|
HC INDWELLING PORT
|
Facility
|
IP
|
$1,388.73
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$966.56 |
| Max. Negotiated Rate |
$1,249.86 |
| Rate for Payer: Aetna Commercial |
$1,180.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,146.95
|
| Rate for Payer: BCN Commercial |
$1,146.95
|
| Rate for Payer: Cash Price |
$1,110.98
|
| Rate for Payer: Cofinity Commercial |
$1,194.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,110.98
|
| Rate for Payer: Healthscope Commercial |
$1,249.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,041.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,180.42
|
| Rate for Payer: Nomi Health Commercial |
$1,138.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,041.55
|
| Rate for Payer: PHP Commercial |
$1,180.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,208.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$966.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,222.08
|
| Rate for Payer: UHC Core |
$1,159.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,041.55
|
|
|
HC INDWELLING PORT
|
Facility
|
OP
|
$1,388.73
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.83 |
| Max. Negotiated Rate |
$1,249.86 |
| Rate for Payer: Aetna Commercial |
$1,180.42
|
| Rate for Payer: Aetna Medicare |
$361.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$433.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$433.98
|
| Rate for Payer: BCBS Complete |
$257.05
|
| Rate for Payer: BCBS MAPPO |
$347.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,141.67
|
| Rate for Payer: BCN Commercial |
$1,141.67
|
| Rate for Payer: BCN Medicare Advantage |
$347.18
|
| Rate for Payer: Cash Price |
$1,110.98
|
| Rate for Payer: Cofinity Commercial |
$1,194.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,110.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.18
|
| Rate for Payer: Healthscope Commercial |
$1,249.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,041.55
|
| Rate for Payer: Mclaren Medicaid |
$244.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$364.54
|
| Rate for Payer: Meridian Medicaid |
$257.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$381.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,180.42
|
| Rate for Payer: Nomi Health Commercial |
$1,138.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,041.55
|
| Rate for Payer: PACE Senior Care Partners |
$329.82
|
| Rate for Payer: PACE SWMI |
$347.18
|
| Rate for Payer: PHP Commercial |
$1,180.42
|
| Rate for Payer: PHP Medicare Advantage |
$347.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,208.20
|
| Rate for Payer: Priority Health Medicare |
$350.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$966.56
|
| Rate for Payer: Railroad Medicare Medicare |
$347.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,222.08
|
| Rate for Payer: UHC Core |
$1,159.59
|
| Rate for Payer: UHC Exchange |
$347.18
|
| Rate for Payer: UHC Medicaid |
$244.83
|
| Rate for Payer: UHC Medicare Advantage |
$347.18
|
| Rate for Payer: UHCCP Medicaid |
$244.83
|
| Rate for Payer: VA VA |
$347.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,041.55
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
OP
|
$684.33
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$120.65 |
| Max. Negotiated Rate |
$615.90 |
| Rate for Payer: Aetna Commercial |
$581.68
|
| Rate for Payer: Aetna Medicare |
$177.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$213.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$213.85
|
| Rate for Payer: BCBS Complete |
$126.67
|
| Rate for Payer: BCBS MAPPO |
$171.08
|
| Rate for Payer: BCBS Trust/PPO |
$562.59
|
| Rate for Payer: BCN Commercial |
$562.59
|
| Rate for Payer: BCN Medicare Advantage |
$171.08
|
| Rate for Payer: Cash Price |
$547.46
|
| Rate for Payer: Cofinity Commercial |
$588.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.08
|
| Rate for Payer: Healthscope Commercial |
$615.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.25
|
| Rate for Payer: Mclaren Medicaid |
$120.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.64
|
| Rate for Payer: Meridian Medicaid |
$126.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$188.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.68
|
| Rate for Payer: Nomi Health Commercial |
$561.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.25
|
| Rate for Payer: PACE Senior Care Partners |
$162.53
|
| Rate for Payer: PACE SWMI |
$171.08
