|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$65.31 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.94
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS MAPPO |
$68.75
|
| Rate for Payer: BCBS Trust/PPO |
$213.81
|
| Rate for Payer: BCN Commercial |
$213.81
|
| Rate for Payer: BCN Medicare Advantage |
$68.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.75
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$72.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PACE Senior Care Partners |
$65.31
|
| Rate for Payer: PACE SWMI |
$68.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: PHP Medicare Advantage |
$68.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.25
|
| Rate for Payer: Priority Health Medicare |
$68.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.72
|
| Rate for Payer: Railroad Medicare Medicare |
$68.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.00
|
| Rate for Payer: UHC Core |
$229.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.75
|
| Rate for Payer: UHC Medicare Advantage |
$70.81
|
| Rate for Payer: VA VA |
$68.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$42.69 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: BCBS Trust/PPO |
$54.10
|
| Rate for Payer: BCN Commercial |
$54.10
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.60
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$16.62 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.88
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS MAPPO |
$17.50
|
| Rate for Payer: BCBS Trust/PPO |
$54.42
|
| Rate for Payer: BCN Commercial |
$54.42
|
| Rate for Payer: BCN Medicare Advantage |
$17.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PACE Senior Care Partners |
$16.62
|
| Rate for Payer: PACE SWMI |
$17.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: PHP Medicare Advantage |
$17.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.90
|
| Rate for Payer: Priority Health Medicare |
$17.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.69
|
| Rate for Payer: Railroad Medicare Medicare |
$17.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.60
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.50
|
| Rate for Payer: UHC Medicare Advantage |
$18.02
|
| Rate for Payer: VA VA |
$17.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
IP
|
$178.26
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.72 |
| Max. Negotiated Rate |
$160.43 |
| Rate for Payer: Aetna Commercial |
$151.52
|
| Rate for Payer: BCBS Trust/PPO |
$137.76
|
| Rate for Payer: BCN Commercial |
$137.76
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cofinity Commercial |
$153.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.61
|
| Rate for Payer: Healthscope Commercial |
$160.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.52
|
| Rate for Payer: PHP Commercial |
$151.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.87
|
| Rate for Payer: UHC Core |
$148.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.70
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
OP
|
$178.26
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.34 |
| Max. Negotiated Rate |
$160.43 |
| Rate for Payer: Aetna Commercial |
$151.52
|
| Rate for Payer: Aetna Medicare |
$46.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.71
|
| Rate for Payer: BCBS Complete |
$71.30
|
| Rate for Payer: BCBS MAPPO |
$44.56
|
| Rate for Payer: BCBS Trust/PPO |
$138.60
|
| Rate for Payer: BCN Commercial |
$138.60
|
| Rate for Payer: BCN Medicare Advantage |
$44.56
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cofinity Commercial |
$153.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.56
|
| Rate for Payer: Healthscope Commercial |
$160.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.52
|
| Rate for Payer: PACE Senior Care Partners |
$42.34
|
| Rate for Payer: PACE SWMI |
$44.56
|
| Rate for Payer: PHP Commercial |
$151.52
|
| Rate for Payer: PHP Medicare Advantage |
$44.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.09
|
| Rate for Payer: Priority Health Medicare |
$44.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.72
|
| Rate for Payer: Railroad Medicare Medicare |
$44.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.87
|
| Rate for Payer: UHC Core |
$148.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.56
|
| Rate for Payer: UHC Medicare Advantage |
$45.90
|
| Rate for Payer: VA VA |
$44.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.70
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
OP
|
$66.69
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.84 |
| Max. Negotiated Rate |
$60.02 |
| Rate for Payer: Aetna Commercial |
$56.69
|
| Rate for Payer: Aetna Medicare |
$17.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.84
|
| Rate for Payer: BCBS Complete |
$26.68
|
| Rate for Payer: BCBS MAPPO |
$16.67
|
| Rate for Payer: BCBS Trust/PPO |
$51.85
|
| Rate for Payer: BCN Commercial |
$51.85
|
| Rate for Payer: BCN Medicare Advantage |
$16.67
|
| Rate for Payer: Cash Price |
$53.35
|
| Rate for Payer: Cofinity Commercial |
$57.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.67
|
| Rate for Payer: Healthscope Commercial |
$60.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.69
|
| Rate for Payer: PACE Senior Care Partners |
$15.84
|
| Rate for Payer: PACE SWMI |
$16.67
|
| Rate for Payer: PHP Commercial |
$56.69
|
| Rate for Payer: PHP Medicare Advantage |
$16.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.02
|
| Rate for Payer: Priority Health Medicare |
