|
HC MENENCEPH CMPT 5
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
30200253
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: BCBS Trust/PPO |
$11.55
|
| Rate for Payer: BCN Commercial |
$10.94
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
|
HC MENENCEPH CMPT 5
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
30200253
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$12.79 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$3.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.42
|
| Rate for Payer: BCBS Complete |
$12.79
|
| Rate for Payer: BCBS MAPPO |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$11.63
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: BCN Medicare Advantage |
$3.54
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Mclaren Medicaid |
$12.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.71
|
| Rate for Payer: Meridian Medicaid |
$12.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PACE Senior Care Partners |
$3.36
|
| Rate for Payer: PACE SWMI |
$3.54
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$3.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Medicare |
$3.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.54
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$3.54
|
| Rate for Payer: UHCCP Medicaid |
$12.18
|
| Rate for Payer: VA VA |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
|
HC MENENCEPH CMPT 6
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200257
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$3.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.42
|
| Rate for Payer: BCBS Complete |
$10.01
|
| Rate for Payer: BCBS MAPPO |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$11.63
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: BCN Medicare Advantage |
$3.54
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Mclaren Medicaid |
$9.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.71
|
| Rate for Payer: Meridian Medicaid |
$10.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PACE Senior Care Partners |
$3.36
|
| Rate for Payer: PACE SWMI |
$3.54
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$3.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Medicare |
$3.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.54
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$3.54
|
| Rate for Payer: UHCCP Medicaid |
$9.54
|
| Rate for Payer: VA VA |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
|
HC MENENCEPH CMPT 6
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200257
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: BCBS Trust/PPO |
$11.55
|
| Rate for Payer: BCN Commercial |
$10.94
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
|
HC MENENCEPH CMPT 7
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$3.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.42
|
| Rate for Payer: BCBS Complete |
$10.01
|
| Rate for Payer: BCBS MAPPO |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$11.63
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: BCN Medicare Advantage |
$3.54
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Mclaren Medicaid |
$9.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.71
|
| Rate for Payer: Meridian Medicaid |
$10.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PACE Senior Care Partners |
$3.36
|
| Rate for Payer: PACE SWMI |
$3.54
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$3.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Medicare |
$3.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.54
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$3.54
|
| Rate for Payer: UHCCP Medicaid |
$9.54
|
| Rate for Payer: VA VA |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
|
HC MENENCEPH CMPT 7
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200282
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: BCBS Trust/PPO |
$11.55
|
| Rate for Payer: BCN Commercial |
$10.94
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
|
HC MENENCEPH CMPT 8
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$3.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.42
|
| Rate for Payer: BCBS Complete |
$14.69
|
| Rate for Payer: BCBS MAPPO |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$11.63
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: BCN Medicare Advantage |
$3.54
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Mclaren Medicaid |
$13.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.71
|
| Rate for Payer: Meridian Medicaid |
$14.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PACE Senior Care Partners |
$3.36
|
| Rate for Payer: PACE SWMI |
$3.54
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$3.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Medicare |
$3.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.54
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$3.54
|
| Rate for Payer: UHCCP Medicaid |
$13.99
|
| Rate for Payer: VA VA |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
|
HC MENENCEPH CMPT 8
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200284
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: BCBS Trust/PPO |
$11.55
|
| Rate for Payer: BCN Commercial |
$10.94
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
|
HC MENENCEPH CMPT 9
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
30200304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: BCBS Trust/PPO |
$11.55
|
| Rate for Payer: BCN Commercial |
$10.94
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
|
HC MENENCEPH CMPT 9
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86727
|
| Hospital Charge Code |
30200304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$3.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.42
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS MAPPO |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$11.63
