02
|
|
|
HC RUBELLA ANTIBODY IGC
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$33.97
|
| Rate for Payer: BCN Commercial |
$32.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
HC RUBELLA ANTIBODY IGC
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.01
|
| Rate for Payer: BCBS Complete |
$10.92
|
| Rate for Payer: BCBS MAPPO |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$34.22
|
| Rate for Payer: BCN Commercial |
$32.36
|
| Rate for Payer: BCN Medicare Advantage |
$10.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Mclaren Medicaid |
$10.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.93
|
| Rate for Payer: Meridian Medicaid |
$10.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Senior Care Partners |
$9.88
|
| Rate for Payer: PACE SWMI |
$10.40
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$10.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Medicare |
$10.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: Railroad Medicare Medicare |
$10.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.40
|
| Rate for Payer: UHC Exchange |
$10.40
|
| Rate for Payer: UHC Medicare Advantage |
$10.40
|
| Rate for Payer: UHCCP Medicaid |
$10.40
|
| Rate for Payer: VA VA |
$10.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
HC RUBELLA ANTIBODY IGM
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$33.97
|
| Rate for Payer: BCN Commercial |
$32.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
HC RUBELLA ANTIBODY IGM
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.01
|
| Rate for Payer: BCBS Complete |
$10.92
|
| Rate for Payer: BCBS MAPPO |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$34.22
|
| Rate for Payer: BCN Commercial |
$32.36
|
| Rate for Payer: BCN Medicare Advantage |
$10.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Mclaren Medicaid |
$10.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.93
|
| Rate for Payer: Meridian Medicaid |
$10.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Senior Care Partners |
$9.88
|
| Rate for Payer: PACE SWMI |
$10.40
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$10.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Medicare |
$10.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: Railroad Medicare Medicare |
$10.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.40
|
| Rate for Payer: UHC Exchange |
$10.40
|
| Rate for Payer: UHC Medicare Advantage |
$10.40
|
| Rate for Payer: UHCCP Medicaid |
$10.40
|
| Rate for Payer: VA VA |
$10.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
