|
HC SACRAL NERVE STIM, TEST LEAD, EACH
|
Facility
|
IP
|
$1,352.52
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27200315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$879.14 |
| Max. Negotiated Rate |
$1,217.27 |
| Rate for Payer: Aetna Commercial |
$1,149.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,104.06
|
| Rate for Payer: BCN Commercial |
$1,045.23
|
| Rate for Payer: Cash Price |
$1,082.02
|
| Rate for Payer: Cofinity Commercial |
$1,163.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.02
|
| Rate for Payer: Healthscope Commercial |
$1,217.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,014.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,149.64
|
| Rate for Payer: Nomi Health Commercial |
$1,109.07
|
| Rate for Payer: PHP Commercial |
$1,149.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.14
|
| Rate for Payer: Priority Health HMO/PPO |
$1,176.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$906.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.22
|
| Rate for Payer: UHC Core |
$1,129.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,014.39
|
|
|
HC SALICYLATE LVL.
|
Facility
|
IP
|
$102.44
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.59 |
| Max. Negotiated Rate |
$92.20 |
| Rate for Payer: Aetna Commercial |
$87.07
|
| Rate for Payer: BCBS Trust/PPO |
$83.62
|
| Rate for Payer: BCN Commercial |
$79.17
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cofinity Commercial |
$88.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.95
|
| Rate for Payer: Healthscope Commercial |
$92.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.07
|
| Rate for Payer: Nomi Health Commercial |
$84.00
|
| Rate for Payer: PHP Commercial |
$87.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.59
|
| Rate for Payer: Priority Health HMO/PPO |
$89.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.15
|
| Rate for Payer: UHC Core |
$85.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.83
|
|
|
HC SALICYLATE LVL.
|
Facility
|
OP
|
$102.44
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$92.20 |
| Rate for Payer: Aetna Commercial |
$87.07
|
| Rate for Payer: Aetna Medicare |
$26.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.01
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$25.61
|
| Rate for Payer: BCBS Trust/PPO |
$84.22
|
| Rate for Payer: BCN Commercial |
$79.65
|
| Rate for Payer: BCN Medicare Advantage |
$25.61
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cofinity Commercial |
$88.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.61
|
| Rate for Payer: Healthscope Commercial |
$92.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.83
|
| Rate for Payer: Mclaren Medicaid |
$44.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.89
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.07
|
| Rate for Payer: Nomi Health Commercial |
$84.00
|
| Rate for Payer: PACE Senior Care Partners |
$24.33
|
| Rate for Payer: PACE SWMI |
$25.61
|
| Rate for Payer: PHP Commercial |
$87.07
|
| Rate for Payer: PHP Medicare Advantage |
$25.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.59
|
| Rate for Payer: Priority Health HMO/PPO |
$89.12
|
| Rate for Payer: Priority Health Medicare |
$25.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.63
|
| Rate for Payer: Railroad Medicare Medicare |
$25.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.15
|
| Rate for Payer: UHC Core |
$85.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.61
|
| Rate for Payer: UHC Exchange |
$25.61
|
| Rate for Payer: UHC Medicare Advantage |
$25.61
|
| Rate for Payer: UHCCP Medicaid |
$44.93
|
| Rate for Payer: VA VA |
$25.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.83
|
|
|
HC SALICYLATE THERAPEUTIC DRUG ASSAY
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80179
|
| Hospital Charge Code |
30100730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.01
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS MAPPO |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$34.22
|
| Rate for Payer: BCN Commercial |
$32.36
|
| Rate for Payer: BCN Medicare Advantage |
$10.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Mclaren Medicaid |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.93
|
| Rate for Payer: Meridian Medicaid |
$14.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Senior Care Partners |
$9.88
|
| Rate for Payer: PACE SWMI |
$10.40
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$10.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Medicare |
$10.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: Railroad Medicare Medicare |
$10.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.40
|
| Rate for Payer: UHC Exchange |
$10.40
|
| Rate for Payer: UHC Medicare Advantage |
$10.40
|