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: BCN Medicare Advantage |
$3.54
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.71
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PACE Senior Care Partners |
$3.36
|
| Rate for Payer: PACE SWMI |
$3.54
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$3.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Medicare |
$3.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.54
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$3.54
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
|
HC MENIGOCOCCAL, QUADRIVALENT (MCV4 OR MENACWY) IM
|
Facility
|
OP
|
$160.22
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.05 |
| Max. Negotiated Rate |
$144.20 |
| Rate for Payer: Aetna Commercial |
$136.19
|
| Rate for Payer: Aetna Medicare |
$41.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.07
|
| Rate for Payer: BCBS Complete |
$64.09
|
| Rate for Payer: BCBS MAPPO |
$40.06
|
| Rate for Payer: BCBS Trust/PPO |
$131.72
|
| Rate for Payer: BCN Commercial |
$124.57
|
| Rate for Payer: BCN Medicare Advantage |
$40.06
|
| Rate for Payer: Cash Price |
$128.18
|
| Rate for Payer: Cofinity Commercial |
$137.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$144.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.19
|
| Rate for Payer: Nomi Health Commercial |
$131.38
|
| Rate for Payer: PACE Senior Care Partners |
$38.05
|
| Rate for Payer: PACE SWMI |
$40.06
|
| Rate for Payer: PHP Commercial |
$136.19
|
| Rate for Payer: PHP Medicare Advantage |
$40.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.14
|
| Rate for Payer: Priority Health HMO/PPO |
$139.39
|
| Rate for Payer: Priority Health Medicare |
$40.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.35
|
| Rate for Payer: Railroad Medicare Medicare |
$40.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.99
|
| Rate for Payer: UHC Core |
$133.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.06
|
| Rate for Payer: UHC Exchange |
$40.06
|
| Rate for Payer: UHC Medicare Advantage |
$40.06
|
| Rate for Payer: VA VA |
$40.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.16
|
|
|
HC MENIGOCOCCAL, QUADRIVALENT (MCV4 OR MENACWY) IM
|
Facility
|
IP
|
$160.22
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.14 |
| Max. Negotiated Rate |
$144.20 |
| Rate for Payer: Aetna Commercial |
$136.19
|
| Rate for Payer: BCBS Trust/PPO |
$130.79
|
| Rate for Payer: BCN Commercial |
$123.82
|
| Rate for Payer: Cash Price |
$128.18
|
| Rate for Payer: Cofinity Commercial |
$137.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.18
|
| Rate for Payer: Healthscope Commercial |
$144.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.19
|
| Rate for Payer: Nomi Health Commercial |
$131.38
|
| Rate for Payer: PHP Commercial |
$136.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.14
|
| Rate for Payer: Priority Health HMO/PPO |
$139.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.99
|
| Rate for Payer: UHC Core |
$133.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.16
|
|
|
HC MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
IP
|
$728.28
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
30600287
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$473.38 |
| Max. Negotiated Rate |
$655.45 |
| Rate for Payer: Aetna Commercial |
$619.04
|
| Rate for Payer: BCBS Trust/PPO |
$594.49
|
| Rate for Payer: BCN Commercial |
$562.81
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cofinity Commercial |
$626.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.62
|
| Rate for Payer: Healthscope Commercial |
$655.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: Nomi Health Commercial |
$597.19
|
| Rate for Payer: PHP Commercial |
$619.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.38
|
| Rate for Payer: Priority Health HMO/PPO |
$633.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$487.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.89
|
| Rate for Payer: UHC Core |
$608.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.21
|
|
|
HC MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
OP
|
$728.28
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
30600287
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$172.97 |
| Max. Negotiated Rate |
$655.45 |
| Rate for Payer: Aetna Commercial |
$619.04
|
| Rate for Payer: Aetna Medicare |
$189.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$227.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$227.59
|
| Rate for Payer: BCBS Complete |
$316.42
|
| Rate for Payer: BCBS MAPPO |
$182.07
|
| Rate for Payer: BCBS Trust/PPO |
$598.72
|
| Rate for Payer: BCN Commercial |
$566.24
|
| Rate for Payer: BCN Medicare Advantage |
$182.07
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cofinity Commercial |
$626.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.07
|
| Rate for Payer: Healthscope Commercial |
$655.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.21
|
| Rate for Payer: Mclaren Medicaid |
$301.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.17
|
| Rate for Payer: Meridian Medicaid |
$316.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: Nomi Health Commercial |
$597.19
|
| Rate for Payer: PACE Senior Care Partners |
$172.97
|
| Rate for Payer: PACE SWMI |
$182.07
|
| Rate for Payer: PHP Commercial |
$619.04
|
| Rate for Payer: PHP Medicare Advantage |
$182.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$301.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.38
|
| Rate for Payer: Priority Health HMO/PPO |
$633.60
|
| Rate for Payer: Priority Health Medicare |
$183.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$487.95
|
| Rate for Payer: Railroad Medicare Medicare |
$182.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.89
|
| Rate for Payer: UHC Core |