$16.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.67
|
| Rate for Payer: Railroad Medicare Medicare |
$16.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.69
|
| Rate for Payer: UHC Core |
$55.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.67
|
| Rate for Payer: UHC Medicare Advantage |
$17.17
|
| Rate for Payer: VA VA |
$16.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.02
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
IP
|
$66.69
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$60.02 |
| Rate for Payer: Aetna Commercial |
$56.69
|
| Rate for Payer: BCBS Trust/PPO |
$51.54
|
| Rate for Payer: BCN Commercial |
$51.54
|
| Rate for Payer: Cash Price |
$53.35
|
| Rate for Payer: Cofinity Commercial |
$57.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.35
|
| Rate for Payer: Healthscope Commercial |
$60.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.69
|
| Rate for Payer: PHP Commercial |
$56.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.69
|
| Rate for Payer: UHC Core |
$55.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.02
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: BCBS Trust/PPO |
$55.18
|
| Rate for Payer: BCN Commercial |
$55.18
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.31
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS MAPPO |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$55.51
|
| Rate for Payer: BCN Commercial |
$55.51
|
| Rate for Payer: BCN Medicare Advantage |
$17.85
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PACE Senior Care Partners |
$16.96
|
| Rate for Payer: PACE SWMI |
$17.85
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$17.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.12
|
| Rate for Payer: Priority Health Medicare |
$17.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.55
|
| Rate for Payer: Railroad Medicare Medicare |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.85
|
| Rate for Payer: UHC Medicare Advantage |
$18.39
|
| Rate for Payer: VA VA |
$17.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
IP
|
$823.05
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$501.98 |
| Max. Negotiated Rate |
$740.74 |
| Rate for Payer: Aetna Commercial |
$699.59
|
| Rate for Payer: BCBS Trust/PPO |
$636.05
|
| Rate for Payer: BCN Commercial |
$636.05
|
| Rate for Payer: Cash Price |
$658.44
|
| Rate for Payer: Cofinity Commercial |
$707.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.44
|
| Rate for Payer: Healthscope Commercial |
$740.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$617.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$699.59
|
| Rate for Payer: PHP Commercial |
$699.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$724.28
|
| Rate for Payer: UHC Core |
$687.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$617.29
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
OP
|
$823.05
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.47 |
| Max. Negotiated Rate |
$740.74 |
| Rate for Payer: Aetna Commercial |
$699.59
|
| Rate for Payer: Aetna Medicare |
$213.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$257.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$257.20
|
| Rate for Payer: BCBS Complete |
$329.22
|
| Rate for Payer: BCBS MAPPO |
$205.76
|
| Rate for Payer: BCBS Trust/PPO |
$639.92
|
| Rate for Payer: BCN Commercial |
$639.92
|
| Rate for Payer: BCN Medicare Advantage |
$205.76
|
| Rate for Payer: Cash Price |
$658.44
|
| Rate for Payer: Cofinity Commercial |
$707.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.76
|
| Rate for Payer: Healthscope Commercial |
$740.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$617.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$216.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$699.59
|
| Rate for Payer: PACE Senior Care Partners |
$195.47
|
| Rate for Payer: PACE SWMI |
$205.76
|
| Rate for Payer: PHP Commercial |
$699.59
|
| Rate for Payer: PHP Medicare Advantage |
$205.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$716.05
|
| Rate for Payer: Priority Health Medicare |
$205.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.98
|
| Rate for Payer: Railroad Medicare Medicare |
$205.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$724.28
|
| Rate for Payer: UHC Core |
$687.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.76
|
| Rate for Payer: UHC Medicare Advantage |
$211.94
|
| Rate for Payer: VA VA |
$205.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$617.29
|
|
|
HC VACC RSV PREF RECOMB ADJT IM
|
Facility
|
OP
|
$781.20
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
63600225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.54 |
| Max. Negotiated Rate |
$703.08 |
| Rate for Payer: Aetna Commercial |
$664.02
|
| Rate for Payer: Aetna Medicare |
$203.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$244.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$244.12
|
| Rate for Payer: BCBS Complete |
$312.48
|
| Rate for Payer: BCBS MAPPO |
$195.30
|
| Rate for Payer: BCBS Trust/PPO |
$607.38
|
| Rate for Payer: BCN Commercial |
$607.38
|
| Rate for Payer: BCN Medicare Advantage |
$195.30
|
| Rate for Payer: Cash Price |
$624.96
|
| Rate for Payer: Cofinity Commercial |
$671.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.30
|
| Rate for Payer: Healthscope Commercial |
$703.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$205.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$664.02
|
| Rate for Payer: PACE Senior Care Partners |
$185.54
|
| Rate for Payer: PACE SWMI |