| Rate for Payer: UHCCP Medicaid |
$13.48
|
| Rate for Payer: VA VA |
$10.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC SALICYLATE THERAPEUTIC DRUG ASSAY
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80179
|
| Hospital Charge Code |
30100730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$33.97
|
| Rate for Payer: BCN Commercial |
$32.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.21
|
|
|
HC SALMON IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200059
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC SALMON IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200059
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC SAMARIUM 153 THERAPEUTIC PER TREATMENT DOSE
|
Facility
|
OP
|
$12,673.76
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
34400005
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$3,010.02 |
| Max. Negotiated Rate |
$11,406.38 |
| Rate for Payer: Aetna Commercial |
$10,772.70
|
| Rate for Payer: Aetna Medicare |
$3,295.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,960.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,960.55
|
| Rate for Payer: BCBS Complete |
$3,275.88
|
| Rate for Payer: BCBS MAPPO |
$3,168.44
|
| Rate for Payer: BCBS Trust/PPO |
$10,419.10
|
| Rate for Payer: BCN Commercial |
$9,853.85
|
| Rate for Payer: BCN Medicare Advantage |
$3,168.44
|
| Rate for Payer: Cash Price |
$10,139.01
|
| Rate for Payer: Cash Price |
$10,139.01
|
| Rate for Payer: Cofinity Commercial |
$10,899.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,139.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,168.44
|
| Rate for Payer: Healthscope Commercial |
$11,406.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,505.32
|
| Rate for Payer: Mclaren Medicaid |
$3,119.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,326.86
|
| Rate for Payer: Meridian Medicaid |
$3,275.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,643.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,772.70
|
| Rate for Payer: Nomi Health Commercial |
$10,392.48
|
| Rate for Payer: PACE Senior Care Partners |
$3,010.02
|
| Rate for Payer: PACE SWMI |
$3,168.44
|
| Rate for Payer: PHP Commercial |
$10,772.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,168.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,119.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,237.94
|
| Rate for Payer: Priority Health HMO/PPO |
$11,026.17
|
| Rate for Payer: Priority Health Medicare |
$3,200.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,491.42
|
| Rate for Payer: Railroad Medicare Medicare |
$3,168.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,152.91
|
| Rate for Payer: UHC Core |
$10,582.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,168.44
|
| Rate for Payer: UHC Exchange |
$3,168.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,168.44
|
| Rate for Payer: UHCCP Medicaid |
$3,119.68
|
| Rate for Payer: VA VA |
$3,168.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,505.32
|
|
|
HC SAMARIUM 153 THERAPEUTIC PER TREATMENT DOSE
|
Facility
|
IP
|
$12,673.76
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
34400005
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$8,237.94 |
| Max. Negotiated Rate |
$11,406.38 |
| Rate for Payer: Aetna Commercial |
$10,772.70
|
| Rate for Payer: BCBS Trust/PPO |
$10,345.59
|
| Rate for Payer: BCN Commercial |
$9,794.28
|
| Rate for Payer: Cash Price |
$10,139.01
|
| Rate for Payer: Cofinity Commercial |
$10,899.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,139.01
|
| Rate for Payer: Healthscope Commercial |
$11,406.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,505.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,772.70
|
| Rate for Payer: Nomi Health Commercial |
$10,392.48
|
| Rate for Payer: PHP Commercial |
$10,772.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,237.94
|
| Rate for Payer: Priority Health HMO/PPO |
$11,026.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,491.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,152.91
|
| Rate for Payer: UHC Core |
$10,582.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,505.32
|
|
|
HC SARS CORONAVIRUS 2 IGG AB,S
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
30200479
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$54.68
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health HMO/PPO |
$61.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.26
|
| Rate for Payer: UHC Core |
$59.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC SARS CORONAVIRUS 2 IGG AB,S
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
30200479
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$18.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.11
|
| Rate for Payer: BCBS Complete |
$31.99
|