|
| Rate for Payer: PHP Commercial |
$581.68
|
| Rate for Payer: PHP Medicare Advantage |
$171.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$595.37
|
| Rate for Payer: Priority Health Medicare |
$172.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.29
|
| Rate for Payer: Railroad Medicare Medicare |
$171.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$602.21
|
| Rate for Payer: UHC Core |
$571.42
|
| Rate for Payer: UHC Exchange |
$171.08
|
| Rate for Payer: UHC Medicaid |
$120.65
|
| Rate for Payer: UHC Medicare Advantage |
$171.08
|
| Rate for Payer: UHCCP Medicaid |
$120.65
|
| Rate for Payer: VA VA |
$171.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.25
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
IP
|
$684.33
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$476.29 |
| Max. Negotiated Rate |
$615.90 |
| Rate for Payer: Aetna Commercial |
$581.68
|
| Rate for Payer: BCBS Trust/PPO |
$565.19
|
| Rate for Payer: BCN Commercial |
$565.19
|
| Rate for Payer: Cash Price |
$547.46
|
| Rate for Payer: Cofinity Commercial |
$588.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$547.46
|
| Rate for Payer: Healthscope Commercial |
$615.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$513.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.68
|
| Rate for Payer: Nomi Health Commercial |
$561.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.25
|
| Rate for Payer: PHP Commercial |
$581.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$595.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$602.21
|
| Rate for Payer: UHC Core |
$571.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$513.25
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
OP
|
$159.18
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$143.26 |
| Rate for Payer: Aetna Commercial |
$135.30
|
| Rate for Payer: Aetna Medicare |
$41.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.74
|
| Rate for Payer: BCBS Complete |
$29.46
|
| Rate for Payer: BCBS MAPPO |
$39.80
|
| Rate for Payer: BCBS Trust/PPO |
$130.86
|
| Rate for Payer: BCN Commercial |
$130.86
|
| Rate for Payer: BCN Medicare Advantage |
$39.80
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cofinity Commercial |
$136.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.80
|
| Rate for Payer: Healthscope Commercial |
$143.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.39
|
| Rate for Payer: Mclaren Medicaid |
$28.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.78
|
| Rate for Payer: Meridian Medicaid |
$29.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.30
|
| Rate for Payer: Nomi Health Commercial |
$130.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.39
|
| Rate for Payer: PACE Senior Care Partners |
$37.81
|
| Rate for Payer: PACE SWMI |
$39.80
|
| Rate for Payer: PHP Commercial |
$135.30
|
| Rate for Payer: PHP Medicare Advantage |
$39.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$138.49
|
| Rate for Payer: Priority Health Medicare |
$40.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.79
|
| Rate for Payer: Railroad Medicare Medicare |
$39.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.08
|
| Rate for Payer: UHC Core |
$132.92
|
| Rate for Payer: UHC Exchange |
$39.80
|
| Rate for Payer: UHC Medicaid |
$28.06
|
| Rate for Payer: UHC Medicare Advantage |
$39.80
|
| Rate for Payer: UHCCP Medicaid |
$28.06
|
| Rate for Payer: VA VA |
$39.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.39
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
IP
|
$159.18
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.79 |
| Max. Negotiated Rate |
$143.26 |
| Rate for Payer: Aetna Commercial |
$135.30
|
| Rate for Payer: BCBS Trust/PPO |
$131.47
|
| Rate for Payer: BCN Commercial |
$131.47
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cofinity Commercial |
$136.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.34
|
| Rate for Payer: Healthscope Commercial |
$143.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.30
|
| Rate for Payer: Nomi Health Commercial |
$130.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.39
|
| Rate for Payer: PHP Commercial |
$135.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$138.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.08
|
| Rate for Payer: UHC Core |
$132.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.39
|
|
|
HC INFLIXIMAB AB
|
Facility
|
IP
|
$192.47
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$133.96 |
