|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.34 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: BCBS Trust/PPO |
$59.45
|
| Rate for Payer: BCN Commercial |
$56.28
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health HMO/PPO |
$63.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.09
|
| Rate for Payer: UHC Core |
$60.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.62
|
|
|
HC VACC CCIIV4 NO PRSV 0.5 ML IM
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
63600222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$18.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.76
|
| Rate for Payer: BCBS Complete |
$29.13
|
| Rate for Payer: BCBS MAPPO |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$59.87
|
| Rate for Payer: BCN Commercial |
$56.63
|
| Rate for Payer: BCN Medicare Advantage |
$18.21
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: Nomi Health Commercial |
$59.72
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.21
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: PHP Medicare Advantage |
$18.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health HMO/PPO |
$63.36
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.80
|
| Rate for Payer: Railroad Medicare Medicare |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.09
|
| Rate for Payer: UHC Core |
$60.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.21
|
| Rate for Payer: UHC Exchange |
$18.21
|
| Rate for Payer: UHC Medicare Advantage |
$18.21
|
| Rate for Payer: VA VA |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.62
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
OP
|
$839.51
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$199.38 |
| Max. Negotiated Rate |
$755.56 |
| Rate for Payer: Aetna Commercial |
$713.58
|
| Rate for Payer: Aetna Medicare |
$218.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.35
|
| Rate for Payer: BCBS Complete |
$335.80
|
| Rate for Payer: BCBS MAPPO |
$209.88
|
| Rate for Payer: BCBS Trust/PPO |
$690.16
|
| Rate for Payer: BCN Commercial |
$652.72
|
| Rate for Payer: BCN Medicare Advantage |
$209.88
|
| Rate for Payer: Cash Price |
$671.61
|
| Rate for Payer: Cofinity Commercial |
$721.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.88
|
| Rate for Payer: Healthscope Commercial |
$755.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.58
|
| Rate for Payer: Nomi Health Commercial |
$688.40
|
| Rate for Payer: PACE Senior Care Partners |
$199.38
|
| Rate for Payer: PACE SWMI |
$209.88
|
| Rate for Payer: PHP Commercial |
$713.58
|
| Rate for Payer: PHP Medicare Advantage |
$209.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.68
|
| Rate for Payer: Priority Health HMO/PPO |
$730.37
|
| Rate for Payer: Priority Health Medicare |
$211.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$562.47
|
| Rate for Payer: Railroad Medicare Medicare |
$209.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.77
|
| Rate for Payer: UHC Core |
$700.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.88
|
| Rate for Payer: UHC Exchange |
$209.88
|
| Rate for Payer: UHC Medicare Advantage |
$209.88
|
| Rate for Payer: VA VA |
$209.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.63
|
|
|
HC VACC RSV PREF BIVALENT IM
|
Facility
|
IP
|
$839.51
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
63600226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$545.68 |
| Max. Negotiated Rate |
$755.56 |
| Rate for Payer: Aetna Commercial |
$713.58
|
| Rate for Payer: BCBS Trust/PPO |
$685.29
|
| Rate for Payer: BCN Commercial |
$648.77
|
| Rate for Payer: Cash Price |
$671.61
|
| Rate for Payer: Cofinity Commercial |
$721.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.61
|
| Rate for Payer: Healthscope Commercial |
$755.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.58
|
| Rate for Payer: Nomi Health Commercial |
$688.40
|
| Rate for Payer: PHP Commercial |
$713.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.68
|
| Rate for Payer: Priority Health HMO/PPO |
$730.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$562.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.77
|
| Rate for Payer: UHC Core |
$700.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.63
|
|
|
HC VACC RSV PREF RECOMB ADJT IM
|
Facility
|
IP
|
$796.82
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
63600225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$517.93 |
| Max. Negotiated Rate |
$717.14 |
| Rate for Payer: Aetna Commercial |
$677.30
|
| Rate for Payer: BCBS Trust/PPO |
$650.44
|
| Rate for Payer: BCN Commercial |
$615.78
|
| Rate for Payer: Cash Price |
$637.46
|
| Rate for Payer: Cofinity Commercial |
$685.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$637.46
|
| Rate for Payer: Healthscope Commercial |
$717.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$597.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$677.30
|
| Rate for Payer: Nomi Health Commercial |
$653.39
|
| Rate for Payer: PHP Commercial |
$677.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.93
|
| Rate for Payer: Priority Health HMO/PPO |
