|
HC INFLUENZA VIRUS VAC, QUAD (IIV4), SPLIT VIRUS, PF, CHILD 6-35 MONTHS, IM
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
63600077
|
|
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, CHILD 6-35 MONTHS, IM
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 90685
|
| Hospital Charge Code |
63600077
|
|
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, TRIVALENT (CCIIV3) 0.5 ML IM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 90661
|
| Hospital Charge Code |
63600250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.12
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$34.53
|
| Rate for Payer: BCN Commercial |
$32.66
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: PACE Senior Care Partners |
$9.97
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO |
$36.54
|
| Rate for Payer: Priority Health Medicare |
$10.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.50
|
| Rate for Payer: UHC Exchange |
$10.50
|
| Rate for Payer: UHC Medicare Advantage |
$10.50
|
| Rate for Payer: VA VA |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (CCIIV3) 0.5 ML IM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 90661
|
| Hospital Charge Code |
63600250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: BCBS Trust/PPO |
$34.28
|
| Rate for Payer: BCN Commercial |
$32.46
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO |
$36.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
63600248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.12
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$34.53
|
| Rate for Payer: BCN Commercial |
$32.66
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: PACE Senior Care Partners |
$9.97
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO |
$36.54
|
| Rate for Payer: Priority Health Medicare |
$10.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.50
|
| Rate for Payer: UHC Exchange |
$10.50
|
| Rate for Payer: UHC Medicare Advantage |
$10.50
|
| Rate for Payer: VA VA |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS, 0.25 ML IM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 90657
|
| Hospital Charge Code |
63600248
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: BCBS Trust/PPO |
$34.28
|
| Rate for Payer: BCN Commercial |
$32.46
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO |
$36.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
HC INFLUENZA VIRUS VAC TRIVALENT (IIV3), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
63600247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: BCBS Trust/PPO |
$34.28
|
| Rate for Payer: BCN Commercial |
$32.46
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO |
$36.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
HC INFLUENZA VIRUS VAC TRIVALENT (IIV3), SPLIT VIRUS, 0.5 ML IM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
63600247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.12
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$34.53
|
| Rate for Payer: BCN Commercial |
$32.66
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: PACE Senior Care Partners |
$9.97
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO |
$36.54
|
| Rate for Payer: Priority Health Medicare |
$10.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.50
|
| Rate for Payer: UHC Exchange |
$10.50
|
| Rate for Payer: UHC Medicare Advantage |
$10.50
|
| Rate for Payer: VA VA |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.12
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$34.53
|
| Rate for Payer: BCN Commercial |
$32.66
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: PACE Senior Care Partners |
$9.97
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO |
$36.54
|
| Rate for Payer: Priority Health Medicare |
$10.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.50
|
| Rate for Payer: UHC Exchange |
$10.50
|
| Rate for Payer: UHC Medicare Advantage |
$10.50
|
| Rate for Payer: VA VA |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (IIV3), SPLIT VIRUS PF, 0.5 ML IM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 90656
|
| Hospital Charge Code |
63600072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: BCBS Trust/PPO |
$34.28
|
| Rate for Payer: BCN Commercial |
$32.46
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.70
|
| Rate for Payer: Nomi Health Commercial |
$34.44
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO |
$36.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT LIVE, INTRANASAL
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 90660
|
| Hospital Charge Code |
63600252
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: BCBS Trust/PPO |
$55.51
|
| Rate for Payer: BCN Commercial |
$52.55
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.80
|
| Rate for Payer: Nomi Health Commercial |
$55.76
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: Priority Health HMO/PPO |
$59.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.84