$195.30
|
| Rate for Payer: PHP Commercial |
$664.02
|
| Rate for Payer: PHP Medicare Advantage |
$195.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$679.64
|
| Rate for Payer: Priority Health Medicare |
$195.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.45
|
| Rate for Payer: Railroad Medicare Medicare |
$195.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.46
|
| Rate for Payer: UHC Core |
$652.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$195.30
|
| Rate for Payer: UHC Medicare Advantage |
$201.16
|
| Rate for Payer: VA VA |
$195.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.90
|
|
|
HC VACC RSV PREF RECOMB ADJT IM
|
Facility
|
IP
|
$781.20
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
63600225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$476.45 |
| Max. Negotiated Rate |
$703.08 |
| Rate for Payer: Aetna Commercial |
$664.02
|
| Rate for Payer: BCBS Trust/PPO |
$603.71
|
| Rate for Payer: BCN Commercial |
$603.71
|
| Rate for Payer: Cash Price |
$624.96
|
| Rate for Payer: Cofinity Commercial |
$671.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.96
|
| Rate for Payer: Healthscope Commercial |
$703.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$664.02
|
| Rate for Payer: PHP Commercial |
$664.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$679.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.46
|
| Rate for Payer: UHC Core |
$652.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.90
|
|
|
HC VAGINAL DELIVERY (OB)
|
Facility
|
IP
|
$1,757.26
|
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,071.75 |
| Max. Negotiated Rate |
$1,581.53 |
| Rate for Payer: Aetna Commercial |
$1,493.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,358.01
|
| Rate for Payer: BCN Commercial |
$1,358.01
|
| Rate for Payer: Cash Price |
$1,405.81
|
| Rate for Payer: Cofinity Commercial |
$1,511.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.81
|
| Rate for Payer: Healthscope Commercial |
$1,581.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,493.67
|
| Rate for Payer: PHP Commercial |
$1,493.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,230.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,528.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,071.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,546.39
|
| Rate for Payer: UHC Core |
$1,467.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.94
|
|
|
HC VAGINAL DELIVERY (OB)
|
Facility
|
OP
|
$1,757.26
|
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$417.35 |
| Max. Negotiated Rate |
$1,581.53 |
| Rate for Payer: Aetna Commercial |
$1,493.67
|
| Rate for Payer: Aetna Medicare |
$456.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$549.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$549.14
|
| Rate for Payer: BCBS Complete |
$702.90
|
| Rate for Payer: BCBS MAPPO |
$439.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,366.27
|
| Rate for Payer: BCN Commercial |
$1,366.27
|
| Rate for Payer: BCN Medicare Advantage |
$439.32
|
| Rate for Payer: Cash Price |
$1,405.81
|
| Rate for Payer: Cofinity Commercial |
$1,511.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.32
|
| Rate for Payer: Healthscope Commercial |
$1,581.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$461.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,493.67
|
| Rate for Payer: PACE Senior Care Partners |
$417.35
|
| Rate for Payer: PACE SWMI |
$439.32
|
| Rate for Payer: PHP Commercial |
$1,493.67
|
| Rate for Payer: PHP Medicare Advantage |
$439.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,230.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,528.82
|
| Rate for Payer: Priority Health Medicare |
$439.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,071.75
|
| Rate for Payer: Railroad Medicare Medicare |
$439.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,546.39
|
| Rate for Payer: UHC Core |
$1,467.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.32
|
| Rate for Payer: UHC Medicare Advantage |
$452.49
|
| Rate for Payer: VA VA |
$439.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.94
|
|
|
HC VALPROIC ACID DEPAKENE LVL
|
Facility
|
IP
|
$105.40
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
30100589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.28 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: BCBS Trust/PPO |
$81.45
|
| Rate for Payer: BCN Commercial |
$81.45
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.75
|
| Rate for Payer: UHC Core |
$88.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.05
|
|
|
HC VALPROIC ACID DEPAKENE LVL
|
Facility
|
OP
|
$105.40
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
30100589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna Medicare |
$27.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.94
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$26.35
|
| Rate for Payer: BCBS Trust/PPO |
$81.95
|
| Rate for Payer: BCN Commercial |
$81.95
|
| Rate for Payer: BCN Medicare Advantage |
$26.35
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.35
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.05
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PACE Senior Care Partners |
$25.03
|
| Rate for Payer: PACE SWMI |
$26.35
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: PHP Medicare Advantage |
$26.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.70
|
| Rate for Payer: Priority Health Medicare |
$26.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.28
|
| Rate for Payer: Railroad Medicare Medicare |
