|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
IP
|
$32.90
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.90 |
| Max. Negotiated Rate |
$29.61 |
| Rate for Payer: Aetna Commercial |
$27.96
|
| Rate for Payer: BCBS Trust/PPO |
$27.17
|
| Rate for Payer: BCN Commercial |
$27.17
|
| 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: Healthscope Commercial |
$29.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.68
|
| 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: PHP Commercial |
$27.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.95
|
| Rate for Payer: UHC Core |
$27.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.68
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
63600126
|
|
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 VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
63600126
|
|
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 VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
63600078
|
|
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 VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
63600078
|
|
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 VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
63600077
|
|
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 VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
63600077
|
|
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 VAC, TRIVALENT (CCIIV3) 0.5 ML IM
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 90661
|
| Hospital Charge Code |
63600250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.39
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS MAPPO |
$10.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.22
|
| Rate for Payer: BCN Commercial |
$35.22
|
| Rate for Payer: BCN Medicare Advantage |
$10.71
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$7.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.25
|
| Rate for Payer: Meridian Medicaid |
$7.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PACE Senior Care Partners |
$10.17
|
| Rate for Payer: PACE SWMI |
$10.71
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Medicare |
$10.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.82
|
| Rate for Payer: Railroad Medicare Medicare |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: UHC Exchange |
$10.71
|
| Rate for Payer: UHC Medicaid |
$7.55
|
| Rate for Payer: UHC Medicare Advantage |
$10.71
|
| Rate for Payer: UHCCP Medicaid |
$7.55
|
| Rate for Payer: VA VA |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (CCIIV3) 0.5 ML IM
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 90661
|
| Hospital Charge Code |
63600250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: BCBS Trust/PPO |
$35.38
|
| Rate for Payer: BCN Commercial |
$35.38
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
63600248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: BCBS Trust/PPO |
$35.38
|
| Rate for Payer: BCN Commercial |
$35.38
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
63600248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.39
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS MAPPO |
$10.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.22
|
| Rate for Payer: BCN Commercial |
$35.22
|
| Rate for Payer: BCN Medicare Advantage |
$10.71
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$7.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.25
|
| Rate for Payer: Meridian Medicaid |
$7.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PACE Senior Care Partners |
$10.17
|
| Rate for Payer: PACE SWMI |
$10.71
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Medicare |
$10.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.82
|
| Rate for Payer: Railroad Medicare Medicare |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: UHC Exchange |
$10.71
|
| Rate for Payer: UHC Medicaid |
$7.55
|
| Rate for Payer: UHC Medicare Advantage |
$10.71
|
| Rate for Payer: UHCCP Medicaid |
$7.55
|
| Rate for Payer: VA VA |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC INFLUENZA VIRUS VAC TRIVALENT (IIV3), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
63600247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.39
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS MAPPO |
$10.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.22
|
| Rate for Payer: BCN Commercial |
$35.22
|
| Rate for Payer: BCN Medicare Advantage |
$10.71
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$7.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.25
|
| Rate for Payer: Meridian Medicaid |
$7.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PACE Senior Care Partners |
$10.17
|
| Rate for Payer: PACE SWMI |
$10.71
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Medicare |
$10.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.82
|
| Rate for Payer: Railroad Medicare Medicare |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: UHC Exchange |
$10.71
|
| Rate for Payer: UHC Medicaid |
$7.55
|
| Rate for Payer: UHC Medicare Advantage |
$10.71
|
| Rate for Payer: UHCCP Medicaid |
$7.55
|
| Rate for Payer: VA VA |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC INFLUENZA VIRUS VAC TRIVALENT (IIV3), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
