|
HC INFLIXIMAB, S
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna Medicare |
$63.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.56
|
| Rate for Payer: BCBS Complete |
$29.89
|
| Rate for Payer: BCBS MAPPO |
$61.25
|
| Rate for Payer: BCBS Trust/PPO |
$190.49
|
| Rate for Payer: BCN Commercial |
$190.49
|
| Rate for Payer: BCN Medicare Advantage |
$61.25
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.25
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: Mclaren Medicaid |
$28.46
|
| Rate for Payer: Meridian Medicaid |
$29.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PACE Senior Care Partners |
$58.19
|
| Rate for Payer: PACE SWMI |
$61.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: PHP Medicare Advantage |
$61.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.15
|
| Rate for Payer: Priority Health Medicare |
$61.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.43
|
| Rate for Payer: Railroad Medicare Medicare |
$61.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.60
|
| Rate for Payer: UHC Core |
$204.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.25
|
| Rate for Payer: UHC Medicare Advantage |
$63.09
|
| Rate for Payer: VA VA |
$61.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
IP
|
$212.70
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$129.73 |
| Max. Negotiated Rate |
$191.43 |
| Rate for Payer: Aetna Commercial |
$180.80
|
| Rate for Payer: BCBS Trust/PPO |
$164.37
|
| Rate for Payer: BCN Commercial |
$164.37
|
| Rate for Payer: Cash Price |
$170.16
|
| Rate for Payer: Cofinity Commercial |
$182.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.16
|
| Rate for Payer: Healthscope Commercial |
$191.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.80
|
| Rate for Payer: PHP Commercial |
$180.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.18
|
| Rate for Payer: UHC Core |
$177.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.52
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
OP
|
$212.70
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.52 |
| Max. Negotiated Rate |
$191.43 |
| Rate for Payer: Aetna Commercial |
$180.80
|
| Rate for Payer: Aetna Medicare |
$55.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.47
|
| Rate for Payer: BCBS Complete |
$110.52
|
| Rate for Payer: BCBS MAPPO |
$53.18
|
| Rate for Payer: BCBS Trust/PPO |
$165.37
|
| Rate for Payer: BCN Commercial |
$165.37
|
| Rate for Payer: BCN Medicare Advantage |
$53.18
|
| Rate for Payer: Cash Price |
$170.16
|
| Rate for Payer: Cash Price |
$170.16
|
| Rate for Payer: Cofinity Commercial |
$182.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.18
|
| Rate for Payer: Healthscope Commercial |
$191.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.52
|
| Rate for Payer: Mclaren Medicaid |
$105.26
|
| Rate for Payer: Meridian Medicaid |
$110.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.80
|
| Rate for Payer: PACE Senior Care Partners |
$50.52
|
| Rate for Payer: PACE SWMI |
$53.18
|
| Rate for Payer: PHP Commercial |
$180.80
|
| Rate for Payer: PHP Medicare Advantage |
$53.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.05
|
| Rate for Payer: Priority Health Medicare |
$53.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.73
|
| Rate for Payer: Railroad Medicare Medicare |
$53.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.18
|
| Rate for Payer: UHC Core |
$177.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.18
|
| Rate for Payer: UHC Medicare Advantage |
$54.77
|
| Rate for Payer: VA VA |
$53.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.52
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
OP
|
$142.87
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$128.58 |
| Rate for Payer: Aetna Commercial |
$121.44
|
| Rate for Payer: Aetna Medicare |
$37.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.65
|
| Rate for Payer: BCBS Complete |
$74.24
|
| Rate for Payer: BCBS MAPPO |
$35.72
|
| Rate for Payer: BCBS Trust/PPO |
$111.08
|
| Rate for Payer: BCN Commercial |
$111.08
|
| Rate for Payer: BCN Medicare Advantage |
$35.72
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cofinity Commercial |
$122.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$128.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.15
|
| Rate for Payer: Mclaren Medicaid |
$70.70
|
| Rate for Payer: Meridian Medicaid |
$74.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.44
|
| Rate for Payer: PACE Senior Care Partners |
$33.93
|
| Rate for Payer: PACE SWMI |
$35.72
|
| Rate for Payer: PHP Commercial |
$121.44
|
| Rate for Payer: PHP Medicare Advantage |
$35.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.30
|
| Rate for Payer: Priority Health Medicare |
$35.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.14
|
| Rate for Payer: Railroad Medicare Medicare |
$35.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.73
|
| Rate for Payer: UHC Core |
$119.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.72
|
| Rate for Payer: UHC Medicare Advantage |
$36.79
|
| Rate for Payer: VA VA |
$35.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.15
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
IP
|
$142.87