| Max. Negotiated Rate |
$173.22 |
| Rate for Payer: Aetna Commercial |
$163.60
|
| Rate for Payer: BCBS Trust/PPO |
$158.96
|
| Rate for Payer: BCN Commercial |
$158.96
|
| Rate for Payer: Cash Price |
$153.98
|
| Rate for Payer: Cofinity Commercial |
$165.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.98
|
| Rate for Payer: Healthscope Commercial |
$173.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.60
|
| Rate for Payer: Nomi Health Commercial |
$157.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.35
|
| Rate for Payer: PHP Commercial |
$163.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.37
|
| Rate for Payer: UHC Core |
$160.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.35
|
|
|
HC INFLIXIMAB AB
|
Facility
|
OP
|
$192.47
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$173.22 |
| Rate for Payer: Aetna Commercial |
$163.60
|
| Rate for Payer: Aetna Medicare |
$50.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.15
|
| Rate for Payer: BCBS Complete |
$35.63
|
| Rate for Payer: BCBS MAPPO |
$48.12
|
| Rate for Payer: BCBS Trust/PPO |
$158.23
|
| Rate for Payer: BCN Commercial |
$158.23
|
| Rate for Payer: BCN Medicare Advantage |
$48.12
|
| Rate for Payer: Cash Price |
$153.98
|
| Rate for Payer: Cofinity Commercial |
$165.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.12
|
| Rate for Payer: Healthscope Commercial |
$173.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.35
|
| Rate for Payer: Mclaren Medicaid |
$33.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.52
|
| Rate for Payer: Meridian Medicaid |
$35.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.60
|
| Rate for Payer: Nomi Health Commercial |
$157.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.35
|
| Rate for Payer: PACE Senior Care Partners |
$45.71
|
| Rate for Payer: PACE SWMI |
$48.12
|
| Rate for Payer: PHP Commercial |
$163.60
|
| Rate for Payer: PHP Medicare Advantage |
$48.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$167.45
|
| Rate for Payer: Priority Health Medicare |
$48.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.96
|
| Rate for Payer: Railroad Medicare Medicare |
$48.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.37
|
| Rate for Payer: UHC Core |
$160.71
|
| Rate for Payer: UHC Exchange |
$48.12
|
| Rate for Payer: UHC Medicaid |
$33.93
|
| Rate for Payer: UHC Medicare Advantage |
$48.12
|
| Rate for Payer: UHCCP Medicaid |
$33.93
|
| Rate for Payer: VA VA |
$48.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.35
|
|
|
HC INFLIXIMAB, S
|
Facility
|
IP
|
$254.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$177.41 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: BCBS Trust/PPO |
$210.52
|
| Rate for Payer: BCN Commercial |
$210.52
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Nomi Health Commercial |
$209.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.18
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$221.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.31
|
| Rate for Payer: UHC Core |
$212.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.18
|
|
|
HC INFLIXIMAB, S
|
Facility
|
OP
|
$254.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.66
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$63.73
|
| Rate for Payer: BCBS Trust/PPO |
$209.55
|
| Rate for Payer: BCN Commercial |
$209.55
|
| Rate for Payer: BCN Medicare Advantage |
$63.73
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.73
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.18
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.91
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Nomi Health Commercial |
$209.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.18
|
| Rate for Payer: PACE Senior Care Partners |
$60.54
|
| Rate for Payer: PACE SWMI |
$63.73
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: PHP Medicare Advantage |
$63.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$221.76
|
| Rate for Payer: Priority Health Medicare |
$64.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.41
|
| Rate for Payer: Railroad Medicare Medicare |
$63.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.31
|
| Rate for Payer: UHC Core |
$212.84
|
| Rate for Payer: UHC Exchange |
$63.73
|
| Rate for Payer: UHC Medicaid |
$44.94
|
| Rate for Payer: UHC Medicare Advantage |
$63.73
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
| Rate for Payer: VA VA |