$26.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.75
|
| Rate for Payer: UHC Core |
$88.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.35
|
| Rate for Payer: UHC Medicare Advantage |
$27.14
|
| Rate for Payer: VA VA |
$26.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.05
|
|
|
HC VALVE VENT NONADJ
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC VALVE VENT NONADJ
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC VALVE VENT ONE WAY
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
27000662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.98 |
| 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 |
$32.66
|
| 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 Wellcare - Medicare Advantage |
$11.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: PACE Senior Care Partners |
$9.98
|
| 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 |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.54
|
| Rate for Payer: Priority Health Medicare |
$10.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.62
|
| 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 Medicare Advantage |
$10.82
|
| Rate for Payer: VA VA |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
HC VALVE VENT ONE WAY
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
27000662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: BCBS Trust/PPO |
$32.46
|
| 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 Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.62
|
| 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 VANCOMYCIN LEVEL
|
Facility
|
OP
|
$135.70
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
30100051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$122.13 |
| Rate for Payer: Aetna Commercial |
$115.34
|
| Rate for Payer: Aetna Medicare |
$35.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.41
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$33.92
|
| Rate for Payer: BCBS Trust/PPO |
$105.51
|
| Rate for Payer: BCN Commercial |
$105.51
|
| Rate for Payer: BCN Medicare Advantage |
$33.92
|
| Rate for Payer: Cash Price |
$108.56
|
| Rate for Payer: Cash Price |
$108.56
|
| Rate for Payer: Cofinity Commercial |
$116.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.92
|
| Rate for Payer: Healthscope Commercial |
$122.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.78
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.34
|
| Rate for Payer: PACE Senior Care Partners |
$32.23
|
| Rate for Payer: PACE SWMI |
$33.92
|
| Rate for Payer: PHP Commercial |
$115.34
|
| Rate for Payer: PHP Medicare Advantage |
$33.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.06
|
| Rate for Payer: Priority Health Medicare |
$33.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.76
|
| Rate for Payer: Railroad Medicare Medicare |
$33.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.42
|
| Rate for Payer: UHC Core |
$113.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.92
|
| Rate for Payer: UHC Medicare Advantage |
$34.94
|
| Rate for Payer: VA VA |
$33.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.78
|
|
|
HC VANCOMYCIN LEVEL
|
Facility
|
IP
|
$135.70
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
30100051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.76 |
| Max. Negotiated Rate |
$122.13 |
| Rate for Payer: Aetna Commercial |
$115.34
|
| Rate for Payer: BCBS Trust/PPO |
$104.87
|
| Rate for Payer: BCN Commercial |
$104.87
|
| Rate for Payer: Cash Price |
$108.56
|
| Rate for Payer: Cofinity Commercial |
$116.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.56
|
| Rate for Payer: Healthscope Commercial |
$122.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.34
|
| Rate for Payer: PHP Commercial |
$115.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.42
|
| Rate for Payer: UHC Core |
$113.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.78
|
|
|
HC VAP CHOLESTEROL
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
30100281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$21.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.50
|
| Rate for Payer: BCBS Complete |
$26.24
|
| Rate for Payer: BCBS MAPPO |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$63.44
|
| Rate for Payer: BCN Commercial |
$63.44
|
| Rate for Payer: BCN Medicare Advantage |
$20.40
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Mclaren Medicaid |
$24.99
|
| Rate for Payer: Meridian Medicaid |
$26.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.36
|
| Rate for Payer: PACE Senior Care Partners |
$19.38
|
| Rate for Payer: PACE SWMI |
$20.40
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: PHP Medicare Advantage |
$20.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.99
|
| Rate for Payer: Priority Health Medicare |
$20.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.77
|
| Rate for Payer: Railroad Medicare Medicare |
$20.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.81
|
| Rate for Payer: UHC Core |
$68.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.40
|
| Rate for Payer: UHC Medicare Advantage |
$21.01
|
| Rate for Payer: VA VA |
$20.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC VAP CHOLESTEROL
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
30100281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: BCBS Trust/PPO |
$63.06
|
| Rate for Payer: BCN Commercial |
$63.06
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.81
|
| Rate for Payer: UHC Core |
$68.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