$693.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$533.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$701.20
|
| Rate for Payer: UHC Core |
$665.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$597.62
|
|
|
HC VACC RSV PREF RECOMB ADJT IM
|
Facility
|
OP
|
$796.82
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
63600225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.24 |
| Max. Negotiated Rate |
$717.14 |
| Rate for Payer: Aetna Commercial |
$677.30
|
| Rate for Payer: Aetna Medicare |
$207.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.01
|
| Rate for Payer: BCBS Complete |
$318.73
|
| Rate for Payer: BCBS MAPPO |
$199.21
|
| Rate for Payer: BCBS Trust/PPO |
$655.07
|
| Rate for Payer: BCN Commercial |
$619.53
|
| Rate for Payer: BCN Medicare Advantage |
$199.21
|
| Rate for Payer: Cash Price |
$637.46
|
| Rate for Payer: Cofinity Commercial |
$685.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$637.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.21
|
| Rate for Payer: Healthscope Commercial |
$717.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$597.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$677.30
|
| Rate for Payer: Nomi Health Commercial |
$653.39
|
| Rate for Payer: PACE Senior Care Partners |
$189.24
|
| Rate for Payer: PACE SWMI |
$199.21
|
| Rate for Payer: PHP Commercial |
$677.30
|
| Rate for Payer: PHP Medicare Advantage |
$199.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.93
|
| Rate for Payer: Priority Health HMO/PPO |
$693.23
|
| Rate for Payer: Priority Health Medicare |
$201.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$533.87
|
| Rate for Payer: Railroad Medicare Medicare |
$199.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$701.20
|
| Rate for Payer: UHC Core |
$665.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.21
|
| Rate for Payer: UHC Exchange |
$199.21
|
| Rate for Payer: UHC Medicare Advantage |
$199.21
|
| Rate for Payer: VA VA |
$199.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$597.62
|
|
|
HC VAC WOUND PREVENA
|
Facility
|
IP
|
$1,482.30
|
|
| Hospital Charge Code |
27000697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$963.50 |
| Max. Negotiated Rate |
$1,334.07 |
| Rate for Payer: Aetna Commercial |
$1,259.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,210.00
|
| Rate for Payer: BCN Commercial |
$1,145.52
|
| Rate for Payer: Cash Price |
$1,185.84
|
| Rate for Payer: Cofinity Commercial |
$1,274.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.84
|
| Rate for Payer: Healthscope Commercial |
$1,334.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.95
|
| Rate for Payer: Nomi Health Commercial |
$1,215.49
|
| Rate for Payer: PHP Commercial |
$1,259.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,289.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$993.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,304.42
|
| Rate for Payer: UHC Core |
$1,237.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.72
|
|
|
HC VAC WOUND PREVENA
|
Facility
|
OP
|
$1,482.30
|
|
| Hospital Charge Code |
27000697
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$352.05 |
| Max. Negotiated Rate |
$1,334.07 |
| Rate for Payer: Aetna Commercial |
$1,259.95
|
| Rate for Payer: Aetna Medicare |
$385.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$463.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$463.22
|
| Rate for Payer: BCBS Complete |
$592.92
|
| Rate for Payer: BCBS MAPPO |
$370.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.60
|
| Rate for Payer: BCN Commercial |
$1,152.49
|
| Rate for Payer: BCN Medicare Advantage |
$370.57
|
| Rate for Payer: Cash Price |
$1,185.84
|
| Rate for Payer: Cofinity Commercial |
$1,274.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,185.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.57
|
| Rate for Payer: Healthscope Commercial |
$1,334.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,111.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$426.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.95
|
| Rate for Payer: Nomi Health Commercial |
$1,215.49
|
| Rate for Payer: PACE Senior Care Partners |
$352.05
|
| Rate for Payer: PACE SWMI |
$370.57
|
| Rate for Payer: PHP Commercial |
$1,259.95
|
| Rate for Payer: PHP Medicare Advantage |
$370.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$963.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,289.60
|
| Rate for Payer: Priority Health Medicare |
$374.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$993.14
|
| Rate for Payer: Railroad Medicare Medicare |
$370.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,304.42
|
| Rate for Payer: UHC Core |
$1,237.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.57
|
| Rate for Payer: UHC Exchange |
$370.57
|
| Rate for Payer: UHC Medicare Advantage |
$370.57
|
| Rate for Payer: VA VA |
$370.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,111.72
|
|
|
HC VAGINAL DELIVERY (OB)
|
Facility
|
OP
|
$1,792.41
|
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$425.70 |