$63.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.18
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
IP
|
$221.29
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$154.02 |
| Max. Negotiated Rate |
$199.16 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: BCBS Trust/PPO |
$182.76
|
| Rate for Payer: BCN Commercial |
$182.76
|
| Rate for Payer: Cash Price |
$177.03
|
| Rate for Payer: Cofinity Commercial |
$190.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.03
|
| Rate for Payer: Healthscope Commercial |
$199.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.10
|
| Rate for Payer: Nomi Health Commercial |
$181.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.97
|
| Rate for Payer: PHP Commercial |
$188.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$192.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.74
|
| Rate for Payer: UHC Core |
$184.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.97
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
OP
|
$221.29
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.01 |
| Max. Negotiated Rate |
$199.16 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Medicare |
$57.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.15
|
| Rate for Payer: BCBS Complete |
$40.96
|
| Rate for Payer: BCBS MAPPO |
$55.32
|
| Rate for Payer: BCBS Trust/PPO |
$181.92
|
| Rate for Payer: BCN Commercial |
$181.92
|
| Rate for Payer: BCN Medicare Advantage |
$55.32
|
| Rate for Payer: Cash Price |
$177.03
|
| Rate for Payer: Cofinity Commercial |
$190.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.32
|
| Rate for Payer: Healthscope Commercial |
$199.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.97
|
| Rate for Payer: Mclaren Medicaid |
$39.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.09
|
| Rate for Payer: Meridian Medicaid |
$40.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.10
|
| Rate for Payer: Nomi Health Commercial |
$181.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.97
|
| Rate for Payer: PACE Senior Care Partners |
$52.56
|
| Rate for Payer: PACE SWMI |
$55.32
|
| Rate for Payer: PHP Commercial |
$188.10
|
| Rate for Payer: PHP Medicare Advantage |
$55.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$192.52
|
| Rate for Payer: Priority Health Medicare |
$55.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.02
|
| Rate for Payer: Railroad Medicare Medicare |
$55.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.74
|
| Rate for Payer: UHC Core |
$184.78
|
| Rate for Payer: UHC Exchange |
$55.32
|
| Rate for Payer: UHC Medicaid |
$39.01
|
| Rate for Payer: UHC Medicare Advantage |
$55.32
|
| Rate for Payer: UHCCP Medicaid |
$39.01
|
| Rate for Payer: VA VA |
$55.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.97
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
OP
|
$148.64
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$133.78 |
| Rate for Payer: Aetna Commercial |
$126.34
|
| Rate for Payer: Aetna Medicare |
$38.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.45
|
| Rate for Payer: BCBS Complete |
$27.51
|
| Rate for Payer: BCBS MAPPO |
$37.16
|
| Rate for Payer: BCBS Trust/PPO |
$122.20
|
| Rate for Payer: BCN Commercial |
$122.20
|
| Rate for Payer: BCN Medicare Advantage |
$37.16
|
| Rate for Payer: Cash Price |
$118.91
|
| Rate for Payer: Cofinity Commercial |
$127.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.16
|
| Rate for Payer: Healthscope Commercial |
$133.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.48
|
| Rate for Payer: Mclaren Medicaid |
$26.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.02
|
| Rate for Payer: Meridian Medicaid |
$27.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.34
|
| Rate for Payer: Nomi Health Commercial |
$121.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.48
|
| Rate for Payer: PACE Senior Care Partners |
$35.30
|
| Rate for Payer: PACE SWMI |
$37.16
|
| Rate for Payer: PHP Commercial |
$126.34
|
| Rate for Payer: PHP Medicare Advantage |
$37.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$129.32
|
| Rate for Payer: Priority Health Medicare |
$37.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.45
|
| Rate for Payer: Railroad Medicare Medicare |
$37.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.80
|
| Rate for Payer: UHC Core |
$124.11
|
| Rate for Payer: UHC Exchange |
$37.16
|
| Rate for Payer: UHC Medicaid |
$26.21
|
| Rate for Payer: UHC Medicare Advantage |