| Rate for Payer: BCBS MAPPO |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$58.16
|
| Rate for Payer: BCN Commercial |
$55.01
|
| Rate for Payer: BCN Medicare Advantage |
$17.69
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.69
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Mclaren Medicaid |
$30.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.57
|
| Rate for Payer: Meridian Medicaid |
$31.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: PACE Senior Care Partners |
$16.80
|
| Rate for Payer: PACE SWMI |
$17.69
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: PHP Medicare Advantage |
$17.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health HMO/PPO |
$61.55
|
| Rate for Payer: Priority Health Medicare |
$17.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.40
|
| Rate for Payer: Railroad Medicare Medicare |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.26
|
| Rate for Payer: UHC Core |
$59.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.69
|
| Rate for Payer: UHC Exchange |
$17.69
|
| Rate for Payer: UHC Medicare Advantage |
$17.69
|
| Rate for Payer: UHCCP Medicaid |
$30.46
|
| Rate for Payer: VA VA |
$17.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
OP
|
$154.02
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600339
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$138.62 |
| Rate for Payer: Aetna Commercial |
$130.92
|
| Rate for Payer: Aetna Medicare |
$40.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.13
|
| Rate for Payer: BCBS Complete |
$38.95
|
| Rate for Payer: BCBS MAPPO |
$38.51
|
| Rate for Payer: BCBS Trust/PPO |
$126.62
|
| Rate for Payer: BCN Commercial |
$119.75
|
| Rate for Payer: BCN Medicare Advantage |
$38.51
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cofinity Commercial |
$132.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.51
|
| Rate for Payer: Healthscope Commercial |
$138.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.52
|
| Rate for Payer: Mclaren Medicaid |
$37.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.43
|
| Rate for Payer: Meridian Medicaid |
$38.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.92
|
| Rate for Payer: Nomi Health Commercial |
$126.30
|
| Rate for Payer: PACE Senior Care Partners |
$36.58
|
| Rate for Payer: PACE SWMI |
$38.51
|
| Rate for Payer: PHP Commercial |
$130.92
|
| Rate for Payer: PHP Medicare Advantage |
$38.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.11
|
| Rate for Payer: Priority Health HMO/PPO |
$134.00
|
| Rate for Payer: Priority Health Medicare |
$38.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.19
|
| Rate for Payer: Railroad Medicare Medicare |
$38.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.54
|
| Rate for Payer: UHC Core |
$128.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.51
|
| Rate for Payer: UHC Exchange |
$38.51
|
| Rate for Payer: UHC Medicare Advantage |
$38.51
|
| Rate for Payer: UHCCP Medicaid |
$37.10
|
| Rate for Payer: VA VA |
$38.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.52
|
|
|
HC SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
IP
|
$154.02
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600339
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$100.11 |
| Max. Negotiated Rate |
$138.62 |
| Rate for Payer: Aetna Commercial |
$130.92
|
| Rate for Payer: BCBS Trust/PPO |
$125.73
|
| Rate for Payer: BCN Commercial |
$119.03
|
| Rate for Payer: Cash Price |
$123.22
|
| Rate for Payer: Cofinity Commercial |
$132.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.22
|
| Rate for Payer: Healthscope Commercial |
$138.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.92
|
| Rate for Payer: Nomi Health Commercial |
$126.30
|
| Rate for Payer: PHP Commercial |
$130.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.11
|
| Rate for Payer: Priority Health HMO/PPO |
$134.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.54
|
| Rate for Payer: UHC Core |
$128.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.52
|
|
|
HC SARS-COV2/FLU A&B
|
Facility
|
OP
|
$218.48
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
30600318
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.89 |
| Max. Negotiated Rate |
$196.63 |
| Rate for Payer: Aetna Commercial |
$185.71
|
| Rate for Payer: Aetna Medicare |
$56.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.28
|
| Rate for Payer: BCBS Complete |
$108.28
|
| Rate for Payer: BCBS MAPPO |
$54.62
|
| Rate for Payer: BCBS Trust/PPO |
$179.61
|
| Rate for Payer: BCN Commercial |
$169.87
|
| Rate for Payer: BCN Medicare Advantage |
$54.62
|
| Rate for Payer: Cash Price |
$174.78
|
| Rate for Payer: Cash Price |
$174.78
|
| Rate for Payer: Cofinity Commercial |
$187.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.62
|
