|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: BCBS Trust/PPO |
$127.39
|
| Rate for Payer: BCN Commercial |
$120.60
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC INFLIXIMAB AB
|
Facility
|
OP
|
$188.70
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$169.83 |
| Rate for Payer: Aetna Commercial |
$160.40
|
| Rate for Payer: Aetna Medicare |
$49.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.97
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: BCBS MAPPO |
$47.17
|
| Rate for Payer: BCBS Trust/PPO |
$155.13
|
| Rate for Payer: BCN Commercial |
$146.71
|
| Rate for Payer: BCN Medicare Advantage |
$47.17
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$162.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.17
|
| Rate for Payer: Healthscope Commercial |
$169.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.53
|
| Rate for Payer: Mclaren Medicaid |
$10.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.53
|
| Rate for Payer: Meridian Medicaid |
$10.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.40
|
| Rate for Payer: Nomi Health Commercial |
$154.73
|
| Rate for Payer: PACE Senior Care Partners |
$44.82
|
| Rate for Payer: PACE SWMI |
$47.17
|
| Rate for Payer: PHP Commercial |
$160.40
|
| Rate for Payer: PHP Medicare Advantage |
$47.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.66
|
| Rate for Payer: Priority Health HMO/PPO |
$164.17
|
| Rate for Payer: Priority Health Medicare |
$47.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.43
|
| Rate for Payer: Railroad Medicare Medicare |
$47.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.06
|
| Rate for Payer: UHC Core |
$157.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.17
|
| Rate for Payer: UHC Exchange |
$47.17
|
| Rate for Payer: UHC Medicare Advantage |
$47.17
|
| Rate for Payer: UHCCP Medicaid |
$10.21
|
| Rate for Payer: VA VA |
$47.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.53
|
|
|
HC INFLIXIMAB AB
|
Facility
|
IP
|
$188.70
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.66 |
| Max. Negotiated Rate |
$169.83 |
| Rate for Payer: Aetna Commercial |
$160.40
|
| Rate for Payer: BCBS Trust/PPO |
$154.04
|
| Rate for Payer: BCN Commercial |
$145.83
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$162.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.96
|
| Rate for Payer: Healthscope Commercial |
$169.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.40
|
| Rate for Payer: Nomi Health Commercial |
$154.73
|
| Rate for Payer: PHP Commercial |
$160.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.66
|
| Rate for Payer: Priority Health HMO/PPO |
$164.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.06
|
| Rate for Payer: UHC Core |
$157.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.53
|
|
|
HC INFLIXIMAB, S
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: BCBS Trust/PPO |
$203.99
|
| Rate for Payer: BCN Commercial |
$193.12
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO |
$217.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Core |
$208.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.43
|
|
|
HC INFLIXIMAB, S
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.89 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$64.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.09
|
| Rate for Payer: BCBS Complete |
$29.28
|
| Rate for Payer: BCBS MAPPO |
$62.48
|
| Rate for Payer: BCBS Trust/PPO |
$205.44
|
| Rate for Payer: BCN Commercial |
$194.30
|
| Rate for Payer: BCN Medicare Advantage |
$62.48
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.48
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.43
|
| Rate for Payer: Mclaren Medicaid |
$27.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.60
|
| Rate for Payer: Meridian Medicaid |
$29.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PACE Senior Care Partners |
$59.35
|
| Rate for Payer: PACE SWMI |
$62.48
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: PHP Medicare Advantage |
$62.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO |
$217.41
|
| Rate for Payer: Priority Health Medicare |
$63.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.43
|
| Rate for Payer: Railroad Medicare Medicare |
$62.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Core |
$208.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.48
|
| Rate for Payer: UHC Exchange |
$62.48
|
| Rate for Payer: UHC Medicare Advantage |
$62.48
|
| Rate for Payer: UHCCP Medicaid |
$27.89
|
| Rate for Payer: VA VA |
$62.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.43
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
OP
|
$216.95
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.53 |
| Max. Negotiated Rate |
$195.25 |
| Rate for Payer: Aetna Commercial |
$184.41
|
| Rate for Payer: Aetna Medicare |
$56.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.80
|
| Rate for Payer: BCBS Complete |
$108.28
|
| Rate for Payer: BCBS MAPPO |
$54.24
|
| Rate for Payer: BCBS Trust/PPO |
$178.35
|
| Rate for Payer: BCN Commercial |
$168.68
|
| Rate for Payer: BCN Medicare Advantage |
$54.24
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$186.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.24