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$128.58 |
| Rate for Payer: Aetna Commercial |
$121.44
|
| Rate for Payer: BCBS Trust/PPO |
$110.41
|
| Rate for Payer: BCN Commercial |
$110.41
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cofinity Commercial |
$122.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.30
|
| Rate for Payer: Healthscope Commercial |
$128.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.44
|
| Rate for Payer: PHP Commercial |
$121.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.73
|
| Rate for Payer: UHC Core |
$119.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.15
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
IP
|
$218.96
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$133.54 |
| Max. Negotiated Rate |
$197.06 |
| Rate for Payer: Aetna Commercial |
$186.12
|
| Rate for Payer: BCBS Trust/PPO |
$169.21
|
| Rate for Payer: BCN Commercial |
$169.21
|
| Rate for Payer: Cash Price |
$175.17
|
| Rate for Payer: Cofinity Commercial |
$188.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.17
|
| Rate for Payer: Healthscope Commercial |
$197.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.12
|
| Rate for Payer: PHP Commercial |
$186.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.68
|
| Rate for Payer: UHC Core |
$182.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.22
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
OP
|
$218.96
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$197.06 |
| Rate for Payer: Aetna Commercial |
$186.12
|
| Rate for Payer: Aetna Medicare |
$56.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.42
|
| Rate for Payer: BCBS Complete |
$110.52
|
| Rate for Payer: BCBS MAPPO |
$54.74
|
| Rate for Payer: BCBS Trust/PPO |
$170.24
|
| Rate for Payer: BCN Commercial |
$170.24
|
| Rate for Payer: BCN Medicare Advantage |
$54.74
|
| Rate for Payer: Cash Price |
$175.17
|
| Rate for Payer: Cash Price |
$175.17
|
| Rate for Payer: Cofinity Commercial |
$188.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.74
|
| Rate for Payer: Healthscope Commercial |
$197.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.22
|
| Rate for Payer: Mclaren Medicaid |
$105.26
|
| Rate for Payer: Meridian Medicaid |
$110.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.12
|
| Rate for Payer: PACE Senior Care Partners |
$52.00
|
| Rate for Payer: PACE SWMI |
$54.74
|
| Rate for Payer: PHP Commercial |
$186.12
|
| Rate for Payer: PHP Medicare Advantage |
$54.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.50
|
| Rate for Payer: Priority Health Medicare |
$54.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.54
|
| Rate for Payer: Railroad Medicare Medicare |
$54.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.68
|
| Rate for Payer: UHC Core |
$182.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.74
|
| Rate for Payer: UHC Medicare Advantage |
$56.38
|
| Rate for Payer: VA VA |
$54.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.22
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$23.18
|
| Rate for Payer: BCN Commercial |
$23.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.40
|
| Rate for Payer: UHC Core |
$25.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$32.72 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.38
|
| Rate for Payer: BCBS Complete |
$32.72
|
| Rate for Payer: BCBS MAPPO |
$7.50
|
| Rate for Payer: BCBS Trust/PPO |
$23.32
|
| Rate for Payer: BCN Commercial |
$23.32
|
| Rate for Payer: BCN Medicare Advantage |
$7.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Mclaren Medicaid |
$31.16
|
| Rate for Payer: Meridian Medicaid |
$32.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PACE Senior Care Partners |
$7.12
|
| Rate for Payer: PACE SWMI |
$7.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: PHP Medicare Advantage |
$7.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.10
|
| Rate for Payer: Priority Health Medicare |
$7.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.30
|
| Rate for Payer: Railroad Medicare Medicare |
$7.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.40
|
| Rate for Payer: UHC Core |
$25.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.50
|
| Rate for Payer: UHC Medicare Advantage |
$7.72
|
| Rate for Payer: VA VA |
$7.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: BCBS Trust/PPO |
$53.60
|
| Rate for Payer: BCN Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.04
|
| Rate for Payer: UHC Core |
$57.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.47 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$18.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.68
|
| Rate for Payer: BCBS Complete |
$27.74
|
| Rate for Payer: BCBS MAPPO |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$53.93
|
| Rate for Payer: BCN Commercial |
$53.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.34
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PACE Senior Care Partners |
$16.47
|
| Rate for Payer: PACE SWMI |
$17.34
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: PHP Medicare Advantage |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.34
|
| Rate for Payer: Priority Health Medicare |
$17.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.30