| Rate for Payer: Healthscope Commercial |
$196.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.86
|
| Rate for Payer: Mclaren Medicaid |
$103.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.35
|
| Rate for Payer: Meridian Medicaid |
$108.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.71
|
| Rate for Payer: Nomi Health Commercial |
$179.15
|
| Rate for Payer: PACE Senior Care Partners |
$51.89
|
| Rate for Payer: PACE SWMI |
$54.62
|
| Rate for Payer: PHP Commercial |
$185.71
|
| Rate for Payer: PHP Medicare Advantage |
$54.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.01
|
| Rate for Payer: Priority Health HMO/PPO |
$190.08
|
| Rate for Payer: Priority Health Medicare |
$55.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.38
|
| Rate for Payer: Railroad Medicare Medicare |
$54.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.26
|
| Rate for Payer: UHC Core |
$182.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.62
|
| Rate for Payer: UHC Exchange |
$54.62
|
| Rate for Payer: UHC Medicare Advantage |
$54.62
|
| Rate for Payer: UHCCP Medicaid |
$103.12
|
| Rate for Payer: VA VA |
$54.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.86
|
|
|
HC SARS-COV2/FLU A&B
|
Facility
|
IP
|
$218.48
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
30600318
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$142.01 |
| Max. Negotiated Rate |
$196.63 |
| Rate for Payer: Aetna Commercial |
$185.71
|
| Rate for Payer: BCBS Trust/PPO |
$178.35
|
| Rate for Payer: BCN Commercial |
$168.84
|
| Rate for Payer: Cash Price |
$174.78
|
| Rate for Payer: Cofinity Commercial |
$187.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.78
|
| Rate for Payer: Healthscope Commercial |
$196.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.71
|
| Rate for Payer: Nomi Health Commercial |
$179.15
|
| Rate for Payer: PHP Commercial |
$185.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.01
|
| Rate for Payer: Priority Health HMO/PPO |
$190.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.26
|
| Rate for Payer: UHC Core |
$182.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.86
|
|
|
HC SARS-COV2/FLU A&B/RSV
|
Facility
|
OP
|
$254.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600319
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.54 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: Aetna Medicare |
$66.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.66
|
| Rate for Payer: BCBS Complete |
$108.28
|
| Rate for Payer: BCBS MAPPO |
$63.73
|
| Rate for Payer: BCBS Trust/PPO |
$209.55
|
| Rate for Payer: BCN Commercial |
$198.18
|
| Rate for Payer: BCN Medicare Advantage |
$63.73
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.73
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.18
|
| Rate for Payer: Mclaren Medicaid |
$103.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.91
|
| Rate for Payer: Meridian Medicaid |
$108.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Nomi Health Commercial |
$209.02
|
| Rate for Payer: PACE Senior Care Partners |
$60.54
|
| Rate for Payer: PACE SWMI |
$63.73
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: PHP Medicare Advantage |
$63.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.69
|
| Rate for Payer: Priority Health HMO/PPO |
$221.76
|
| Rate for Payer: Priority Health Medicare |
$64.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.78
|
| Rate for Payer: Railroad Medicare Medicare |
$63.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.31
|
| Rate for Payer: UHC Core |
$212.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.73
|
| Rate for Payer: UHC Exchange |
$63.73
|
| Rate for Payer: UHC Medicare Advantage |
$63.73
|
| Rate for Payer: UHCCP Medicaid |
$103.12
|
| Rate for Payer: VA VA |
$63.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.18
|
|
|
HC SARS-COV2/FLU A&B/RSV
|
Facility
|
IP
|
$254.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600319
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$165.69 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: BCBS Trust/PPO |
$208.07
|
| Rate for Payer: BCN Commercial |
$196.99
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Nomi Health Commercial |
$209.02
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.69
|
| Rate for Payer: Priority Health HMO/PPO |
$221.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.31
|
| Rate for Payer: UHC Core |
$212.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.18
|
|
|
HC SARSCOV2 INF AB RSV AMP PRB
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600344
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: BCBS Trust/PPO |
$203.99
|
| Rate for Payer: BCN Commercial |
$193.12
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO |
