|
HC ATHERECTOMY RENAL ARTERY
|
Facility
|
OP
|
$12,970.49
|
|
|
Service Code
|
CPT 0234T
|
| Hospital Charge Code |
36100304
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,080.49 |
| Max. Negotiated Rate |
$11,673.44 |
| Rate for Payer: Aetna Commercial |
$11,024.92
|
| Rate for Payer: Aetna Medicare |
$3,372.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,053.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,053.28
|
| Rate for Payer: BCBS Complete |
$8,435.67
|
| Rate for Payer: BCBS MAPPO |
$3,242.62
|
| Rate for Payer: BCBS Trust/PPO |
$10,663.04
|
| Rate for Payer: BCN Commercial |
$10,084.56
|
| Rate for Payer: BCN Medicare Advantage |
$3,242.62
|
| Rate for Payer: Cash Price |
$10,376.39
|
| Rate for Payer: Cash Price |
$10,376.39
|
| Rate for Payer: Cofinity Commercial |
$11,154.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,376.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,242.62
|
| Rate for Payer: Healthscope Commercial |
$11,673.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,727.87
|
| Rate for Payer: Mclaren Medicaid |
$8,033.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,404.75
|
| Rate for Payer: Meridian Medicaid |
$8,435.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,729.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,024.92
|
| Rate for Payer: Nomi Health Commercial |
$10,635.80
|
| Rate for Payer: PACE Senior Care Partners |
$3,080.49
|
| Rate for Payer: PACE SWMI |
$3,242.62
|
| Rate for Payer: PHP Commercial |
$11,024.92
|
| Rate for Payer: PHP Medicare Advantage |
$3,242.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,033.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,430.82
|
| Rate for Payer: Priority Health HMO/PPO |
$11,284.33
|
| Rate for Payer: Priority Health Medicare |
$3,275.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,690.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3,242.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,414.03
|
| Rate for Payer: UHC Core |
$10,830.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,242.62
|
| Rate for Payer: UHC Exchange |
$3,242.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,242.62
|
| Rate for Payer: UHCCP Medicaid |
$8,033.44
|
| Rate for Payer: VA VA |
$3,242.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,727.87
|
|
|
HC ATHERECT VISCERAL EACH VESS
|
Facility
|
IP
|
$12,970.49
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
36100303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,430.82 |
| Max. Negotiated Rate |
$11,673.44 |
| Rate for Payer: Aetna Commercial |
$11,024.92
|
| Rate for Payer: BCBS Trust/PPO |
$10,587.81
|
| Rate for Payer: BCN Commercial |
$10,023.59
|
| Rate for Payer: Cash Price |
$10,376.39
|
| Rate for Payer: Cofinity Commercial |
$11,154.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,376.39
|
| Rate for Payer: Healthscope Commercial |
$11,673.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,727.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,024.92
|
| Rate for Payer: Nomi Health Commercial |
$10,635.80
|
| Rate for Payer: PHP Commercial |
$11,024.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,430.82
|
| Rate for Payer: Priority Health HMO/PPO |
$11,284.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,690.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,414.03
|
| Rate for Payer: UHC Core |
$10,830.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,727.87
|
|
|
HC ATHERECT VISCERAL EACH VESS
|
Facility
|
OP
|
$12,970.49
|
|
|
Service Code
|
CPT 0235T
|
| Hospital Charge Code |
36100303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,080.49 |
| Max. Negotiated Rate |
$11,673.44 |
| Rate for Payer: Aetna Commercial |
$11,024.92
|
| Rate for Payer: Aetna Medicare |
$3,372.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,053.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,053.28
|
| Rate for Payer: BCBS Complete |
$5,188.20
|
| Rate for Payer: BCBS MAPPO |
$3,242.62
|
| Rate for Payer: BCBS Trust/PPO |
$10,663.04
|
| Rate for Payer: BCN Commercial |
$10,084.56
|
| Rate for Payer: BCN Medicare Advantage |
$3,242.62
|
| Rate for Payer: Cash Price |
$10,376.39
|
| Rate for Payer: Cofinity Commercial |
$11,154.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,376.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,242.62
|
| Rate for Payer: Healthscope Commercial |
$11,673.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,727.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,404.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,729.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,024.92
|
| Rate for Payer: Nomi Health Commercial |
$10,635.80
|
| Rate for Payer: PACE Senior Care Partners |
$3,080.49
|
| Rate for Payer: PACE SWMI |
$3,242.62
|
| Rate for Payer: PHP Commercial |
$11,024.92
|
| Rate for Payer: PHP Medicare Advantage |
$3,242.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,430.82
|
| Rate for Payer: Priority Health HMO/PPO |
$11,284.33
