|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
IP
|
$785.96
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$510.87 |
| Max. Negotiated Rate |
$707.36 |
| Rate for Payer: Aetna Commercial |
$668.07
|
| Rate for Payer: BCBS Trust/PPO |
$641.58
|
| Rate for Payer: BCN Commercial |
$607.39
|
| Rate for Payer: Cash Price |
$628.77
|
| Rate for Payer: Cofinity Commercial |
$675.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.77
|
| Rate for Payer: Healthscope Commercial |
$707.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.07
|
| Rate for Payer: Nomi Health Commercial |
$644.49
|
| Rate for Payer: PHP Commercial |
$668.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.87
|
| Rate for Payer: Priority Health HMO/PPO |
$683.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$526.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$691.64
|
| Rate for Payer: UHC Core |
$656.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.47
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$315.90 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: BCBS Trust/PPO |
$396.72
|
| Rate for Payer: BCN Commercial |
$375.58
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cofinity Commercial |
$417.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.80
|
| Rate for Payer: Healthscope Commercial |
$437.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.10
|
| Rate for Payer: Nomi Health Commercial |
$398.52
|
| Rate for Payer: PHP Commercial |
$413.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.90
|
| Rate for Payer: Priority Health HMO/PPO |
$422.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.68
|
| Rate for Payer: UHC Core |
$405.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.50
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: Aetna Medicare |
$126.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.88
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$121.50
|
| Rate for Payer: BCBS Trust/PPO |
$399.54
|
| Rate for Payer: BCN Commercial |
$377.87
|
| Rate for Payer: BCN Medicare Advantage |
$121.50
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cofinity Commercial |
$417.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.50
|
| Rate for Payer: Healthscope Commercial |
$437.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.50
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.58
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.10
|
| Rate for Payer: Nomi Health Commercial |
$398.52
|
| Rate for Payer: PACE Senior Care Partners |
$115.42
|
| Rate for Payer: PACE SWMI |
$121.50
|
| Rate for Payer: PHP Commercial |
$413.10
|
| Rate for Payer: PHP Medicare Advantage |
$121.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.90
|
| Rate for Payer: Priority Health HMO/PPO |
$422.82
|
| Rate for Payer: Priority Health Medicare |
$122.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.62
|
| Rate for Payer: Railroad Medicare Medicare |
$121.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.68
|
| Rate for Payer: UHC Core |
$405.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.50
|
| Rate for Payer: UHC Exchange |
$121.50
|
| Rate for Payer: UHC Medicare Advantage |
$121.50
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$121.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.50
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
OP
|
$680.42
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$612.38 |
| Rate for Payer: Aetna Commercial |
$578.36
|
| Rate for Payer: Aetna Medicare |
$176.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.63
|
| Rate for Payer: BCBS Complete |
$272.17
|
| Rate for Payer: BCBS MAPPO |
$170.10
|
| Rate for Payer: BCBS Trust/PPO |
$559.37
|
| Rate for Payer: BCN Commercial |
$529.03
|
| Rate for Payer: BCN Medicare Advantage |
$170.10
|
| Rate for Payer: Cash Price |
$544.34
|
| Rate for Payer: Cofinity Commercial |
$585.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.10
|
| Rate for Payer: Healthscope Commercial |
$612.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.36
|
| Rate for Payer: Nomi Health Commercial |
$557.94
|
| Rate for Payer: PACE Senior Care Partners |
$161.60
|
| Rate for Payer: PACE SWMI |
$170.10
|
| Rate for Payer: PHP Commercial |
$578.36
|
| Rate for Payer: PHP Medicare Advantage |
$170.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.27
|
| Rate for Payer: Priority Health HMO/PPO |
$591.97
|
| Rate for Payer: Priority Health Medicare |
$171.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$455.88
|
| Rate for Payer: Railroad Medicare Medicare |
$170.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.77
|
| Rate for Payer: UHC Core |
$568.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.10
|
| Rate for Payer: UHC Exchange |
$170.10
|
| Rate for Payer: UHC Medicare Advantage |
$170.10
|
| Rate for Payer: VA VA |
$170.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.31
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
IP
|
$680.42
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.27 |
| Max. Negotiated Rate |
$612.38 |
| Rate for Payer: Aetna Commercial |
$578.36
|
| Rate for Payer: BCBS Trust/PPO |
$555.43
|
| Rate for Payer: BCN Commercial |
$525.83
|
| Rate for Payer: Cash Price |
$544.34
|
| Rate for Payer: Cofinity Commercial |
$585.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.34
|
| Rate for Payer: Healthscope Commercial |
$612.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$578.36
|
| Rate for Payer: Nomi Health Commercial |
$557.94
|
| Rate for Payer: PHP Commercial |