$217.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Core |
$208.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.43
|
|
|
HC SARSCOV2 INF AB RSV AMP PRB
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600344
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$59.35 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$64.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.09
|
| Rate for Payer: BCBS Complete |
$108.28
|
| Rate for Payer: BCBS MAPPO |
$62.48
|
| Rate for Payer: BCBS Trust/PPO |
$205.44
|
| Rate for Payer: BCN Commercial |
$194.30
|
| Rate for Payer: BCN Medicare Advantage |
$62.48
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.48
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.43
|
| Rate for Payer: Mclaren Medicaid |
$103.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.60
|
| Rate for Payer: Meridian Medicaid |
$108.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PACE Senior Care Partners |
$59.35
|
| Rate for Payer: PACE SWMI |
$62.48
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: PHP Medicare Advantage |
$62.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO |
$217.41
|
| Rate for Payer: Priority Health Medicare |
$63.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.43
|
| Rate for Payer: Railroad Medicare Medicare |
$62.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Core |
$208.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.48
|
| Rate for Payer: UHC Exchange |
$62.48
|
| Rate for Payer: UHC Medicare Advantage |
$62.48
|
| Rate for Payer: UHCCP Medicaid |
$103.12
|
| Rate for Payer: VA VA |
$62.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.43
|
|
|
HC SARSCOV2 VAC 10MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$219.13
|
|
|
Service Code
|
CPT 91319
|
| Hospital Charge Code |
63600230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.43 |
| Max. Negotiated Rate |
$197.22 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: BCBS Trust/PPO |
$178.88
|
| Rate for Payer: BCN Commercial |
$169.34
|
| Rate for Payer: Cash Price |
$175.30
|
| Rate for Payer: Cofinity Commercial |
$188.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.30
|
| Rate for Payer: Healthscope Commercial |
$197.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.26
|
| Rate for Payer: Nomi Health Commercial |
$179.69
|
| Rate for Payer: PHP Commercial |
$186.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.43
|
| Rate for Payer: Priority Health HMO/PPO |
$190.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.83
|
| Rate for Payer: UHC Core |
$182.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.35
|
|
|
HC SARSCOV2 VAC 10MCG/0.3ML TRS-SUC IM
|
Facility
|
OP
|
$219.13
|
|
|
Service Code
|
CPT 91319
|
| Hospital Charge Code |
63600230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.04 |
| Max. Negotiated Rate |
$197.22 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna Medicare |
$56.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.48
|
| Rate for Payer: BCBS Complete |
$87.65
|
| Rate for Payer: BCBS MAPPO |
$54.78
|
| Rate for Payer: BCBS Trust/PPO |
$180.15
|
| Rate for Payer: BCN Commercial |
$170.37
|
| Rate for Payer: BCN Medicare Advantage |
$54.78
|
| Rate for Payer: Cash Price |
$175.30
|
| Rate for Payer: Cofinity Commercial |
$188.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.78
|
| Rate for Payer: Healthscope Commercial |
$197.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.26
|
| Rate for Payer: Nomi Health Commercial |
$179.69
|
| Rate for Payer: PACE Senior Care Partners |
$52.04
|
| Rate for Payer: PACE SWMI |
$54.78
|
| Rate for Payer: PHP Commercial |
$186.26
|
| Rate for Payer: PHP Medicare Advantage |
$54.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.43
|
| Rate for Payer: Priority Health HMO/PPO |
$190.64
|
| Rate for Payer: Priority Health Medicare |
$55.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.82
|
| Rate for Payer: Railroad Medicare Medicare |
$54.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.83
|
| Rate for Payer: UHC Core |
$182.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.78
|
| Rate for Payer: UHC Exchange |
$54.78
|
| Rate for Payer: UHC Medicare Advantage |
$54.78
|
| Rate for Payer: VA VA |
$54.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.35
|
|
|
HC SARSCOV2 VAC 30MCG/0.3ML TRS-SUC IM
|
Facility
|
OP
|
$327.27
|
|
|
Service Code
|
CPT 91320
|
| Hospital Charge Code |
63600231
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.73 |
| Max. Negotiated Rate |
$294.54 |
| Rate for Payer: Aetna Commercial |
$278.18
|
| Rate for Payer: Aetna Medicare |
$85.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.27
|
| Rate for Payer: BCBS Complete |
$130.91
|
| Rate for Payer: BCBS MAPPO |
$81.82
|
| Rate for Payer: BCBS Trust/PPO |
$269.05
|