| Max. Negotiated Rate |
$1,613.17 |
| Rate for Payer: Aetna Commercial |
$1,523.55
|
| Rate for Payer: Aetna Medicare |
$466.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$560.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$560.13
|
| Rate for Payer: BCBS Complete |
$716.96
|
| Rate for Payer: BCBS MAPPO |
$448.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,473.54
|
| Rate for Payer: BCN Commercial |
$1,393.60
|
| Rate for Payer: BCN Medicare Advantage |
$448.10
|
| Rate for Payer: Cash Price |
$1,433.93
|
| Rate for Payer: Cofinity Commercial |
$1,541.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$448.10
|
| Rate for Payer: Healthscope Commercial |
$1,613.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$470.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$515.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.55
|
| Rate for Payer: Nomi Health Commercial |
$1,469.78
|
| Rate for Payer: PACE Senior Care Partners |
$425.70
|
| Rate for Payer: PACE SWMI |
$448.10
|
| Rate for Payer: PHP Commercial |
$1,523.55
|
| Rate for Payer: PHP Medicare Advantage |
$448.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,559.40
|
| Rate for Payer: Priority Health Medicare |
$452.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,200.91
|
| Rate for Payer: Railroad Medicare Medicare |
$448.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.32
|
| Rate for Payer: UHC Core |
$1,496.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$448.10
|
| Rate for Payer: UHC Exchange |
$448.10
|
| Rate for Payer: UHC Medicare Advantage |
$448.10
|
| Rate for Payer: VA VA |
$448.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.31
|
|
|
HC VAGINAL DELIVERY (OB)
|
Facility
|
IP
|
$1,792.41
|
|
| Hospital Charge Code |
72000006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,165.07 |
| Max. Negotiated Rate |
$1,613.17 |
| Rate for Payer: Aetna Commercial |
$1,523.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.14
|
| Rate for Payer: BCN Commercial |
$1,385.17
|
| Rate for Payer: Cash Price |
$1,433.93
|
| Rate for Payer: Cofinity Commercial |
$1,541.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.93
|
| Rate for Payer: Healthscope Commercial |
$1,613.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.55
|
| Rate for Payer: Nomi Health Commercial |
$1,469.78
|
| Rate for Payer: PHP Commercial |
$1,523.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.07
|
| Rate for Payer: Priority Health HMO/PPO |
$1,559.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,200.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.32
|
| Rate for Payer: UHC Core |
$1,496.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.31
|
|
|
HC VALPROIC ACID DEPAKENE LVL
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
30100589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.88 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: BCBS Trust/PPO |
$87.76
|
| Rate for Payer: BCN Commercial |
$83.08
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health HMO/PPO |
$93.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.61
|
| Rate for Payer: UHC Core |
$89.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.63
|
|
|
HC VALPROIC ACID DEPAKENE LVL
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
30100589
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna Medicare |
$27.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.60
|
| Rate for Payer: BCBS Complete |
$10.28
|
| Rate for Payer: BCBS MAPPO |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$88.38
|
| Rate for Payer: BCN Commercial |
$83.59
|
| Rate for Payer: BCN Medicare Advantage |
$26.88
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.88
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.63
|
| Rate for Payer: Mclaren Medicaid |
$9.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.22
|
| Rate for Payer: Meridian Medicaid |
$10.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: PACE Senior Care Partners |
$25.53
|
| Rate for Payer: PACE SWMI |
$26.88
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: PHP Medicare Advantage |
$26.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health HMO/PPO |
$93.53
|
| Rate for Payer: Priority Health Medicare |
$27.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.03
|
| Rate for Payer: Railroad Medicare Medicare |
$26.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.61
|
| Rate for Payer: UHC Core |
$89.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.88
|
| Rate for Payer: UHC Exchange |
$26.88
|
| Rate for Payer: UHC Medicare Advantage |
$26.88
|
| Rate for Payer: UHCCP Medicaid |
$9.79
|
| Rate for Payer: VA VA |
$26.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.63
|
|
|
HC VALVE VENT NONADJ
|
Facility
|
IP
|
$52.02
|
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC VALVE VENT NONADJ
|
Facility
|
OP
|
$52.02
|
|
| Hospital Charge Code |
27000277
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.01
|
| Rate for Payer: UHC Exchange |
$13.01
|
| Rate for Payer: UHC Medicare Advantage |
$13.01
|