|
| Rate for Payer: UHC Core |
$56.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT LIVE, INTRANASAL
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 90660
|
| Hospital Charge Code |
63600252
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna Medicare |
$17.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.25
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS MAPPO |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$55.90
|
| Rate for Payer: BCN Commercial |
$52.87
|
| Rate for Payer: BCN Medicare Advantage |
$17.00
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.00
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.80
|
| Rate for Payer: Nomi Health Commercial |
$55.76
|
| Rate for Payer: PACE Senior Care Partners |
$16.15
|
| Rate for Payer: PACE SWMI |
$17.00
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: Priority Health HMO/PPO |
$59.16
|
| Rate for Payer: Priority Health Medicare |
$17.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.56
|
| Rate for Payer: Railroad Medicare Medicare |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.84
|
| Rate for Payer: UHC Core |
$56.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.00
|
| Rate for Payer: UHC Exchange |
$17.00
|
| Rate for Payer: UHC Medicare Advantage |
$17.00
|
| Rate for Payer: VA VA |
$17.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC INFLUENZA VIRUS VAC, TRIVALENT (RIV3), PF IM
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 90673
|
| Hospital Charge Code |
63600249
|
|
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 VAC, TRIVALENT (RIV3), PF IM
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 90673
|
| Hospital Charge Code |
63600249
|
|
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 INF PUMP PROGRAMMABLE LVL 6
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS C1772
|
| Hospital Charge Code |
27800141
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$163.88 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$586.50
|
| Rate for Payer: Aetna Medicare |
$179.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.62
|
| Rate for Payer: BCBS Complete |
$276.00
|
| Rate for Payer: BCBS MAPPO |
$172.50
|
| Rate for Payer: BCBS Trust/PPO |
$567.25
|
| Rate for Payer: BCN Commercial |
$536.48
|
| Rate for Payer: BCN Medicare Advantage |
$172.50
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Commercial |
$593.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.50
|
| Rate for Payer: Healthscope Commercial |
$621.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.50
|
| Rate for Payer: Nomi Health Commercial |
$565.80
|
| Rate for Payer: PACE Senior Care Partners |
$163.88
|
| Rate for Payer: PACE SWMI |
$172.50
|
| Rate for Payer: PHP Commercial |
$586.50
|
| Rate for Payer: PHP Medicare Advantage |
$172.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.50
|
| Rate for Payer: Priority Health HMO/PPO |
$600.30
|
| Rate for Payer: Priority Health Medicare |
$174.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$462.30
|
| Rate for Payer: Railroad Medicare Medicare |
$172.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.20
|
| Rate for Payer: UHC Core |
$576.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.50
|
| Rate for Payer: UHC Exchange |
$172.50
|
| Rate for Payer: UHC Medicare Advantage |
$172.50
|
| Rate for Payer: VA VA |
$172.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.50
|
|
|
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 |
$448.50 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$586.50
|
| Rate for Payer: BCBS Trust/PPO |
$563.25
|
| Rate for Payer: BCN Commercial |
$533.23
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cofinity Commercial |
$593.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.00
|
| Rate for Payer: Healthscope Commercial |
$621.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.50
|
| Rate for Payer: Nomi Health Commercial |
$565.80
|
| Rate for Payer: PHP Commercial |
$586.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.50
|
| Rate for Payer: Priority Health HMO/PPO |
$600.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$462.30
|
| 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 INFRARED THERAPY
|
Facility
|
IP
|
$58.63
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.11 |
| Max. Negotiated Rate |
$52.77 |
| Rate for Payer: Aetna Commercial |
$49.84
|
| Rate for Payer: BCBS Trust/PPO |
$47.86
|
| Rate for Payer: BCN Commercial |
$45.31
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$50.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.90
|
| Rate for Payer: Healthscope Commercial |
$52.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.84
|
| Rate for Payer: Nomi Health Commercial |
$48.08
|
| Rate for Payer: PHP Commercial |
$49.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.11
|
| Rate for Payer: Priority Health HMO/PPO |
