|
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
|
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 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 ZOSTER IGG
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200327
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.08 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$38.03
|
| Rate for Payer: BCBS Trust/PPO |
$36.52
|
| Rate for Payer: BCN Commercial |
$34.58
|
| 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: Healthscope Commercial |
$40.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.03
|
| Rate for Payer: Nomi Health Commercial |
$36.69
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.08
|
| Rate for Payer: Priority Health HMO/PPO |
$38.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.37
|
| Rate for Payer: UHC Core |
$37.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.56
|
|
|
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 |
$11.18
|
| Rate for Payer: BCBS Trust/PPO |
$36.78
|
| Rate for Payer: BCN Commercial |
$34.79
|
| Rate for Payer: BCN Medicare Advantage |
$11.18
|
| 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 |
$11.18
|
| Rate for Payer: Healthscope Commercial |
$40.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.56
|
| 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 |
$11.18
|
| Rate for Payer: PHP Commercial |
$38.03
|
| Rate for Payer: PHP Medicare Advantage |
$11.18
|
| 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 |
$11.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.37
|
| Rate for Payer: UHC Core |
$37.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.18
|
| Rate for Payer: UHC Exchange |
$11.18
|
| Rate for Payer: UHC Medicare Advantage |
$11.18
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$11.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.56
|
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
IP
|
$80.58
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.38 |
| Max. Negotiated Rate |
$72.52 |
| Rate for Payer: Aetna Commercial |
$68.49
|
| Rate for Payer: BCBS Trust/PPO |
$65.78
|
| Rate for Payer: BCN Commercial |
$62.27
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: Nomi Health Commercial |
$66.08
|
| Rate for Payer: PHP Commercial |
$68.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health HMO/PPO |
$70.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.91
|
| Rate for Payer: UHC Core |
$67.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
HC VARICELLA ZOSTER IGM
|
Facility
|
OP
|
$80.58
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
30200326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$72.52 |
| Rate for Payer: Aetna Commercial |
$68.49
|
| Rate for Payer: Aetna Medicare |
$20.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.18
|
| Rate for Payer: BCBS Complete |
$9.78
|
| Rate for Payer: BCBS MAPPO |
$20.14
|
| Rate for Payer: BCBS Trust/PPO |
$66.24
|
| Rate for Payer: BCN Commercial |
$62.65
|
| Rate for Payer: BCN Medicare Advantage |
$20.14
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.15
|
| Rate for Payer: Meridian Medicaid |
$9.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: Nomi Health Commercial |
$66.08
|
| Rate for Payer: PACE Senior Care Partners |
$19.14
|
| Rate for Payer: PACE SWMI |
$20.14
|
| Rate for Payer: PHP Commercial |
$68.49
|
| Rate for Payer: PHP Medicare Advantage |
$20.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health HMO/PPO |
$70.10
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.99
|
| Rate for Payer: Railroad Medicare Medicare |
$20.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.91
|
| Rate for Payer: UHC Core |
$67.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.14
|
| Rate for Payer: UHC Exchange |
$20.14
|
| Rate for Payer: UHC Medicare Advantage |
$20.14
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$20.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
HC VARICELLA ZOSTER PCR CSF
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600167
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: BCBS Trust/PPO |
$89.17
|
| Rate for Payer: BCN Commercial |
$84.42
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO |
$95.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.13
|
| Rate for Payer: UHC Core |
$91.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC VARICELLA ZOSTER PCR CSF
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600167
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.37 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna Medicare |
$28.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.14
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$27.31
|
| Rate for Payer: BCBS Trust/PPO |
$89.81
|
| Rate for Payer: BCN Commercial |
$84.93
|
| Rate for Payer: BCN Medicare Advantage |
$27.31
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.31
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.68
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PACE Senior Care Partners |
$25.94
|
| Rate for Payer: PACE SWMI |
$27.31
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: PHP Medicare Advantage |
$27.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO |
$95.04
|
| Rate for Payer: Priority Health Medicare |
$27.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.19
|