$578.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.27
|
| Rate for Payer: Priority Health HMO/PPO |
$591.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$455.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.77
|
| Rate for Payer: UHC Core |
$568.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.31
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
OP
|
$166.26
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$149.63 |
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Aetna Medicare |
$43.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.96
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS MAPPO |
$41.56
|
| Rate for Payer: BCBS Trust/PPO |
$136.68
|
| Rate for Payer: BCN Commercial |
$129.27
|
| Rate for Payer: BCN Medicare Advantage |
$41.56
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cofinity Commercial |
$142.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.56
|
| Rate for Payer: Healthscope Commercial |
$149.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.69
|
| Rate for Payer: Mclaren Medicaid |
$12.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.64
|
| Rate for Payer: Meridian Medicaid |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.32
|
| Rate for Payer: Nomi Health Commercial |
$136.33
|
| Rate for Payer: PACE Senior Care Partners |
$39.49
|
| Rate for Payer: PACE SWMI |
$41.56
|
| Rate for Payer: PHP Commercial |
$141.32
|
| Rate for Payer: PHP Medicare Advantage |
$41.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.07
|
| Rate for Payer: Priority Health HMO/PPO |
$144.65
|
| Rate for Payer: Priority Health Medicare |
$41.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.39
|
| Rate for Payer: Railroad Medicare Medicare |
$41.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.31
|
| Rate for Payer: UHC Core |
$138.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.56
|
| Rate for Payer: UHC Exchange |
$41.56
|
| Rate for Payer: UHC Medicare Advantage |
$41.56
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
| Rate for Payer: VA VA |
$41.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.69
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
IP
|
$166.26
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.07 |
| Max. Negotiated Rate |
$149.63 |
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: BCBS Trust/PPO |
$135.72
|
| Rate for Payer: BCN Commercial |
$128.49
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cofinity Commercial |
$142.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.01
|
| Rate for Payer: Healthscope Commercial |
$149.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.32
|
| Rate for Payer: Nomi Health Commercial |
$136.33
|
| Rate for Payer: PHP Commercial |
$141.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.07
|
| Rate for Payer: Priority Health HMO/PPO |
$144.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.31
|
| Rate for Payer: UHC Core |
$138.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.69
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
OP
|
$165.24
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$148.72 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$42.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.64
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS MAPPO |
$41.31
|
| Rate for Payer: BCBS Trust/PPO |
$135.84
|
| Rate for Payer: BCN Commercial |
$128.47
|
| Rate for Payer: BCN Medicare Advantage |
$41.31
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cofinity Commercial |
$142.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.31
|
| Rate for Payer: Healthscope Commercial |
$148.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.93
|
| Rate for Payer: Mclaren Medicaid |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.38
|
| Rate for Payer: Meridian Medicaid |
$14.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.45
|
| Rate for Payer: Nomi Health Commercial |
$135.50
|
| Rate for Payer: PACE Senior Care Partners |
$39.24
|
| Rate for Payer: PACE SWMI |
$41.31
|
| Rate for Payer: PHP Commercial |
$140.45
|
| Rate for Payer: PHP Medicare Advantage |
$41.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.41
|
| Rate for Payer: Priority Health HMO/PPO |
$143.76
|
| Rate for Payer: Priority Health Medicare |
$41.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.71
|
| Rate for Payer: Railroad Medicare Medicare |
$41.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.41
|
| Rate for Payer: UHC Core |
$137.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.31
|
| Rate for Payer: UHC Exchange |
$41.31
|
| Rate for Payer: UHC Medicare Advantage |
$41.31
|
| Rate for Payer: UHCCP Medicaid |
$13.48
|
| Rate for Payer: VA VA |
$41.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.93
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
IP
|
$165.24
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.41 |
| Max. Negotiated Rate |
$148.72 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: BCBS Trust/PPO |
$134.89
|
| Rate for Payer: BCN Commercial |
$127.70
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cofinity Commercial |
$142.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.19
|
| Rate for Payer: Healthscope Commercial |
$148.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.45
|
| Rate for Payer: Nomi Health Commercial |
$135.50
|
| Rate for Payer: PHP Commercial |
$140.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.41
|
| Rate for Payer: Priority Health HMO/PPO |
$143.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.41