| Rate for Payer: VA VA |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC VALVE VENT ONE WAY
|
Facility
|
IP
|
$42.84
|
|
| Hospital Charge Code |
27000662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: BCBS Trust/PPO |
$34.97
|
| Rate for Payer: BCN Commercial |
$33.11
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC VALVE VENT ONE WAY
|
Facility
|
OP
|
$42.84
|
|
| Hospital Charge Code |
27000662
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.39
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS MAPPO |
$10.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.22
|
| Rate for Payer: BCN Commercial |
$33.31
|
| Rate for Payer: BCN Medicare Advantage |
$10.71
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: PACE Senior Care Partners |
$10.17
|
| Rate for Payer: PACE SWMI |
$10.71
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Medicare |
$10.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.70
|
| Rate for Payer: Railroad Medicare Medicare |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.71
|
| Rate for Payer: UHC Exchange |
$10.71
|
| Rate for Payer: UHC Medicare Advantage |
$10.71
|
| Rate for Payer: VA VA |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC VANCOMYCIN LEVEL
|
Facility
|
OP
|
$138.41
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
30100051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$124.57 |
| Rate for Payer: Aetna Commercial |
$117.65
|
| Rate for Payer: Aetna Medicare |
$35.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.25
|
| Rate for Payer: BCBS Complete |
$10.28
|
| Rate for Payer: BCBS MAPPO |
$34.60
|
| Rate for Payer: BCBS Trust/PPO |
$113.79
|
| Rate for Payer: BCN Commercial |
$107.61
|
| Rate for Payer: BCN Medicare Advantage |
$34.60
|
| Rate for Payer: Cash Price |
$110.73
|
| Rate for Payer: Cash Price |
$110.73
|
| Rate for Payer: Cofinity Commercial |
$119.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.60
|
| Rate for Payer: Healthscope Commercial |
$124.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.81
|
| Rate for Payer: Mclaren Medicaid |
$9.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.33
|
| Rate for Payer: Meridian Medicaid |
$10.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.65
|
| Rate for Payer: Nomi Health Commercial |
$113.50
|
| Rate for Payer: PACE Senior Care Partners |
$32.87
|
| Rate for Payer: PACE SWMI |
$34.60
|
| Rate for Payer: PHP Commercial |
$117.65
|
| Rate for Payer: PHP Medicare Advantage |
$34.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.97
|
| Rate for Payer: Priority Health HMO/PPO |
$120.42
|
| Rate for Payer: Priority Health Medicare |
$34.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.73
|
| Rate for Payer: Railroad Medicare Medicare |
$34.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.80
|
| Rate for Payer: UHC Core |
$115.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.60
|
| Rate for Payer: UHC Exchange |
$34.60
|
| Rate for Payer: UHC Medicare Advantage |
$34.60
|
| Rate for Payer: UHCCP Medicaid |
$9.79
|
| Rate for Payer: VA VA |
$34.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.81
|
|
|
HC VANCOMYCIN LEVEL
|
Facility
|
IP
|
$138.41
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
30100051
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.97 |
| Max. Negotiated Rate |
$124.57 |
| Rate for Payer: Aetna Commercial |
$117.65
|
| Rate for Payer: BCBS Trust/PPO |
$112.98
|
| Rate for Payer: BCN Commercial |
$106.96
|
| Rate for Payer: Cash Price |
$110.73
|
| Rate for Payer: Cofinity Commercial |
$119.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.73
|
| Rate for Payer: Healthscope Commercial |
$124.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.65
|
| Rate for Payer: Nomi Health Commercial |
$113.50
|
| Rate for Payer: PHP Commercial |
$117.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.97
|
| Rate for Payer: Priority Health HMO/PPO |
$120.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.80
|
| Rate for Payer: UHC Core |
$115.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.81
|
|
|
HC VAP CHOLESTEROL
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
30100281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: BCBS Complete |
$25.71
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$68.42
|
| Rate for Payer: BCN Commercial |
$64.71
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$24.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: Meridian Medicaid |
$25.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: PACE Senior Care Partners |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: Priority Health HMO/PPO |
$72.41
|
| Rate for Payer: Priority Health Medicare |
$21.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.76
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.24
|
| Rate for Payer: UHC Core |
$69.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.81
|
| Rate for Payer: UHC Exchange |
$20.81
|
| Rate for Payer: UHC Medicare Advantage |
$20.81
|
| Rate for Payer: UHCCP Medicaid |
$24.48
|
| Rate for Payer: VA VA |
$20.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC VAP CHOLESTEROL