|
| Rate for Payer: Healthscope Commercial |
$195.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.71
|
| Rate for Payer: Mclaren Medicaid |
$103.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.95
|
| Rate for Payer: Meridian Medicaid |
$108.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.41
|
| Rate for Payer: Nomi Health Commercial |
$177.90
|
| Rate for Payer: PACE Senior Care Partners |
$51.53
|
| Rate for Payer: PACE SWMI |
$54.24
|
| Rate for Payer: PHP Commercial |
$184.41
|
| Rate for Payer: PHP Medicare Advantage |
$54.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.02
|
| Rate for Payer: Priority Health HMO/PPO |
$188.75
|
| Rate for Payer: Priority Health Medicare |
$54.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.36
|
| Rate for Payer: Railroad Medicare Medicare |
$54.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.92
|
| Rate for Payer: UHC Core |
$181.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.24
|
| Rate for Payer: UHC Exchange |
$54.24
|
| Rate for Payer: UHC Medicare Advantage |
$54.24
|
| Rate for Payer: UHCCP Medicaid |
$103.12
|
| Rate for Payer: VA VA |
$54.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.71
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
IP
|
$216.95
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$141.02 |
| Max. Negotiated Rate |
$195.25 |
| Rate for Payer: Aetna Commercial |
$184.41
|
| Rate for Payer: BCBS Trust/PPO |
$177.10
|
| Rate for Payer: BCN Commercial |
$167.66
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$186.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.56
|
| Rate for Payer: Healthscope Commercial |
$195.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.41
|
| Rate for Payer: Nomi Health Commercial |
$177.90
|
| Rate for Payer: PHP Commercial |
$184.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.02
|
| Rate for Payer: Priority Health HMO/PPO |
$188.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.92
|
| Rate for Payer: UHC Core |
$181.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.71
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
OP
|
$145.73
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$131.16 |
| Rate for Payer: Aetna Commercial |
$123.87
|
| Rate for Payer: Aetna Medicare |
$37.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.54
|
| Rate for Payer: BCBS Complete |
$72.73
|
| Rate for Payer: BCBS MAPPO |
$36.43
|
| Rate for Payer: BCBS Trust/PPO |
$119.80
|
| Rate for Payer: BCN Commercial |
$113.31
|
| Rate for Payer: BCN Medicare Advantage |
$36.43
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cofinity Commercial |
$125.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.43
|
| Rate for Payer: Healthscope Commercial |
$131.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.30
|
| Rate for Payer: Mclaren Medicaid |
$69.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.25
|
| Rate for Payer: Meridian Medicaid |
$72.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: Nomi Health Commercial |
$119.50
|
| Rate for Payer: PACE Senior Care Partners |
$34.61
|
| Rate for Payer: PACE SWMI |
$36.43
|
| Rate for Payer: PHP Commercial |
$123.87
|
| Rate for Payer: PHP Medicare Advantage |
$36.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.72
|
| Rate for Payer: Priority Health HMO/PPO |
$126.79
|
| Rate for Payer: Priority Health Medicare |
$36.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.64
|
| Rate for Payer: Railroad Medicare Medicare |
$36.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.24
|
| Rate for Payer: UHC Core |
$121.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.43
|
| Rate for Payer: UHC Exchange |
$36.43
|
| Rate for Payer: UHC Medicare Advantage |
$36.43
|
| Rate for Payer: UHCCP Medicaid |
$69.26
|
| Rate for Payer: VA VA |
$36.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.30
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
IP
|
$145.73
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$94.72 |
| Max. Negotiated Rate |
$131.16 |
| Rate for Payer: Aetna Commercial |
$123.87
|
| Rate for Payer: BCBS Trust/PPO |
$118.96
|
| Rate for Payer: BCN Commercial |
$112.62
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cofinity Commercial |
$125.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Healthscope Commercial |
$131.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: Nomi Health Commercial |
$119.50
|
| Rate for Payer: PHP Commercial |
$123.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.72
|
| Rate for Payer: Priority Health HMO/PPO |
$126.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.24
|
| Rate for Payer: UHC Core |
$121.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.30
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
IP
|
$223.34
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$145.17 |
| Max. Negotiated Rate |
$201.01 |
| Rate for Payer: Aetna Commercial |
$189.84
|
| Rate for Payer: BCBS Trust/PPO |
$182.31
|
| Rate for Payer: BCN Commercial |
$172.60
|
| Rate for Payer: Cash Price |
$178.67
|
| Rate for Payer: Cofinity Commercial |