63600247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: BCBS Trust/PPO |
$35.38
|
| Rate for Payer: BCN Commercial |
$35.38
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: BCBS Trust/PPO |
$35.38
|
| Rate for Payer: BCN Commercial |
$35.38
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.39
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS MAPPO |
$10.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.22
|
| Rate for Payer: BCN Commercial |
$35.22
|
| Rate for Payer: BCN Medicare Advantage |
$10.71
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$7.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.25
|
| Rate for Payer: Meridian Medicaid |
$7.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.13
|
| Rate for Payer: PACE Senior Care Partners |
$10.17
|
| Rate for Payer: PACE SWMI |
$10.71
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Medicare |
$10.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.82
|
| Rate for Payer: Railroad Medicare Medicare |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: UHC Exchange |
$10.71
|
| Rate for Payer: UHC Medicaid |
$7.55
|
| Rate for Payer: UHC Medicare Advantage |
$10.71
|
| Rate for Payer: UHCCP Medicaid |
$7.55
|
| Rate for Payer: VA VA |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT LIVE, INTRANASAL
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 90660
|
| Hospital Charge Code |
63600252
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.27 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: BCBS Trust/PPO |
$57.28
|
| Rate for Payer: BCN Commercial |
$57.28
|
| 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 Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.02
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.27
|
| 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 VAC, TRIVALENT LIVE, INTRANASAL
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 90660
|
| Hospital Charge Code |
63600252
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.23 |
| 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 |
$12.84
|
| Rate for Payer: BCBS MAPPO |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$57.02
|
| Rate for Payer: BCN Commercial |
$57.02
|
| 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: Mclaren Medicaid |
$12.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.21
|
| Rate for Payer: Meridian Medicaid |
$12.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.02
|
| 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 Choice Medicaid |
$12.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.34
|
| Rate for Payer: Priority Health Medicare |
$17.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.27
|
| 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 Exchange |
$17.34
|
| Rate for Payer: UHC Medicaid |
$12.23
|
| Rate for Payer: UHC Medicare Advantage |
$17.34
|
| Rate for Payer: UHCCP Medicaid |
$12.23
|
| Rate for Payer: VA VA |
$17.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (RIV3), PF IM
|
Facility
|
IP
|
$111.18
|
|
|
Service Code
|
CPT 90673
|
| Hospital Charge Code |
63600249
|
|
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 VAC, TRIVALENT (RIV3), PF IM
|
Facility
|
OP
|
$111.18
|
|
|
Service Code
|
CPT 90673
|
| Hospital Charge Code |
63600249
|
|
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 INF PUMP PROGRAMMABLE LVL 6
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
27800141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$480.24 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$586.50
|
| Rate for Payer: BCBS Trust/PPO |
$569.87
|
| Rate for Payer: BCN Commercial |
$569.87
|
| 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 Commercial |
$586.50
|
| Rate for Payer: Nomi Health Commercial |
$565.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.50
|
| Rate for Payer: PHP Commercial |
$586.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$600.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$480.24
|
| 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 |
$121.65 |
| 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 |
$127.72
|
| Rate for Payer: BCBS MAPPO |
$172.50
|
| Rate for Payer: BCBS Trust/PPO |
$567.25
|
| Rate for Payer: BCN Commercial |
$567.25
|
| 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: Mclaren Medicaid |
$121.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.12
|
| Rate for Payer: Meridian Medicaid |
$127.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$189.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.50
|
| Rate for Payer: Nomi Health Commercial |
$565.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$517.50
|
| 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 Choice Medicaid |
$121.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$600.30
|
| Rate for Payer: Priority Health Medicare |
$174.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$480.24
|
| 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 Exchange |
$172.50
|
| Rate for Payer: UHC Medicaid |
$121.65
|
| Rate for Payer: UHC Medicare Advantage |
$172.50
|
| Rate for Payer: UHCCP Medicaid |
$121.65
|
| Rate for Payer: VA VA |