$608.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.07
|
| Rate for Payer: UHC Exchange |
$182.07
|
| Rate for Payer: UHC Medicare Advantage |
$182.07
|
| Rate for Payer: UHCCP Medicaid |
$301.33
|
| Rate for Payer: VA VA |
$182.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.21
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
IP
|
$9.36
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200218
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: BCBS Trust/PPO |
$7.64
|
| Rate for Payer: BCN Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Nomi Health Commercial |
$7.68
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.08
|
| Rate for Payer: Priority Health HMO/PPO |
$8.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.24
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.02
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
IP
|
$14.15
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$12.74 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: BCBS Trust/PPO |
$11.55
|
| Rate for Payer: BCN Commercial |
$10.94
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
OP
|
$9.36
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200218
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Aetna Commercial |
$7.96
|
| Rate for Payer: Aetna Medicare |
$2.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.92
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS MAPPO |
$2.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.69
|
| Rate for Payer: BCN Commercial |
$7.28
|
| Rate for Payer: BCN Medicare Advantage |
$2.34
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cash Price |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$8.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.02
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.46
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.96
|
| Rate for Payer: Nomi Health Commercial |
$7.68
|
| Rate for Payer: PACE Senior Care Partners |
$2.22
|
| Rate for Payer: PACE SWMI |
$2.34
|
| Rate for Payer: PHP Commercial |
$7.96
|
| Rate for Payer: PHP Medicare Advantage |
$2.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.08
|
| Rate for Payer: Priority Health HMO/PPO |
$8.14
|
| Rate for Payer: Priority Health Medicare |
$2.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.27
|
| Rate for Payer: Railroad Medicare Medicare |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.24
|
| Rate for Payer: UHC Core |
$7.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.34
|
| Rate for Payer: UHC Exchange |
$2.34
|
| Rate for Payer: UHC Medicare Advantage |
$2.34
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$2.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.02
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
OP
|
$14.15
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$12.79 |
| Rate for Payer: Aetna Commercial |
$12.03
|
| Rate for Payer: Aetna Medicare |
$3.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.42
|
| Rate for Payer: BCBS Complete |
$12.79
|
| Rate for Payer: BCBS MAPPO |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$11.63
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: BCN Medicare Advantage |
$3.54
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cash Price |
$11.32
|
| Rate for Payer: Cofinity Commercial |
$12.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$12.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.61
|
| Rate for Payer: Mclaren Medicaid |
$12.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.71
|
| Rate for Payer: Meridian Medicaid |
$12.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.03
|
| Rate for Payer: Nomi Health Commercial |
$11.60
|
| Rate for Payer: PACE Senior Care Partners |
$3.36
|
| Rate for Payer: PACE SWMI |
$3.54
|
| Rate for Payer: PHP Commercial |
$12.03
|
| Rate for Payer: PHP Medicare Advantage |
$3.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.20
|
| Rate for Payer: Priority Health HMO/PPO |
$12.31
|
| Rate for Payer: Priority Health Medicare |
$3.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.45
|
| Rate for Payer: UHC Core |
$11.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.54
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicare Advantage |
$3.54
|
| Rate for Payer: UHCCP Medicaid |
$12.18
|
| Rate for Payer: VA VA |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.61
|
|
|
HC MENINGOENCEPHALITIS PANEL SERUM
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200217
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$11.89
|
| Rate for Payer: BCN Commercial |
$11.26
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC MENINGOENCEPHALITIS PANEL SERUM
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200217
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.55
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS MAPPO |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.98
|
| Rate for Payer: BCN Commercial |
$11.33
|
| Rate for Payer: BCN Medicare Advantage |
$3.64
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.82
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PACE Senior Care Partners |
$3.46
|
| Rate for Payer: PACE SWMI |
$3.64
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: PHP Medicare Advantage |
$3.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.68
|
| Rate for Payer: Priority Health Medicare |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: Railroad Medicare Medicare |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$12.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.64
|
| Rate for Payer: UHC Exchange |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.64
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC MERCURY
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
30100291
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: BCBS Trust/PPO |
$40.77