| Rate for Payer: Railroad Medicare Medicare |
$27.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.13
|
| Rate for Payer: UHC Core |
$91.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.31
|
| Rate for Payer: UHC Exchange |
$27.31
|
| Rate for Payer: UHC Medicare Advantage |
$27.31
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$27.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC VARICELLA ZOSTER VIRUS (VZV)
|
Facility
|
OP
|
$57.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$51.66 |
| Rate for Payer: Aetna Commercial |
$48.79
|
| Rate for Payer: Aetna Medicare |
$14.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.94
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$14.35
|
| Rate for Payer: BCBS Trust/PPO |
$47.19
|
| Rate for Payer: BCN Commercial |
$44.63
|
| Rate for Payer: BCN Medicare Advantage |
$14.35
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$49.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.35
|
| Rate for Payer: Healthscope Commercial |
$51.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.05
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.07
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.79
|
| Rate for Payer: Nomi Health Commercial |
$47.07
|
| Rate for Payer: PACE Senior Care Partners |
$13.63
|
| Rate for Payer: PACE SWMI |
$14.35
|
| Rate for Payer: PHP Commercial |
$48.79
|
| Rate for Payer: PHP Medicare Advantage |
$14.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.31
|
| Rate for Payer: Priority Health HMO/PPO |
$49.94
|
| Rate for Payer: Priority Health Medicare |
$14.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.46
|
| Rate for Payer: Railroad Medicare Medicare |
$14.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.51
|
| Rate for Payer: UHC Core |
$47.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.35
|
| Rate for Payer: UHC Exchange |
$14.35
|
| Rate for Payer: UHC Medicare Advantage |
$14.35
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$14.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.05
|
|
|
HC VARICELLA ZOSTER VIRUS (VZV)
|
Facility
|
IP
|
$57.40
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600278
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$51.66 |
| Rate for Payer: Aetna Commercial |
$48.79
|
| Rate for Payer: BCBS Trust/PPO |
$46.86
|
| Rate for Payer: BCN Commercial |
$44.36
|
| Rate for Payer: Cash Price |
$45.92
|
| Rate for Payer: Cofinity Commercial |
$49.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.92
|
| Rate for Payer: Healthscope Commercial |
$51.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.79
|
| Rate for Payer: Nomi Health Commercial |
$47.07
|
| Rate for Payer: PHP Commercial |
$48.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.31
|
| Rate for Payer: Priority Health HMO/PPO |
$49.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.51
|
| Rate for Payer: UHC Core |
$47.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.05
|
|
|
HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING
|
Facility
|
OP
|
$204.41
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
36100533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$183.97 |
| Rate for Payer: Aetna Commercial |
$173.75
|
| Rate for Payer: Aetna Medicare |
$53.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.88
|
| Rate for Payer: BCBS Complete |
$81.76
|
| Rate for Payer: BCBS MAPPO |
$51.10
|
| Rate for Payer: BCBS Trust/PPO |
$168.05
|
| Rate for Payer: BCN Commercial |
$158.93
|
| Rate for Payer: BCN Medicare Advantage |
$51.10
|
| Rate for Payer: Cash Price |
$163.53
|
| Rate for Payer: Cofinity Commercial |
$175.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.10
|
| Rate for Payer: Healthscope Commercial |
$183.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.75
|
| Rate for Payer: Nomi Health Commercial |
$167.62
|
| Rate for Payer: PACE Senior Care Partners |
$48.55
|
| Rate for Payer: PACE SWMI |
$51.10
|
| Rate for Payer: PHP Commercial |
$173.75
|
| Rate for Payer: PHP Medicare Advantage |
$51.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.87
|
| Rate for Payer: Priority Health HMO/PPO |
$177.84
|
| Rate for Payer: Priority Health Medicare |
$51.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.95
|
| Rate for Payer: Railroad Medicare Medicare |
$51.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.88
|
| Rate for Payer: UHC Core |
$170.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.10
|
| Rate for Payer: UHC Exchange |
$51.10
|
| Rate for Payer: UHC Medicare Advantage |
$51.10
|
| Rate for Payer: VA VA |
$51.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.31
|
|
|
HC VASCLAR EMBO OR OCCLUS DIALYSIS CIRCUIT W IMAGING
|
Facility
|
IP
|
$204.41
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
36100533
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.87 |
| Max. Negotiated Rate |
$183.97 |
| Rate for Payer: Aetna Commercial |
$173.75
|
| Rate for Payer: BCBS Trust/PPO |
$166.86
|
| Rate for Payer: BCN Commercial |
$157.97
|
| Rate for Payer: Cash Price |
$163.53
|
| Rate for Payer: Cofinity Commercial |
$175.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.53
|
| Rate for Payer: Healthscope Commercial |
$183.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.75
|
| Rate for Payer: Nomi Health Commercial |
$167.62
|