|
| Rate for Payer: UHC Core |
$137.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.93
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
IP
|
$510.39
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$331.75 |
| Max. Negotiated Rate |
$459.35 |
| Rate for Payer: Aetna Commercial |
$433.83
|
| Rate for Payer: BCBS Trust/PPO |
$416.63
|
| Rate for Payer: BCN Commercial |
$394.43
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$438.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Healthscope Commercial |
$459.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: Nomi Health Commercial |
$418.52
|
| Rate for Payer: PHP Commercial |
$433.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: Priority Health HMO/PPO |
$444.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.14
|
| Rate for Payer: UHC Core |
$426.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.79
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
OP
|
$510.39
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$459.35 |
| Rate for Payer: Aetna Commercial |
$433.83
|
| Rate for Payer: Aetna Medicare |
$132.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.50
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$127.60
|
| Rate for Payer: BCBS Trust/PPO |
$419.59
|
| Rate for Payer: BCN Commercial |
$396.83
|
| Rate for Payer: BCN Medicare Advantage |
$127.60
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$438.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.60
|
| Rate for Payer: Healthscope Commercial |
$459.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.79
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.98
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: Nomi Health Commercial |
$418.52
|
| Rate for Payer: PACE Senior Care Partners |
$121.22
|
| Rate for Payer: PACE SWMI |
$127.60
|
| Rate for Payer: PHP Commercial |
$433.83
|
| Rate for Payer: PHP Medicare Advantage |
$127.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: Priority Health HMO/PPO |
$444.04
|
| Rate for Payer: Priority Health Medicare |
$128.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.96
|
| Rate for Payer: Railroad Medicare Medicare |
$127.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.14
|
| Rate for Payer: UHC Core |
$426.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.60
|
| Rate for Payer: UHC Exchange |
$127.60
|
| Rate for Payer: UHC Medicare Advantage |
$127.60
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$127.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.79
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
IP
|
$8,058.00
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,237.70 |
| Max. Negotiated Rate |
$7,252.20 |
| Rate for Payer: Aetna Commercial |
$6,849.30
|
| Rate for Payer: BCBS Trust/PPO |
$6,577.75
|
| Rate for Payer: BCN Commercial |
$6,227.22
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$6,929.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Healthscope Commercial |
$7,252.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,043.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: Nomi Health Commercial |
$6,607.56
|
| Rate for Payer: PHP Commercial |
$6,849.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health HMO/PPO |
$7,010.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,398.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,091.04
|
| Rate for Payer: UHC Core |
$6,728.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,043.50
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
OP
|
$8,058.00
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,913.78 |
| Max. Negotiated Rate |
$7,252.20 |
| Rate for Payer: Aetna Commercial |
$6,849.30
|
| Rate for Payer: Aetna Medicare |
$2,095.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,518.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,518.12
|
| Rate for Payer: BCBS Complete |
$2,462.14
|
| Rate for Payer: BCBS MAPPO |
$2,014.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,624.48
|
| Rate for Payer: BCN Commercial |
$6,265.10
|
| Rate for Payer: BCN Medicare Advantage |
$2,014.50
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cash Price |
$6,446.40
|
| Rate for Payer: Cofinity Commercial |
$6,929.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,446.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,014.50
|
| Rate for Payer: Healthscope Commercial |
$7,252.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,043.50
|
| Rate for Payer: Mclaren Medicaid |
$2,344.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,115.22
|
| Rate for Payer: Meridian Medicaid |
$2,462.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,316.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,849.30
|
| Rate for Payer: Nomi Health Commercial |
$6,607.56
|
| Rate for Payer: PACE Senior Care Partners |
$1,913.78
|
| Rate for Payer: PACE SWMI |
$2,014.50
|
| Rate for Payer: PHP Commercial |
$6,849.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,014.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,344.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,237.70
|
| Rate for Payer: Priority Health HMO/PPO |
$7,010.46
|
| Rate for Payer: Priority Health Medicare |
$2,034.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,398.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,014.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,091.04
|
| Rate for Payer: UHC Core |
$6,728.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,014.50
|
| Rate for Payer: UHC Exchange |