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
CPT 83701
|
| Hospital Charge Code |
30100281
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: BCBS Trust/PPO |
$67.94
|
| Rate for Payer: BCN Commercial |
$64.32
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: Priority Health HMO/PPO |
$72.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.24
|
| Rate for Payer: UHC Core |
$69.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC VAP CHOLESTEROL CMPT
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$4.36
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$4.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$4.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$4.15
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC VAP CHOLESTEROL CMPT
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100445
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ
|
Facility
|
OP
|
$220.56
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
63600084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.38 |
| Max. Negotiated Rate |
$198.50 |
| Rate for Payer: Aetna Commercial |
$187.48
|
| Rate for Payer: Aetna Medicare |
$57.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.92
|
| Rate for Payer: BCBS Complete |
$88.22
|
| Rate for Payer: BCBS MAPPO |
$55.14
|
| Rate for Payer: BCBS Trust/PPO |
$181.32
|
| Rate for Payer: BCN Commercial |
$171.49
|
| Rate for Payer: BCN Medicare Advantage |
$55.14
|
| Rate for Payer: Cash Price |
$176.45
|
| Rate for Payer: Cofinity Commercial |
$189.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.14
|
| Rate for Payer: Healthscope Commercial |
$198.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.48
|
| Rate for Payer: Nomi Health Commercial |
$180.86
|
| Rate for Payer: PACE Senior Care Partners |
$52.38
|
| Rate for Payer: PACE SWMI |
$55.14
|
| Rate for Payer: PHP Commercial |
$187.48
|
| Rate for Payer: PHP Medicare Advantage |
$55.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.36
|
| Rate for Payer: Priority Health HMO/PPO |
$191.89
|
| Rate for Payer: Priority Health Medicare |
$55.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.78
|
| Rate for Payer: Railroad Medicare Medicare |
$55.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.09
|
| Rate for Payer: UHC Core |
$184.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.14
|
| Rate for Payer: UHC Exchange |
$55.14
|
| Rate for Payer: UHC Medicare Advantage |
$55.14
|
| Rate for Payer: VA VA |
$55.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.42
|
|
|
HC VARICELLA VIRUS VACCINE (VAR), LIVE SUBQ
|
Facility
|
IP
|
$220.56
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
63600084
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.36 |
| Max. Negotiated Rate |
$198.50 |
| Rate for Payer: Aetna Commercial |
$187.48
|
| Rate for Payer: BCBS Trust/PPO |
$180.04
|
| Rate for Payer: BCN Commercial |
$170.45
|
| Rate for Payer: Cash Price |
$176.45
|
| Rate for Payer: Cofinity Commercial |
$189.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.45
|
| Rate for Payer: Healthscope Commercial |
$198.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.48
|
| Rate for Payer: Nomi Health Commercial |
$180.86
|
| Rate for Payer: PHP Commercial |
$187.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.36
|
| Rate for Payer: Priority Health HMO/PPO |
$191.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.09
|
| Rate for Payer: UHC Core |
$184.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.42
|
|
|
HC VARICELLA ZOSTER IGG
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200327
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: Aetna Medicare |
$11.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.98
|
| Rate for Payer: BCBS Complete |
$9.78
|
| Rate for Payer: BCBS MAPPO |
$11.19
|
| Rate for Payer: BCBS Trust/PPO |
$36.78
|
| Rate for Payer: BCN Commercial |
$34.79
|
| Rate for Payer: BCN Medicare Advantage |
$11.19
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cash Price |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$38.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.19
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.55
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.74
|
| Rate for Payer: Meridian Medicaid |
$9.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: PACE Senior Care Partners |
$10.63
|
| Rate for Payer: PACE SWMI |
$11.19
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: PHP Medicare Advantage |
$11.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health HMO/PPO |
$38.92
|
| Rate for Payer: Priority Health Medicare |
$11.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.98
|
| Rate for Payer: Railroad Medicare Medicare |
$11.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.37
|
| Rate for Payer: UHC Core |
$37.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.19
|
| Rate for Payer: UHC Exchange |
$11.19
|
| Rate for Payer: UHC Medicare Advantage |
$11.19
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$11.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.55
|
|