$192.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.67
|
| Rate for Payer: Healthscope Commercial |
$201.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.84
|
| Rate for Payer: Nomi Health Commercial |
$183.14
|
| Rate for Payer: PHP Commercial |
$189.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.17
|
| Rate for Payer: Priority Health HMO/PPO |
$194.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.54
|
| Rate for Payer: UHC Core |
$186.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.50
|
|
|
HC INFLUENZA AND RSV BY PCR
|
Facility
|
OP
|
$223.34
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600213
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$201.01 |
| Rate for Payer: Aetna Commercial |
$189.84
|
| Rate for Payer: Aetna Medicare |
$58.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.79
|
| Rate for Payer: BCBS Complete |
$108.28
|
| Rate for Payer: BCBS MAPPO |
$55.84
|
| Rate for Payer: BCBS Trust/PPO |
$183.61
|
| Rate for Payer: BCN Commercial |
$173.65
|
| Rate for Payer: BCN Medicare Advantage |
$55.84
|
| Rate for Payer: Cash Price |
$178.67
|
| Rate for Payer: Cash Price |
$178.67
|
| Rate for Payer: Cofinity Commercial |
$192.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.84
|
| Rate for Payer: Healthscope Commercial |
$201.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.50
|
| Rate for Payer: Mclaren Medicaid |
$103.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.63
|
| Rate for Payer: Meridian Medicaid |
$108.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.84
|
| Rate for Payer: Nomi Health Commercial |
$183.14
|
| Rate for Payer: PACE Senior Care Partners |
$53.04
|
| Rate for Payer: PACE SWMI |
$55.84
|
| Rate for Payer: PHP Commercial |
$189.84
|
| Rate for Payer: PHP Medicare Advantage |
$55.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.17
|
| Rate for Payer: Priority Health HMO/PPO |
$194.31
|
| Rate for Payer: Priority Health Medicare |
$56.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.64
|
| Rate for Payer: Railroad Medicare Medicare |
$55.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.54
|
| Rate for Payer: UHC Core |
$186.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.84
|
| Rate for Payer: UHC Exchange |
$55.84
|
| Rate for Payer: UHC Medicare Advantage |
$55.84
|
| Rate for Payer: UHCCP Medicaid |
$103.12
|
| Rate for Payer: VA VA |
$55.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.50
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$24.98
|
| Rate for Payer: BCN Commercial |
$23.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO |
$26.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC INFLUENZA INJECTION
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
HCPCS G0008
|
| Hospital Charge Code |
77100009
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$35.03 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.56
|
| Rate for Payer: BCBS Complete |
$35.03
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$25.16
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: BCN Medicare Advantage |
$7.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$33.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: Meridian Medicaid |
$35.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.01
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: PACE Senior Care Partners |
$7.27
|
| Rate for Payer: PACE SWMI |
$7.65
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO |
$26.62
|
| Rate for Payer: Priority Health Medicare |
$7.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.50
|
| Rate for Payer: Railroad Medicare Medicare |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.65
|
| Rate for Payer: UHC Exchange |
$7.65
|
| Rate for Payer: UHC Medicare Advantage |
$7.65
|
| Rate for Payer: UHCCP Medicaid |
$33.36
|
| Rate for Payer: VA VA |
$7.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC INFLUENZA VAC, INACTIV ADJUVANT IM
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
63600251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.55 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Aetna Commercial |
$141.95
|
| Rate for Payer: BCBS Trust/PPO |
$136.32
|
| Rate for Payer: BCN Commercial |
$129.06
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Healthscope Commercial |
$150.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: Nomi Health Commercial |
$136.94
|
| Rate for Payer: PHP Commercial |
$141.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health HMO/PPO |
$145.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.96
|
| Rate for Payer: UHC Core |
$139.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.25
|
|
|
HC INFLUENZA VAC, INACTIV ADJUVANT IM
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 90653
|
| Hospital Charge Code |
63600251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.66 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Aetna Commercial |
$141.95
|
| Rate for Payer: Aetna Medicare |
$43.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.19
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$41.75
|
| Rate for Payer: BCBS Trust/PPO |
$137.29
|
| Rate for Payer: BCN Commercial |
$129.84
|