$51.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.59
|
| Rate for Payer: UHC Core |
$48.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.97
|
|
|
HC INFRARED THERAPY
|
Facility
|
OP
|
$58.63
|
|
|
Service Code
|
CPT 97026
|
| Hospital Charge Code |
42000013
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$52.77 |
| Rate for Payer: Aetna Commercial |
$49.84
|
| Rate for Payer: Aetna Medicare |
$15.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.32
|
| Rate for Payer: BCBS Complete |
$23.45
|
| Rate for Payer: BCBS MAPPO |
$14.66
|
| Rate for Payer: BCBS Trust/PPO |
$48.20
|
| Rate for Payer: BCN Commercial |
$45.58
|
| Rate for Payer: BCN Medicare Advantage |
$14.66
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$50.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.66
|
| Rate for Payer: Healthscope Commercial |
$52.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.84
|
| Rate for Payer: Nomi Health Commercial |
$48.08
|
| Rate for Payer: PACE Senior Care Partners |
$13.92
|
| Rate for Payer: PACE SWMI |
$14.66
|
| Rate for Payer: PHP Commercial |
$49.84
|
| Rate for Payer: PHP Medicare Advantage |
$14.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.11
|
| Rate for Payer: Priority Health HMO/PPO |
$51.01
|
| Rate for Payer: Priority Health Medicare |
$14.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.28
|
| Rate for Payer: Railroad Medicare Medicare |
$14.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.59
|
| Rate for Payer: UHC Core |
$48.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.66
|
| Rate for Payer: UHC Exchange |
$14.66
|
| Rate for Payer: UHC Medicare Advantage |
$14.66
|
| Rate for Payer: VA VA |
$14.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.97
|
|
|
HC INFUSION CATHETER LVL 1
|
Facility
|
OP
|
$160.65
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.15 |
| 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 |
$64.26
|
| Rate for Payer: BCBS MAPPO |
$40.16
|
| Rate for Payer: BCBS Trust/PPO |
$132.07
|
| Rate for Payer: BCN Commercial |
$124.91
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.55
|
| Rate for Payer: Nomi Health Commercial |
$131.73
|
| 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 Cigna Priority Health |
$104.42
|
| Rate for Payer: Priority Health HMO/PPO |
$139.77
|
| Rate for Payer: Priority Health Medicare |
$40.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.64
|
| 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 Dual Complete DSNP |
$40.16
|
| Rate for Payer: UHC Exchange |
$40.16
|
| Rate for Payer: UHC Medicare Advantage |
$40.16
|
| 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 |
$104.42 |
| Max. Negotiated Rate |
$144.59 |
| Rate for Payer: Aetna Commercial |
$136.55
|
| Rate for Payer: BCBS Trust/PPO |
$131.14
|
| Rate for Payer: BCN Commercial |
$124.15
|
| 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: PHP Commercial |
$136.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.42
|
| Rate for Payer: Priority Health HMO/PPO |
$139.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.64
|
| 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
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
OP
|
$241.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.44 |
| Max. Negotiated Rate |
$217.67 |
| Rate for Payer: Aetna Commercial |
$205.58
|
| Rate for Payer: Aetna Medicare |
$62.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.58
|
| Rate for Payer: BCBS Complete |
$96.74
|
| Rate for Payer: BCBS MAPPO |
$60.47
|
| Rate for Payer: BCBS Trust/PPO |
$198.83
|
| Rate for Payer: BCN Commercial |
$188.05
|
| Rate for Payer: BCN Medicare Advantage |
$60.47
|
| Rate for Payer: Cash Price |
$193.49
|
| Rate for Payer: Cofinity Commercial |
$208.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.47
|
| Rate for Payer: Healthscope Commercial |
$217.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.58
|
| Rate for Payer: Nomi Health Commercial |
$198.33
|
| Rate for Payer: PACE Senior Care Partners |
$57.44
|
| Rate for Payer: PACE SWMI |
$60.47
|
| Rate for Payer: PHP Commercial |
$205.58
|
| Rate for Payer: PHP Medicare Advantage |
$60.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.21
|
| Rate for Payer: Priority Health HMO/PPO |
$210.42
|
| Rate for Payer: Priority Health Medicare |
$61.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.05
|
| Rate for Payer: Railroad Medicare Medicare |
$60.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.84
|
| Rate for Payer: UHC Core |
$201.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.47
|
| Rate for Payer: UHC Exchange |
$60.47
|
| Rate for Payer: UHC Medicare Advantage |
$60.47
|
| Rate for Payer: VA VA |
$60.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.40
|
|
|
HC INFUSION CATHETER LVL 2
|
Facility
|
IP
|
$241.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200005
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.21 |
| Max. Negotiated Rate |