$172.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.50
|
|
|
HC INFRARED THERAPY
|
Facility
|
OP
|
$59.80
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$53.82 |
| Rate for Payer: Aetna Commercial |
$50.83
|
| Rate for Payer: Aetna Medicare |
$15.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.69
|
| Rate for Payer: BCBS Complete |
$11.07
|
| Rate for Payer: BCBS MAPPO |
$14.95
|
| Rate for Payer: BCBS Trust/PPO |
$49.16
|
| Rate for Payer: BCN Commercial |
$49.16
|
| Rate for Payer: BCN Medicare Advantage |
$14.95
|
| Rate for Payer: Cash Price |
$47.84
|
| Rate for Payer: Cofinity Commercial |
$51.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.95
|
| Rate for Payer: Healthscope Commercial |
$53.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.85
|
| Rate for Payer: Mclaren Medicaid |
$10.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.70
|
| Rate for Payer: Meridian Medicaid |
$11.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.83
|
| Rate for Payer: Nomi Health Commercial |
$49.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.85
|
| Rate for Payer: PACE Senior Care Partners |
$14.20
|
| Rate for Payer: PACE SWMI |
$14.95
|
| Rate for Payer: PHP Commercial |
$50.83
|
| Rate for Payer: PHP Medicare Advantage |
$14.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.03
|
| Rate for Payer: Priority Health Medicare |
$15.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.62
|
| Rate for Payer: Railroad Medicare Medicare |
$14.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.62
|
| Rate for Payer: UHC Core |
$49.93
|
| Rate for Payer: UHC Exchange |
$14.95
|
| Rate for Payer: UHC Medicaid |
$10.54
|
| Rate for Payer: UHC Medicare Advantage |
$14.95
|
| Rate for Payer: UHCCP Medicaid |
$10.54
|
| Rate for Payer: VA VA |
$14.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.85
|
|
|
HC INFRARED THERAPY
|
Facility
|
IP
|
$59.80
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$53.82 |
| Rate for Payer: Aetna Commercial |
$50.83
|
| Rate for Payer: BCBS Trust/PPO |
$49.39
|
| Rate for Payer: BCN Commercial |
$49.39
|
| Rate for Payer: Cash Price |
$47.84
|
| Rate for Payer: Cofinity Commercial |
$51.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.84
|
| Rate for Payer: Healthscope Commercial |
$53.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.83
|
| Rate for Payer: Nomi Health Commercial |
$49.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.85
|
| Rate for Payer: PHP Commercial |
$50.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.62
|
| Rate for Payer: UHC Core |
$49.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.85
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
OP
|
$160.65
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.32 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Aetna Commercial |
$136.55
|
| Rate for Payer: Aetna Medicare |
$41.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.20
|
| Rate for Payer: BCBS Complete |
$29.74
|
| Rate for Payer: BCBS MAPPO |
$40.16
|
| Rate for Payer: BCBS Trust/PPO |
$132.07
|
| Rate for Payer: BCN Commercial |
$132.07
|
| Rate for Payer: BCN Medicare Advantage |
$40.16
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.16
|
| Rate for Payer: Healthscope Commercial |
$144.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.49
|
| Rate for Payer: Mclaren Medicaid |
$28.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.17
|
| Rate for Payer: Meridian Medicaid |
$29.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.55
|
| Rate for Payer: Nomi Health Commercial |
$131.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.49
|
| Rate for Payer: PACE Senior Care Partners |
$38.15
|
| Rate for Payer: PACE SWMI |
$40.16
|
| Rate for Payer: PHP Commercial |
$136.55
|
| Rate for Payer: PHP Medicare Advantage |
$40.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.77
|
| Rate for Payer: Priority Health Medicare |
$40.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.81
|
| Rate for Payer: Railroad Medicare Medicare |
$40.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.37
|
| Rate for Payer: UHC Core |
$134.14
|
| Rate for Payer: UHC Exchange |
$40.16
|
| Rate for Payer: UHC Medicaid |
$28.32
|
| Rate for Payer: UHC Medicare Advantage |
$40.16
|
| Rate for Payer: UHCCP Medicaid |
$28.32
|
| Rate for Payer: VA VA |
$40.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.49
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
IP
|
$160.65
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Aetna Commercial |
$136.55
|
| Rate for Payer: BCBS Trust/PPO |
$132.68
|
| Rate for Payer: BCN Commercial |
$132.68
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Cofinity Commercial |
$138.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.52
|
| Rate for Payer: Healthscope Commercial |
$144.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.55
|
| Rate for Payer: Nomi Health Commercial |
$131.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.49
|
| Rate for Payer: PHP Commercial |
$136.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.37
|
| Rate for Payer: UHC Core |
$134.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.49
|
|