$2,014.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,014.50
|
| Rate for Payer: UHCCP Medicaid |
$2,344.74
|
| Rate for Payer: VA VA |
$2,014.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,043.50
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$50.31
|
| Rate for Payer: BCN Commercial |
$47.58
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: PACE Senior Care Partners |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO |
$53.24
|
| Rate for Payer: Priority Health Medicare |
$15.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.00
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Exchange |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
| Rate for Payer: VA VA |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$49.96
|
| Rate for Payer: BCN Commercial |
$47.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO |
$53.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
OP
|
$484.50
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$115.07 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Aetna Commercial |
$411.82
|
| Rate for Payer: Aetna Medicare |
$125.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.41
|
| Rate for Payer: BCBS Complete |
$193.80
|
| Rate for Payer: BCBS MAPPO |
$121.12
|
| Rate for Payer: BCBS Trust/PPO |
$398.31
|
| Rate for Payer: BCN Commercial |
$376.70
|
| Rate for Payer: BCN Medicare Advantage |
$121.12
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$416.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.12
|
| Rate for Payer: Healthscope Commercial |
$436.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.82
|
| Rate for Payer: Nomi Health Commercial |
$397.29
|
| Rate for Payer: PACE Senior Care Partners |
$115.07
|
| Rate for Payer: PACE SWMI |
$121.12
|
| Rate for Payer: PHP Commercial |
$411.82
|
| Rate for Payer: PHP Medicare Advantage |
$121.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.93
|
| Rate for Payer: Priority Health HMO/PPO |
$421.51
|
| Rate for Payer: Priority Health Medicare |
$122.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.62
|
| Rate for Payer: Railroad Medicare Medicare |
$121.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.36
|
| Rate for Payer: UHC Core |
$404.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.12
|
| Rate for Payer: UHC Exchange |
$121.12
|
| Rate for Payer: UHC Medicare Advantage |
$121.12
|
| Rate for Payer: VA VA |
$121.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.38
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
IP
|
$484.50
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$314.93 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Aetna Commercial |
$411.82
|
| Rate for Payer: BCBS Trust/PPO |
$395.50
|
| Rate for Payer: BCN Commercial |
$374.42
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$416.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Healthscope Commercial |
$436.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.82
|
| Rate for Payer: Nomi Health Commercial |
$397.29
|
| Rate for Payer: PHP Commercial |
$411.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.93
|
| Rate for Payer: Priority Health HMO/PPO |
$421.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.36
|
| Rate for Payer: UHC Core |
$404.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.38
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.43
|
| Rate for Payer: BCBS Trust/PPO |
$228.97
|
| Rate for Payer: BCN Commercial |
$216.77
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.43
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: PHP Commercial |
$238.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO |
$244.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.84
|
| Rate for Payer: UHC Core |
$234.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.43
|
| Rate for Payer: Aetna Medicare |
$72.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.66
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS MAPPO |
$70.12
|
| Rate for Payer: BCBS Trust/PPO |
$230.60
|
| Rate for Payer: BCN Commercial |
$218.09
|
| Rate for Payer: BCN Medicare Advantage |
$70.12
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.12
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.43
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: PACE Senior Care Partners |
$66.62
|
| Rate for Payer: PACE SWMI |
$70.12
|
| Rate for Payer: PHP Commercial |
$238.43
|
| Rate for Payer: PHP Medicare Advantage |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO |
$244.03
|
| Rate for Payer: Priority Health Medicare |
$70.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.94
|
| Rate for Payer: Railroad Medicare Medicare |
$70.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.84
|
| Rate for Payer: UHC Core |
$234.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.12
|
| Rate for Payer: UHC Exchange |
$70.12
|
| Rate for Payer: UHC Medicare Advantage |
$70.12
|
| Rate for Payer: VA VA |
$70.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: BCBS Trust/PPO |
$58.28
|
| 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 Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO |
$62.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.84
|
| 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 V5264 EAR MOLD INSERT NOT DISPOSABLE ANY TYPE
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT V5264
|
| Hospital Charge Code |
47000005
|
|
Hospital Revenue Code
|
470
|
| 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 |
$58.70
|