$37.16
|
| Rate for Payer: UHCCP Medicaid |
$26.21
|
| Rate for Payer: VA VA |
$37.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.48
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
IP
|
$148.64
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$103.45 |
| Max. Negotiated Rate |
$133.78 |
| Rate for Payer: Aetna Commercial |
$126.34
|
| Rate for Payer: BCBS Trust/PPO |
$122.76
|
| Rate for Payer: BCN Commercial |
$122.76
|
| Rate for Payer: Cash Price |
$118.91
|
| Rate for Payer: Cofinity Commercial |
$127.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.91
|
| Rate for Payer: Healthscope Commercial |
$133.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.34
|
| Rate for Payer: Nomi Health Commercial |
$121.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.48
|
| Rate for Payer: PHP Commercial |
$126.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$129.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.80
|
| Rate for Payer: UHC Core |
$124.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.48
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
OP
|
$227.81
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$205.03 |
| Rate for Payer: Aetna Commercial |
$193.64
|
| Rate for Payer: Aetna Medicare |
$59.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.19
|
| Rate for Payer: BCBS Complete |
$42.17
|
| Rate for Payer: BCBS MAPPO |
$56.95
|
| Rate for Payer: BCBS Trust/PPO |
$187.28
|
| Rate for Payer: BCN Commercial |
$187.28
|
| Rate for Payer: BCN Medicare Advantage |
$56.95
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cofinity Commercial |
$195.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.95
|
| Rate for Payer: Healthscope Commercial |
$205.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.86
|
| Rate for Payer: Mclaren Medicaid |
$40.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.80
|
| Rate for Payer: Meridian Medicaid |
$42.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.64
|
| Rate for Payer: Nomi Health Commercial |
$186.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.86
|
| Rate for Payer: PACE Senior Care Partners |
$54.10
|
| Rate for Payer: PACE SWMI |
$56.95
|
| Rate for Payer: PHP Commercial |
$193.64
|
| Rate for Payer: PHP Medicare Advantage |
$56.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.19
|
| Rate for Payer: Priority Health Medicare |
$57.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.56
|
| Rate for Payer: Railroad Medicare Medicare |
$56.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.47
|
| Rate for Payer: UHC Core |
$190.22
|
| Rate for Payer: UHC Exchange |
$56.95
|
| Rate for Payer: UHC Medicaid |
$40.16
|
| Rate for Payer: UHC Medicare Advantage |
$56.95
|
| Rate for Payer: UHCCP Medicaid |
$40.16
|
| Rate for Payer: VA VA |
$56.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.86
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
IP
|
$227.81
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$158.56 |
| Max. Negotiated Rate |
$205.03 |
| Rate for Payer: Aetna Commercial |
$193.64
|
| Rate for Payer: BCBS Trust/PPO |
$188.15
|
| Rate for Payer: BCN Commercial |
$188.15
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cofinity Commercial |
$195.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.25
|
| Rate for Payer: Healthscope Commercial |
$205.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.64
|
| Rate for Payer: Nomi Health Commercial |
$186.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.86
|
| Rate for Payer: PHP Commercial |
$193.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.47
|
| Rate for Payer: UHC Core |
$190.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.86
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.78
|
| Rate for Payer: BCN Commercial |
$25.78
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.75
|
| Rate for Payer: BCBS Complete |
$5.78
|
| Rate for Payer: BCBS MAPPO |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$25.66
|
| Rate for Payer: BCN Medicare Advantage |
$7.80
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.80
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$5.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.19
|
| Rate for Payer: Meridian Medicaid |
$5.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PACE Senior Care Partners |
$7.41
|
| Rate for Payer: PACE SWMI |
$7.80
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: UHC Exchange |