|
| Rate for Payer: Railroad Medicare Medicare |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.04
|
| Rate for Payer: UHC Core |
$57.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.34
|
| Rate for Payer: UHC Medicare Advantage |
$17.86
|
| Rate for Payer: VA VA |
$17.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna Medicare |
$8.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.88
|
| Rate for Payer: BCBS Complete |
$12.65
|
| Rate for Payer: BCBS MAPPO |
$7.90
|
| Rate for Payer: BCBS Trust/PPO |
$24.58
|
| Rate for Payer: BCN Commercial |
$24.58
|
| Rate for Payer: BCN Medicare Advantage |
$7.90
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.90
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.88
|
| Rate for Payer: PACE Senior Care Partners |
$7.51
|
| Rate for Payer: PACE SWMI |
$7.90
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: PHP Medicare Advantage |
$7.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.51
|
| Rate for Payer: Priority Health Medicare |
$7.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.29
|
| Rate for Payer: Railroad Medicare Medicare |
$7.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC Core |
$26.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.90
|
| Rate for Payer: UHC Medicare Advantage |
$8.14
|
| Rate for Payer: VA VA |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$24.44
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.88
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC Core |
$26.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
63600126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
63600126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
63600077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
63600077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.65
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: BCBS MAPPO |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$19.03
|
| Rate for Payer: BCN Commercial |
$19.03
|
| Rate for Payer: BCN Medicare Advantage |
$6.12
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.81
|
| Rate for Payer: PACE Senior Care Partners |
$5.81
|
| Rate for Payer: PACE SWMI |
$6.12
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: PHP Medicare Advantage |
$6.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.30
|
| Rate for Payer: Priority Health Medicare |
$6.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.93
|
| Rate for Payer: Railroad Medicare Medicare |
$6.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC Core |
$20.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.12
|
| Rate for Payer: UHC Medicare Advantage |
$6.30
|
| Rate for Payer: VA VA |
$6.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$18.92
|
| Rate for Payer: BCN Commercial |
$18.92
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC Core |
$20.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC INF PUMP PROGRAMMABLE LVL 6
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
27800141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.83 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$586.50
|
| Rate for Payer: BCBS Trust/PPO |
$533.23
|
| Rate for Payer: BCN Commercial |
$533.23
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Commercial |
$593.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.00
|
| Rate for Payer: Healthscope Commercial |
$621.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$586.50
|
| Rate for Payer: PHP Commercial |
$586.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$600.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$420.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.20
|
| Rate for Payer: UHC Core |
$576.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.50
|
|
|
HC INF PUMP PROGRAMMABLE LVL 6
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
27800141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.88 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$586.50
|
| Rate for Payer: Aetna Medicare |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.62
|
| Rate for Payer: BCBS Complete |
$276.00
|
| Rate for Payer: BCBS MAPPO |
$172.50
|
| Rate for Payer: BCBS Trust/PPO |
$536.48
|
| Rate for Payer: BCN Commercial |
$536.48
|
| Rate for Payer: BCN Medicare Advantage |
$172.50
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Commercial |
$593.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.50
|
| Rate for Payer: Healthscope Commercial |
$621.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$586.50
|
| Rate for Payer: PACE Senior Care Partners |
$163.88
|
| Rate for Payer: PACE SWMI |
$172.50
|
| Rate for Payer: PHP Commercial |
$586.50
|
| Rate for Payer: PHP Medicare Advantage |
$172.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$600.30
|
| Rate for Payer: Priority Health Medicare |
$172.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$420.83
|
| Rate for Payer: Railroad Medicare Medicare |
$172.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.20
|
| Rate for Payer: UHC Core |
$576.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.50
|
| Rate for Payer: UHC Medicare Advantage |
$177.68
|
| Rate for Payer: VA VA |
$172.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.50
|
|