$217.67 |
| Rate for Payer: Aetna Commercial |
$205.58
|
| Rate for Payer: BCBS Trust/PPO |
$197.43
|
| Rate for Payer: BCN Commercial |
$186.91
|
| Rate for Payer: Cash Price |
$193.49
|
| Rate for Payer: Cofinity Commercial |
$208.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.49
|
| Rate for Payer: Healthscope Commercial |
$217.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.58
|
| Rate for Payer: Nomi Health Commercial |
$198.33
|
| Rate for Payer: PHP Commercial |
$205.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.21
|
| Rate for Payer: Priority Health HMO/PPO |
$210.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.84
|
| Rate for Payer: UHC Core |
$201.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.40
|
|
|
HC INFUSION CATHETER LVL 3
|
Facility
|
IP
|
$396.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.99 |
| Max. Negotiated Rate |
$357.21 |
| Rate for Payer: Aetna Commercial |
$337.37
|
| Rate for Payer: BCBS Trust/PPO |
$323.99
|
| Rate for Payer: BCN Commercial |
$306.72
|
| Rate for Payer: Cash Price |
$317.52
|
| Rate for Payer: Cofinity Commercial |
$341.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.52
|
| Rate for Payer: Healthscope Commercial |
$357.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.37
|
| Rate for Payer: Nomi Health Commercial |
$325.46
|
| Rate for Payer: PHP Commercial |
$337.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.99
|
| Rate for Payer: Priority Health HMO/PPO |
$345.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.27
|
| Rate for Payer: UHC Core |
$331.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.68
|
|
|
HC INFUSION CATHETER LVL 3
|
Facility
|
OP
|
$396.90
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.26 |
| Max. Negotiated Rate |
$357.21 |
| Rate for Payer: Aetna Commercial |
$337.37
|
| Rate for Payer: Aetna Medicare |
$103.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.03
|
| Rate for Payer: BCBS Complete |
$158.76
|
| Rate for Payer: BCBS MAPPO |
$99.22
|
| Rate for Payer: BCBS Trust/PPO |
$326.29
|
| Rate for Payer: BCN Commercial |
$308.59
|
| Rate for Payer: BCN Medicare Advantage |
$99.22
|
| Rate for Payer: Cash Price |
$317.52
|
| Rate for Payer: Cofinity Commercial |
$341.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.22
|
| Rate for Payer: Healthscope Commercial |
$357.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.37
|
| Rate for Payer: Nomi Health Commercial |
$325.46
|
| Rate for Payer: PACE Senior Care Partners |
$94.26
|
| Rate for Payer: PACE SWMI |
$99.22
|
| Rate for Payer: PHP Commercial |
$337.37
|
| Rate for Payer: PHP Medicare Advantage |
$99.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.99
|
| Rate for Payer: Priority Health HMO/PPO |
$345.30
|
| Rate for Payer: Priority Health Medicare |
$100.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$265.92
|
| Rate for Payer: Railroad Medicare Medicare |
$99.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.27
|
| Rate for Payer: UHC Core |
$331.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.22
|
| Rate for Payer: UHC Exchange |
$99.22
|
| Rate for Payer: UHC Medicare Advantage |
$99.22
|
| Rate for Payer: VA VA |
$99.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.68
|
|
|
HC INFUSION CATHETER LVL 6
|
Facility
|
OP
|
$676.12
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.58 |
| Max. Negotiated Rate |
$608.51 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Medicare |
$175.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$211.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$211.29
|
| Rate for Payer: BCBS Complete |
$270.45
|
| Rate for Payer: BCBS MAPPO |
$169.03
|
| Rate for Payer: BCBS Trust/PPO |
$555.84
|
| Rate for Payer: BCN Commercial |
$525.68
|
| Rate for Payer: BCN Medicare Advantage |
$169.03
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cofinity Commercial |
$581.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.03
|
| Rate for Payer: Healthscope Commercial |
$608.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.70
|
| Rate for Payer: Nomi Health Commercial |
$554.42
|
| Rate for Payer: PACE Senior Care Partners |
$160.58
|
| Rate for Payer: PACE SWMI |
$169.03
|
| Rate for Payer: PHP Commercial |
$574.70
|
| Rate for Payer: PHP Medicare Advantage |
$169.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.48
|
| Rate for Payer: Priority Health HMO/PPO |
$588.22
|
| Rate for Payer: Priority Health Medicare |
$170.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$453.00
|
| Rate for Payer: Railroad Medicare Medicare |
$169.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.99
|
| Rate for Payer: UHC Core |
$564.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.03
|
| Rate for Payer: UHC Exchange |
$169.03
|
| Rate for Payer: UHC Medicare Advantage |
$169.03
|
| Rate for Payer: VA VA |
$169.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.09
|
|