$7.80
|
| Rate for Payer: UHC Medicaid |
$5.50
|
| Rate for Payer: UHC Medicare Advantage |
$7.80
|
| Rate for Payer: UHCCP Medicaid |
$5.50
|
| Rate for Payer: VA VA |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC INFLUENZA VAC, INACTIV ADJUVANT IM
|
Facility
|
OP
|
$170.34
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
63600251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$153.31 |
| Rate for Payer: Aetna Commercial |
$144.79
|
| Rate for Payer: Aetna Medicare |
$44.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.23
|
| Rate for Payer: BCBS Complete |
$31.53
|
| Rate for Payer: BCBS MAPPO |
$42.59
|
| Rate for Payer: BCBS Trust/PPO |
$140.04
|
| Rate for Payer: BCN Commercial |
$140.04
|
| Rate for Payer: BCN Medicare Advantage |
$42.59
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Cofinity Commercial |
$146.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.59
|
| Rate for Payer: Healthscope Commercial |
$153.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.75
|
| Rate for Payer: Mclaren Medicaid |
$30.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.71
|
| Rate for Payer: Meridian Medicaid |
$31.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.79
|
| Rate for Payer: Nomi Health Commercial |
$139.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.75
|
| Rate for Payer: PACE Senior Care Partners |
$40.46
|
| Rate for Payer: PACE SWMI |
$42.59
|
| Rate for Payer: PHP Commercial |
$144.79
|
| Rate for Payer: PHP Medicare Advantage |
$42.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$148.20
|
| Rate for Payer: Priority Health Medicare |
$43.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.56
|
| Rate for Payer: Railroad Medicare Medicare |
$42.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.90
|
| Rate for Payer: UHC Core |
$142.23
|
| Rate for Payer: UHC Exchange |
$42.59
|
| Rate for Payer: UHC Medicaid |
$30.03
|
| Rate for Payer: UHC Medicare Advantage |
$42.59
|
| Rate for Payer: UHCCP Medicaid |
$30.03
|
| Rate for Payer: VA VA |
$42.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.75
|
|
|
HC INFLUENZA VAC, INACTIV ADJUVANT IM
|
Facility
|
IP
|
$170.34
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
63600251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$153.31 |
| Rate for Payer: Aetna Commercial |
$144.79
|
| Rate for Payer: BCBS Trust/PPO |
$140.68
|
| Rate for Payer: BCN Commercial |
$140.68
|
| Rate for Payer: Cash Price |
$136.27
|
| Rate for Payer: Cofinity Commercial |
$146.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.27
|
| Rate for Payer: Healthscope Commercial |
$153.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.79
|
| Rate for Payer: Nomi Health Commercial |
$139.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.75
|
| Rate for Payer: PHP Commercial |
$144.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$148.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.90
|
| Rate for Payer: UHC Core |
$142.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.75
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
IP
|
$111.18
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.38 |
| Max. Negotiated Rate |
$100.06 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: BCBS Trust/PPO |
$91.82
|
| Rate for Payer: BCN Commercial |
$91.82
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cofinity Commercial |
$95.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.94
|
| Rate for Payer: Healthscope Commercial |
$100.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.50
|
| Rate for Payer: Nomi Health Commercial |
$91.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.39
|
| Rate for Payer: PHP Commercial |
$94.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.84
|
| Rate for Payer: UHC Core |
$92.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.39
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
OP
|
$111.18
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$100.06 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Medicare |
$28.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.74
|
| Rate for Payer: BCBS Complete |
$20.58
|
| Rate for Payer: BCBS MAPPO |
$27.80
|
| Rate for Payer: BCBS Trust/PPO |
$91.40
|
| Rate for Payer: BCN Commercial |
$91.40
|
| Rate for Payer: BCN Medicare Advantage |
$27.80
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cofinity Commercial |
$95.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.80