| Rate for Payer: BCN Commercial |
$254.45
|
| Rate for Payer: BCN Medicare Advantage |
$81.82
|
| Rate for Payer: Cash Price |
$261.82
|
| Rate for Payer: Cofinity Commercial |
$281.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.82
|
| Rate for Payer: Healthscope Commercial |
$294.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.18
|
| Rate for Payer: Nomi Health Commercial |
$268.36
|
| Rate for Payer: PACE Senior Care Partners |
$77.73
|
| Rate for Payer: PACE SWMI |
$81.82
|
| Rate for Payer: PHP Commercial |
$278.18
|
| Rate for Payer: PHP Medicare Advantage |
$81.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.73
|
| Rate for Payer: Priority Health HMO/PPO |
$284.72
|
| Rate for Payer: Priority Health Medicare |
$82.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.27
|
| Rate for Payer: Railroad Medicare Medicare |
$81.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.00
|
| Rate for Payer: UHC Core |
$273.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.82
|
| Rate for Payer: UHC Exchange |
$81.82
|
| Rate for Payer: UHC Medicare Advantage |
$81.82
|
| Rate for Payer: VA VA |
$81.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.45
|
|
|
HC SARSCOV2 VAC 30MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$327.27
|
|
|
Service Code
|
CPT 91320
|
| Hospital Charge Code |
63600231
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$212.73 |
| Max. Negotiated Rate |
$294.54 |
| Rate for Payer: Aetna Commercial |
$278.18
|
| Rate for Payer: BCBS Trust/PPO |
$267.15
|
| Rate for Payer: BCN Commercial |
$252.91
|
| Rate for Payer: Cash Price |
$261.82
|
| Rate for Payer: Cofinity Commercial |
$281.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.82
|
| Rate for Payer: Healthscope Commercial |
$294.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.18
|
| Rate for Payer: Nomi Health Commercial |
$268.36
|
| Rate for Payer: PHP Commercial |
$278.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.73
|
| Rate for Payer: Priority Health HMO/PPO |
$284.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.00
|
| Rate for Payer: UHC Core |
$273.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.45
|
|
|
HC SARSCOV2 VAC 3MCG/0.3ML TRS-SUC IM
|
Facility
|
OP
|
$163.65
|
|
|
Service Code
|
CPT 91318
|
| Hospital Charge Code |
63600229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Aetna Commercial |
$139.10
|
| Rate for Payer: Aetna Medicare |
$42.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.14
|
| Rate for Payer: BCBS Complete |
$65.46
|
| Rate for Payer: BCBS MAPPO |
$40.91
|
| Rate for Payer: BCBS Trust/PPO |
$134.54
|
| Rate for Payer: BCN Commercial |
$127.24
|
| Rate for Payer: BCN Medicare Advantage |
$40.91
|
| Rate for Payer: Cash Price |
$130.92
|
| Rate for Payer: Cofinity Commercial |
$140.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.91
|
| Rate for Payer: Healthscope Commercial |
$147.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.10
|
| Rate for Payer: Nomi Health Commercial |
$134.19
|
| Rate for Payer: PACE Senior Care Partners |
$38.87
|
| Rate for Payer: PACE SWMI |
$40.91
|
| Rate for Payer: PHP Commercial |
$139.10
|
| Rate for Payer: PHP Medicare Advantage |
$40.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.37
|
| Rate for Payer: Priority Health HMO/PPO |
$142.38
|
| Rate for Payer: Priority Health Medicare |
$41.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.65
|
| Rate for Payer: Railroad Medicare Medicare |
$40.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.01
|
| Rate for Payer: UHC Core |
$136.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.91
|
| Rate for Payer: UHC Exchange |
$40.91
|
| Rate for Payer: UHC Medicare Advantage |
$40.91
|
| Rate for Payer: VA VA |
$40.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.74
|
|
|
HC SARSCOV2 VAC 3MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$163.65
|
|
|
Service Code
|
CPT 91318
|
| Hospital Charge Code |
63600229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.37 |
| Max. Negotiated Rate |
$147.28 |
| Rate for Payer: Aetna Commercial |
$139.10
|
| Rate for Payer: BCBS Trust/PPO |
$133.59
|
| Rate for Payer: BCN Commercial |
$126.47
|
| Rate for Payer: Cash Price |
$130.92
|
| Rate for Payer: Cofinity Commercial |
$140.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.92
|
| Rate for Payer: Healthscope Commercial |
$147.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.10
|
| Rate for Payer: Nomi Health Commercial |
$134.19
|
| Rate for Payer: PHP Commercial |
$139.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.37
|
| Rate for Payer: Priority Health HMO/PPO |
$142.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.01
|
| Rate for Payer: UHC Core |
$136.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.74
|
|