| 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 Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| 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 |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO |
$62.12
|
| Rate for Payer: Priority Health Medicare |
$18.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.84
|
| 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 Exchange |
$17.85
|
| Rate for Payer: UHC Medicare Advantage |
$17.85
|
| Rate for Payer: VA VA |
$17.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
OP
|
$181.83
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.18 |
| Max. Negotiated Rate |
$163.65 |
| Rate for Payer: Aetna Commercial |
$154.56
|
| Rate for Payer: Aetna Medicare |
$47.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.82
|
| Rate for Payer: BCBS Complete |
$72.73
|
| Rate for Payer: BCBS MAPPO |
$45.46
|
| Rate for Payer: BCBS Trust/PPO |
$149.48
|
| Rate for Payer: BCN Commercial |
$141.37
|
| Rate for Payer: BCN Medicare Advantage |
$45.46
|
| Rate for Payer: Cash Price |
$145.46
|
| Rate for Payer: Cofinity Commercial |
$156.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.46
|
| Rate for Payer: Healthscope Commercial |
$163.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.56
|
| Rate for Payer: Nomi Health Commercial |
$149.10
|
| Rate for Payer: PACE Senior Care Partners |
$43.18
|
| Rate for Payer: PACE SWMI |
$45.46
|
| Rate for Payer: PHP Commercial |
$154.56
|
| Rate for Payer: PHP Medicare Advantage |
$45.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.19
|
| Rate for Payer: Priority Health HMO/PPO |
$158.19
|
| Rate for Payer: Priority Health Medicare |
$45.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.83
|
| Rate for Payer: Railroad Medicare Medicare |
$45.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.01
|
| Rate for Payer: UHC Core |
$151.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.46
|
| Rate for Payer: UHC Exchange |
$45.46
|
| Rate for Payer: UHC Medicare Advantage |
$45.46
|
| Rate for Payer: VA VA |
$45.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.37
|
|
|
HC VACC AIIV4 NO PRSRV 0.5ML IM
|
Facility
|
IP
|
$181.83
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
63600224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.19 |
| Max. Negotiated Rate |
$163.65 |
| Rate for Payer: Aetna Commercial |
$154.56
|
| Rate for Payer: BCBS Trust/PPO |
$148.43
|
| Rate for Payer: BCN Commercial |
$140.52
|
| Rate for Payer: Cash Price |
$145.46
|
| Rate for Payer: Cofinity Commercial |
$156.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.46
|
| Rate for Payer: Healthscope Commercial |
$163.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.56
|
| Rate for Payer: Nomi Health Commercial |
$149.10
|
| Rate for Payer: PHP Commercial |
$154.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.19
|
| Rate for Payer: Priority Health HMO/PPO |
$158.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.01
|
| Rate for Payer: UHC Core |
$151.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.37
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
OP
|
$68.02
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$61.22 |
| Rate for Payer: Aetna Commercial |
$57.82
|
| Rate for Payer: Aetna Medicare |
$17.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.26
|
| Rate for Payer: BCBS Complete |
$27.21
|
| Rate for Payer: BCBS MAPPO |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$55.92
|
| Rate for Payer: BCN Commercial |
$52.89
|
| Rate for Payer: BCN Medicare Advantage |
$17.00
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cofinity Commercial |
$58.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.00
|
| Rate for Payer: Healthscope Commercial |
$61.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.82
|
| Rate for Payer: Nomi Health Commercial |
$55.78
|
| Rate for Payer: PACE Senior Care Partners |
$16.15
|
| Rate for Payer: PACE SWMI |
$17.00
|
| Rate for Payer: PHP Commercial |
$57.82
|
| Rate for Payer: PHP Medicare Advantage |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.21
|
| Rate for Payer: Priority Health HMO/PPO |
$59.18
|
| Rate for Payer: Priority Health Medicare |
$17.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.57
|
| Rate for Payer: Railroad Medicare Medicare |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.86
|
| Rate for Payer: UHC Core |
$56.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.00
|
| Rate for Payer: UHC Exchange |
$17.00
|
| Rate for Payer: UHC Medicare Advantage |
$17.00
|
| Rate for Payer: VA VA |
$17.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.02
|
|
|
HC VACC CCIIV4 ABX FREE 0.5 ML IM
|
Facility
|
IP
|
$68.02
|
|
|
Service Code
|
CPT 90756
|
| Hospital Charge Code |
63600223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.21 |
| Max. Negotiated Rate |
$61.22 |
| Rate for Payer: Aetna Commercial |
$57.82
|
| Rate for Payer: BCBS Trust/PPO |
$55.52
|
| Rate for Payer: BCN Commercial |
$52.57
|
| Rate for Payer: Cash Price |
$54.42
|
| Rate for Payer: Cofinity Commercial |
$58.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.42
|
| Rate for Payer: Healthscope Commercial |
$61.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.82
|
| Rate for Payer: Nomi Health Commercial |
$55.78
|
| Rate for Payer: PHP Commercial |
$57.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.21
|
| Rate for Payer: Priority Health HMO/PPO |
$59.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.86
|
| Rate for Payer: UHC Core |
$56.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.02
|
|