| Rate for Payer: PHP Commercial |
$173.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.87
|
| Rate for Payer: Priority Health HMO/PPO |
$177.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.88
|
| Rate for Payer: UHC Core |
$170.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.31
|
|
|
HC VASCULAR EMBOL/OCCLU W PRESSURE GEN CATH
|
Facility
|
OP
|
$33,420.00
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
36100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,937.25 |
| Max. Negotiated Rate |
$30,078.00 |
| Rate for Payer: Aetna Commercial |
$28,407.00
|
| Rate for Payer: Aetna Medicare |
$8,689.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,443.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,443.75
|
| Rate for Payer: BCBS Complete |
$13,357.09
|
| Rate for Payer: BCBS MAPPO |
$8,355.00
|
| Rate for Payer: BCBS Trust/PPO |
$27,474.58
|
| Rate for Payer: BCN Commercial |
$25,984.05
|
| Rate for Payer: BCN Medicare Advantage |
$8,355.00
|
| Rate for Payer: Cash Price |
$26,736.00
|
| Rate for Payer: Cash Price |
$26,736.00
|
| Rate for Payer: Cofinity Commercial |
$28,741.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,736.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,355.00
|
| Rate for Payer: Healthscope Commercial |
$30,078.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25,065.00
|
| Rate for Payer: Mclaren Medicaid |
$12,720.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,772.75
|
| Rate for Payer: Meridian Medicaid |
$13,357.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,608.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,407.00
|
| Rate for Payer: Nomi Health Commercial |
$27,404.40
|
| Rate for Payer: PACE Senior Care Partners |
$7,937.25
|
| Rate for Payer: PACE SWMI |
$8,355.00
|
| Rate for Payer: PHP Commercial |
$28,407.00
|
| Rate for Payer: PHP Medicare Advantage |
$8,355.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,720.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,723.00
|
| Rate for Payer: Priority Health HMO/PPO |
$29,075.40
|
| Rate for Payer: Priority Health Medicare |
$8,438.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22,391.40
|
| Rate for Payer: Railroad Medicare Medicare |
$8,355.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,409.60
|
| Rate for Payer: UHC Core |
$27,905.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,355.00
|
| Rate for Payer: UHC Exchange |
$8,355.00
|
| Rate for Payer: UHC Medicare Advantage |
$8,355.00
|
| Rate for Payer: UHCCP Medicaid |
$12,720.20
|
| Rate for Payer: VA VA |
$8,355.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25,065.00
|
|
|
HC VASCULAR EMBOL/OCCLU W PRESSURE GEN CATH
|
Facility
|
IP
|
$33,420.00
|
|
|
Service Code
|
CPT C9797
|
| Hospital Charge Code |
36100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21,723.00 |
| Max. Negotiated Rate |
$30,078.00 |
| Rate for Payer: Aetna Commercial |
$28,407.00
|
| Rate for Payer: BCBS Trust/PPO |
$27,280.75
|
| Rate for Payer: BCN Commercial |
$25,826.98
|
| Rate for Payer: Cash Price |
$26,736.00
|
| Rate for Payer: Cofinity Commercial |
$28,741.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,736.00
|
| Rate for Payer: Healthscope Commercial |
$30,078.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25,065.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,407.00
|
| Rate for Payer: Nomi Health Commercial |
$27,404.40
|
| Rate for Payer: PHP Commercial |
$28,407.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,723.00
|
| Rate for Payer: Priority Health HMO/PPO |
$29,075.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22,391.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,409.60
|
| Rate for Payer: UHC Core |
$27,905.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25,065.00
|
|
|
HC VASCULAR GRAFT
|
Facility
|
IP
|
$2,314.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27800033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,504.36 |
| Max. Negotiated Rate |
$2,082.96 |
| Rate for Payer: Aetna Commercial |
$1,967.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,889.24
|
| Rate for Payer: BCN Commercial |
$1,788.57
|
| Rate for Payer: Cash Price |
$1,851.52
|
| Rate for Payer: Cofinity Commercial |
$1,990.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,851.52
|
| Rate for Payer: Healthscope Commercial |
$2,082.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,735.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,967.24
|
| Rate for Payer: Nomi Health Commercial |
$1,897.81
|
| Rate for Payer: PHP Commercial |
$1,967.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,504.36
|
| Rate for Payer: Priority Health HMO/PPO |
$2,013.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,550.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,036.67
|
| Rate for Payer: UHC Core |
$1,932.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,735.80
|
|
|
HC VASCULAR GRAFT
|
Facility
|
OP
|
$2,314.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27800033
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.67 |
| Max. Negotiated Rate |
$2,082.96 |
| Rate for Payer: Aetna Commercial |
$1,967.24
|
| Rate for Payer: Aetna Medicare |
$601.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$723.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$723.25
|