| Rate for Payer: BCN Medicare Advantage |
$41.75
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.75
|
| Rate for Payer: Healthscope Commercial |
$150.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: Nomi Health Commercial |
$136.94
|
| Rate for Payer: PACE Senior Care Partners |
$39.66
|
| Rate for Payer: PACE SWMI |
$41.75
|
| Rate for Payer: PHP Commercial |
$141.95
|
| Rate for Payer: PHP Medicare Advantage |
$41.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health HMO/PPO |
$145.29
|
| Rate for Payer: Priority Health Medicare |
$42.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.89
|
| Rate for Payer: Railroad Medicare Medicare |
$41.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.96
|
| Rate for Payer: UHC Core |
$139.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.75
|
| Rate for Payer: UHC Exchange |
$41.75
|
| Rate for Payer: UHC Medicare Advantage |
$41.75
|
| Rate for Payer: VA VA |
$41.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.25
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: BCBS Trust/PPO |
$88.98
|
| Rate for Payer: BCN Commercial |
$84.24
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: Nomi Health Commercial |
$89.38
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health HMO/PPO |
$94.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.92
|
| Rate for Payer: UHC Core |
$91.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.75
|
|
|
HC INFLUENZA VIRUS VACCINE (IIV), SPLIT VIRUS, PRESERVATIVE FREE IM
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
63600073
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: Aetna Medicare |
$28.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.06
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS MAPPO |
$27.25
|
| Rate for Payer: BCBS Trust/PPO |
$89.61
|
| Rate for Payer: BCN Commercial |
$84.75
|
| Rate for Payer: BCN Medicare Advantage |
$27.25
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.25
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.65
|
| Rate for Payer: Nomi Health Commercial |
$89.38
|
| Rate for Payer: PACE Senior Care Partners |
$25.89
|
| Rate for Payer: PACE SWMI |
$27.25
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: PHP Medicare Advantage |
$27.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health HMO/PPO |
$94.83
|
| Rate for Payer: Priority Health Medicare |
$27.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.03
|
| Rate for Payer: Railroad Medicare Medicare |
$27.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.92
|
| Rate for Payer: UHC Core |
$91.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.25
|
| Rate for Payer: UHC Exchange |
$27.25
|
| Rate for Payer: UHC Medicare Advantage |
$27.25
|
| Rate for Payer: VA VA |
$27.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.75
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT (IIV4), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna Commercial |
$27.41
|
| Rate for Payer: Aetna Medicare |
$8.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.08
|
| Rate for Payer: BCBS Complete |
$12.90
|
| Rate for Payer: BCBS MAPPO |
$8.06
|
| Rate for Payer: BCBS Trust/PPO |
$26.51
|
| Rate for Payer: BCN Commercial |
$25.07
|
| Rate for Payer: BCN Medicare Advantage |
$8.06
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$27.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$29.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: PACE Senior Care Partners |
$7.66
|
| Rate for Payer: PACE SWMI |
$8.06
|
| Rate for Payer: PHP Commercial |
$27.41
|
| Rate for Payer: PHP Medicare Advantage |
$8.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: Priority Health HMO/PPO |
$28.06
|
| Rate for Payer: Priority Health Medicare |
$8.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: Railroad Medicare Medicare |
$8.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.38
|
| Rate for Payer: UHC Core |
$26.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.06
|
| Rate for Payer: UHC Exchange |
$8.06
|
| Rate for Payer: UHC Medicare Advantage |
$8.06
|
| Rate for Payer: VA VA |
$8.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.19
|
|
|
HC INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE (LAIV4) INTRANASAL
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
63600075
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna Commercial |
$27.41
|
| Rate for Payer: BCBS Trust/PPO |
$26.33
|
| Rate for Payer: BCN Commercial |
$24.92
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$27.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$29.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: PHP Commercial |
$27.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: Priority Health HMO/PPO |
$28.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.38
|
| Rate for Payer: UHC Core |
$26.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.19
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
63600126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
63600126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, 0.5 ML IM
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
63600078
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
