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All Charges

Charge Type Setting Price  
Service Code NDC 00904608261
Hospital Charge Code 11701
Hospital Revenue Code 637
Min. Negotiated Rate $3.12
Max. Negotiated Rate $11.82
Rate for Payer: Aetna Commercial $11.16
Rate for Payer: Aetna Medicare $3.41
Rate for Payer: Allen County Amish Medical Aid Commercial $4.10
Rate for Payer: Amish Plain Church Group Commercial $4.10
Rate for Payer: BCBS Complete $5.25
Rate for Payer: BCBS MAPPO $3.28
Rate for Payer: BCBS Trust/PPO $10.79
Rate for Payer: BCN Commercial $10.21
Rate for Payer: BCN Medicare Advantage $3.28
Rate for Payer: Cash Price $10.50
Rate for Payer: Cofinity Commercial $11.29
Rate for Payer: Encore Health Key Benefits Commercial $10.50
Rate for Payer: Health Alliance Plan Medicare Advantage $3.28
Rate for Payer: Healthscope Commercial $11.82
Rate for Payer: Lakeland Regional Health Systems Commercial $9.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage $3.45
Rate for Payer: MI Amish Medical Board Commercial $3.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial $11.16
Rate for Payer: Nomi Health Commercial $10.77
Rate for Payer: PACE Senior Care Partners $3.12
Rate for Payer: PACE SWMI $3.28
Rate for Payer: PHP Commercial $11.16
Rate for Payer: PHP Medicare Advantage $3.28
Rate for Payer: Priority Health Cigna Priority Health $8.53
Rate for Payer: Priority Health HMO/PPO $11.42
Rate for Payer: Priority Health Medicare $3.32
Rate for Payer: Priority Health Narrow/Tiered Network $8.80
Rate for Payer: Railroad Medicare Medicare $3.28
Rate for Payer: UHC All Payor (Choice/PPO) $11.55
Rate for Payer: UHC Core $10.96
Rate for Payer: UHC Dual Complete DSNP $3.28
Rate for Payer: UHC Exchange $3.28
Rate for Payer: UHC Medicare Advantage $3.28
Rate for Payer: VA VA $3.28
Rate for Payer: Van Buren County Sheriff Dept. Commercial $9.85
Service Code NDC 00904608261
Hospital Charge Code 11701
Hospital Revenue Code 637
Min. Negotiated Rate $8.53
Max. Negotiated Rate $11.82
Rate for Payer: Aetna Commercial $11.16
Rate for Payer: BCBS Trust/PPO $10.72
Rate for Payer: BCN Commercial $10.15
Rate for Payer: Cash Price $10.50
Rate for Payer: Cofinity Commercial $11.29
Rate for Payer: Encore Health Key Benefits Commercial $10.50
Rate for Payer: Healthscope Commercial $11.82
Rate for Payer: Lakeland Regional Health Systems Commercial $9.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial $11.16
Rate for Payer: Nomi Health Commercial $10.77
Rate for Payer: PHP Commercial $11.16
Rate for Payer: Priority Health Cigna Priority Health $8.53
Rate for Payer: Priority Health HMO/PPO $11.42
Rate for Payer: Priority Health Narrow/Tiered Network $8.80
Rate for Payer: UHC All Payor (Choice/PPO) $11.55
Rate for Payer: UHC Core $10.96
Rate for Payer: Van Buren County Sheriff Dept. Commercial $9.85