|
| Rate for Payer: Healthscope Commercial |
$100.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.39
|
| Rate for Payer: Mclaren Medicaid |
$19.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.18
|
| Rate for Payer: Meridian Medicaid |
$20.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.50
|
| Rate for Payer: Nomi Health Commercial |
$91.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.39
|
| Rate for Payer: PACE Senior Care Partners |
$26.41
|
| Rate for Payer: PACE SWMI |
$27.80
|
| Rate for Payer: PHP Commercial |
$94.50
|
| Rate for Payer: PHP Medicare Advantage |
$27.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.73
|
| Rate for Payer: Priority Health Medicare |
$28.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.38
|
| Rate for Payer: Railroad Medicare Medicare |
$27.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.84
|
| Rate for Payer: UHC Core |
$92.84
|
| Rate for Payer: UHC Exchange |
$27.80
|
| Rate for Payer: UHC Medicaid |
$19.60
|
| Rate for Payer: UHC Medicare Advantage |
$27.80
|
| Rate for Payer: UHCCP Medicaid |
$19.60
|
| Rate for Payer: VA VA |
$27.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.39
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: BCBS Trust/PPO |
$21.91
|
| Rate for Payer: BCN Commercial |
$21.91
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.35
|
| Rate for Payer: UHC Core |
$22.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$6.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.29
|
| Rate for Payer: BCBS Complete |
$4.91
|
| Rate for Payer: BCBS MAPPO |
$6.63
|
| Rate for Payer: BCBS Trust/PPO |
$21.81
|
| Rate for Payer: BCN Commercial |
$21.81
|
| Rate for Payer: BCN Medicare Advantage |
$6.63
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.63
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.90
|
| Rate for Payer: Mclaren Medicaid |
$4.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.96
|
| Rate for Payer: Meridian Medicaid |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$21.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Senior Care Partners |
$6.30
|
| Rate for Payer: PACE SWMI |
$6.63
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$6.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.08
|
| Rate for Payer: Priority Health Medicare |
$6.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.46
|
| Rate for Payer: Railroad Medicare Medicare |
$6.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.35
|
| Rate for Payer: UHC Core |
$22.15
|
| Rate for Payer: UHC Exchange |
$6.63
|
| Rate for Payer: UHC Medicaid |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$6.63
|
| Rate for Payer: UHCCP Medicaid |
$4.68
|
| Rate for Payer: VA VA |
$6.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.90
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
OP
|
$32.90
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$29.61 |
| Rate for Payer: Aetna Commercial |
$27.96
|
| Rate for Payer: Aetna Medicare |
$8.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.28
|
| Rate for Payer: BCBS Complete |
$6.09
|
| Rate for Payer: BCBS MAPPO |
$8.22
|
| Rate for Payer: BCBS Trust/PPO |
$27.05
|
| Rate for Payer: BCN Commercial |
$27.05
|
| Rate for Payer: BCN Medicare Advantage |
$8.22
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.22
|
| Rate for Payer: Healthscope Commercial |
$29.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.68
|
| Rate for Payer: Mclaren Medicaid |
$5.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.64
|
| Rate for Payer: Meridian Medicaid |
$6.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Nomi Health Commercial |
$26.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: PACE Senior Care Partners |
$7.81
|
| Rate for Payer: PACE SWMI |
$8.22
|
| Rate for Payer: PHP Commercial |
$27.96
|
| Rate for Payer: PHP Medicare Advantage |
$8.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.62
|
| Rate for Payer: Priority Health Medicare |
$8.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.90
|
| Rate for Payer: Railroad Medicare Medicare |
$8.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.95
|
| Rate for Payer: UHC Core |
$27.47
|
| Rate for Payer: UHC Exchange |
$8.22
|
| Rate for Payer: UHC Medicaid |
$5.80
|
| Rate for Payer: UHC Medicare Advantage |
$8.22
|
| Rate for Payer: UHCCP Medicaid |
$5.80
|
| Rate for Payer: VA VA |
$8.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.68
|
|