| Rate for Payer: BCBS Complete |
$925.76
|
| Rate for Payer: BCBS MAPPO |
$578.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,902.67
|
| Rate for Payer: BCN Commercial |
$1,799.45
|
| Rate for Payer: BCN Medicare Advantage |
$578.60
|
| Rate for Payer: Cash Price |
$1,851.52
|
| Rate for Payer: Cofinity Commercial |
$1,990.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,851.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$578.60
|
| Rate for Payer: Healthscope Commercial |
$2,082.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,735.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$607.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$665.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,967.24
|
| Rate for Payer: Nomi Health Commercial |
$1,897.81
|
| Rate for Payer: PACE Senior Care Partners |
$549.67
|
| Rate for Payer: PACE SWMI |
$578.60
|
| Rate for Payer: PHP Commercial |
$1,967.24
|
| Rate for Payer: PHP Medicare Advantage |
$578.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,504.36
|
| Rate for Payer: Priority Health HMO/PPO |
$2,013.53
|
| Rate for Payer: Priority Health Medicare |
$584.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,550.65
|
| Rate for Payer: Railroad Medicare Medicare |
$578.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,036.67
|
| Rate for Payer: UHC Core |
$1,932.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$578.60
|
| Rate for Payer: UHC Exchange |
$578.60
|
| Rate for Payer: UHC Medicare Advantage |
$578.60
|
| Rate for Payer: VA VA |
$578.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,735.80
|
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
OP
|
$84.27
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
30100456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.01 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$21.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.33
|
| Rate for Payer: BCBS Complete |
$26.82
|
| Rate for Payer: BCBS MAPPO |
$21.07
|
| Rate for Payer: BCBS Trust/PPO |
$69.28
|
| Rate for Payer: BCN Commercial |
$65.52
|
| Rate for Payer: BCN Medicare Advantage |
$21.07
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.07
|
| Rate for Payer: Healthscope Commercial |
$75.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.20
|
| Rate for Payer: Mclaren Medicaid |
$25.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.12
|
| Rate for Payer: Meridian Medicaid |
$26.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: PACE Senior Care Partners |
$20.01
|
| Rate for Payer: PACE SWMI |
$21.07
|
| Rate for Payer: PHP Commercial |
$71.63
|
| Rate for Payer: PHP Medicare Advantage |
$21.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: Priority Health HMO/PPO |
$73.31
|
| Rate for Payer: Priority Health Medicare |
$21.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.46
|
| Rate for Payer: Railroad Medicare Medicare |
$21.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.16
|
| Rate for Payer: UHC Core |
$70.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.07
|
| Rate for Payer: UHC Exchange |
$21.07
|
| Rate for Payer: UHC Medicare Advantage |
$21.07
|
| Rate for Payer: UHCCP Medicaid |
$25.54
|
| Rate for Payer: VA VA |
$21.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.20
|
|
|
HC VASOACTIVE INTESTINAL PEPTIDE/VIP
|
Facility
|
IP
|
$84.27
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
30100456
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: BCBS Trust/PPO |
$68.79
|
| Rate for Payer: BCN Commercial |
$65.12
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Healthscope Commercial |
$75.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: PHP Commercial |
$71.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: Priority Health HMO/PPO |
$73.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.16
|
| Rate for Payer: UHC Core |
$70.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.20
|
|
|
HC VASOPNEUMATIC TREATMENT
|
Facility
|
OP
|
$74.91
|
|
|
Service Code
|
CPT 97016
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.79 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$19.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.41
|
| Rate for Payer: BCBS Complete |
$29.96
|
| Rate for Payer: BCBS MAPPO |
$18.73
|
| Rate for Payer: BCBS Trust/PPO |
$61.58
|
| Rate for Payer: BCN Commercial |
$58.24
|
| Rate for Payer: BCN Medicare Advantage |
$18.73
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.73
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Nomi Health Commercial |
$61.43
|
| Rate for Payer: PACE Senior Care Partners |
$17.79
|
| Rate for Payer: PACE SWMI |
$18.73
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: PHP Medicare Advantage |
$18.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.69
|
| Rate for Payer: Priority Health HMO/PPO |
$65.17
|
| Rate for Payer: Priority Health Medicare |
$18.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.19
|
| Rate for Payer: Railroad Medicare Medicare |
$18.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.92
|
| Rate for Payer: UHC Core |
$62.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.73
|
| Rate for Payer: UHC Exchange |
$18.73
|
| Rate for Payer: UHC Medicare Advantage |
$18.73
|
| Rate for Payer: VA VA |
$18.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.18
|
|