|
| Rate for Payer: BCN Commercial |
$38.59
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO |
$43.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.95
|
| Rate for Payer: UHC Core |
$41.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.46
|
|
|
HC MERCURY
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
30100291
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna Medicare |
$12.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.61
|
| Rate for Payer: BCBS Complete |
$12.34
|
| Rate for Payer: BCBS MAPPO |
$12.48
|
| Rate for Payer: BCBS Trust/PPO |
$41.06
|
| Rate for Payer: BCN Commercial |
$38.83
|
| Rate for Payer: BCN Medicare Advantage |
$12.48
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.48
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$11.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.11
|
| Rate for Payer: Meridian Medicaid |
$12.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PACE Senior Care Partners |
$11.86
|
| Rate for Payer: PACE SWMI |
$12.48
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: PHP Medicare Advantage |
$12.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO |
$43.45
|
| Rate for Payer: Priority Health Medicare |
$12.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.46
|
| Rate for Payer: Railroad Medicare Medicare |
$12.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.95
|
| Rate for Payer: UHC Core |
$41.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.48
|
| Rate for Payer: UHC Exchange |
$12.48
|
| Rate for Payer: UHC Medicare Advantage |
$12.48
|
| Rate for Payer: UHCCP Medicaid |
$11.76
|
| Rate for Payer: VA VA |
$12.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.46
|
|
|
HC MESH
|
Facility
|
OP
|
$4,646.30
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27800022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,103.50 |
| Max. Negotiated Rate |
$4,181.67 |
| Rate for Payer: Aetna Commercial |
$3,949.36
|
| Rate for Payer: Aetna Medicare |
$1,208.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,451.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,451.97
|
| Rate for Payer: BCBS Complete |
$1,858.52
|
| Rate for Payer: BCBS MAPPO |
$1,161.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,819.72
|
| Rate for Payer: BCN Commercial |
$3,612.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,161.58
|
| Rate for Payer: Cash Price |
$3,717.04
|
| Rate for Payer: Cofinity Commercial |
$3,995.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,717.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,161.58
|
| Rate for Payer: Healthscope Commercial |
$4,181.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,484.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,219.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,335.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,949.36
|
| Rate for Payer: Nomi Health Commercial |
$3,809.97
|
| Rate for Payer: PACE Senior Care Partners |
$1,103.50
|
| Rate for Payer: PACE SWMI |
$1,161.58
|
| Rate for Payer: PHP Commercial |
$3,949.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,161.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,020.10
|
| Rate for Payer: Priority Health HMO/PPO |
$4,042.28
|
| Rate for Payer: Priority Health Medicare |
$1,173.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,113.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,161.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,088.74
|
| Rate for Payer: UHC Core |
$3,879.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,161.58
|
| Rate for Payer: UHC Exchange |
$1,161.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,161.58
|
| Rate for Payer: VA VA |
$1,161.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,484.72
|
|
|
HC MESH
|
Facility
|
IP
|
$4,646.30
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27800022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,020.10 |
| Max. Negotiated Rate |
$4,181.67 |
| Rate for Payer: Aetna Commercial |
$3,949.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,792.77
|
| Rate for Payer: BCN Commercial |
$3,590.66
|
| Rate for Payer: Cash Price |
$3,717.04
|
| Rate for Payer: Cofinity Commercial |
$3,995.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,717.04
|
| Rate for Payer: Healthscope Commercial |
$4,181.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,484.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,949.36
|
| Rate for Payer: Nomi Health Commercial |
$3,809.97
|
| Rate for Payer: PHP Commercial |
$3,949.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,020.10
|
| Rate for Payer: Priority Health HMO/PPO |
$4,042.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,113.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,088.74
|
| Rate for Payer: UHC Core |
$3,879.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,484.72
|
|
|
HC METANEB SUPPLY
|
Facility
|
IP
|
$259.27
|
|
| Hospital Charge Code |
27000466
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$168.53 |
| Max. Negotiated Rate |
$233.34 |
| Rate for Payer: Aetna Commercial |
$220.38
|
| Rate for Payer: BCBS Trust/PPO |
$211.64
|
| Rate for Payer: BCN Commercial |
$200.36
|
| Rate for Payer: Cash Price |
$207.42
|
| Rate for Payer: Cofinity Commercial |
$222.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.42
|
| Rate for Payer: Healthscope Commercial |
$233.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$194.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.38
|
| Rate for Payer: Nomi Health Commercial |
$212.60
|
| Rate for Payer: PHP Commercial |
$220.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.53
|
| Rate for Payer: Priority Health HMO/PPO |
$225.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.16
|
| Rate for Payer: UHC Core |
$216.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$194.45
|
|