|
| Rate for Payer: Priority Health Medicare |
$3,275.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,690.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3,242.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,414.03
|
| Rate for Payer: UHC Core |
$10,830.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,242.62
|
| Rate for Payer: UHC Exchange |
$3,242.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,242.62
|
| Rate for Payer: VA VA |
$3,242.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,727.87
|
|
|
HC ATS NON OPEN HEART
|
Facility
|
IP
|
$2,250.45
|
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,462.79 |
| Max. Negotiated Rate |
$2,025.40 |
| Rate for Payer: Aetna Commercial |
$1,912.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,837.04
|
| Rate for Payer: BCN Commercial |
$1,739.15
|
| Rate for Payer: Cash Price |
$1,800.36
|
| Rate for Payer: Cofinity Commercial |
$1,935.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.36
|
| Rate for Payer: Healthscope Commercial |
$2,025.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,687.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.88
|
| Rate for Payer: Nomi Health Commercial |
$1,845.37
|
| Rate for Payer: PHP Commercial |
$1,912.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,462.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,957.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,507.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,980.40
|
| Rate for Payer: UHC Core |
$1,879.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,687.84
|
|
|
HC ATS NON OPEN HEART
|
Facility
|
OP
|
$2,250.45
|
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$534.48 |
| Max. Negotiated Rate |
$2,025.40 |
| Rate for Payer: Aetna Commercial |
$1,912.88
|
| Rate for Payer: Aetna Medicare |
$585.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$703.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$703.27
|
| Rate for Payer: BCBS Complete |
$900.18
|
| Rate for Payer: BCBS MAPPO |
$562.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,850.09
|
| Rate for Payer: BCN Commercial |
$1,749.72
|
| Rate for Payer: BCN Medicare Advantage |
$562.61
|
| Rate for Payer: Cash Price |
$1,800.36
|
| Rate for Payer: Cofinity Commercial |
$1,935.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$562.61
|
| Rate for Payer: Healthscope Commercial |
$2,025.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,687.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$590.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$647.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,912.88
|
| Rate for Payer: Nomi Health Commercial |
$1,845.37
|
| Rate for Payer: PACE Senior Care Partners |
$534.48
|
| Rate for Payer: PACE SWMI |
$562.61
|
| Rate for Payer: PHP Commercial |
$1,912.88
|
| Rate for Payer: PHP Medicare Advantage |
$562.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,462.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,957.89
|
| Rate for Payer: Priority Health Medicare |
$568.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,507.80
|
| Rate for Payer: Railroad Medicare Medicare |
$562.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,980.40
|
| Rate for Payer: UHC Core |
$1,879.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$562.61
|
| Rate for Payer: UHC Exchange |
$562.61
|
| Rate for Payer: UHC Medicare Advantage |
$562.61
|
| Rate for Payer: VA VA |
$562.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,687.84
|
|
|
HC ATS STAND BY HR
|
Facility
|
IP
|
$1,537.13
|
|
| Hospital Charge Code |
27000089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$999.13 |
| Max. Negotiated Rate |
$1,383.42 |
| Rate for Payer: Aetna Commercial |
$1,306.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,254.76
|
| Rate for Payer: BCN Commercial |
$1,187.89
|
| Rate for Payer: Cash Price |
$1,229.70
|
| Rate for Payer: Cofinity Commercial |
$1,321.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.70
|
| Rate for Payer: Healthscope Commercial |
$1,383.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,152.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.56
|
| Rate for Payer: Nomi Health Commercial |
$1,260.45
|
| Rate for Payer: PHP Commercial |
$1,306.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,337.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,029.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,352.67
|
| Rate for Payer: UHC Core |
$1,283.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,152.85
|
|
|
HC ATS STAND BY HR
|
Facility
|
OP
|
$1,537.13
|
|
| Hospital Charge Code |
27000089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$365.07 |
| Max. Negotiated Rate |
$1,383.42 |
| Rate for Payer: Aetna Commercial |
$1,306.56
|
| Rate for Payer: Aetna Medicare |
$399.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$480.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$480.35
|
| Rate for Payer: BCBS Complete |
$614.85
|
| Rate for Payer: BCBS MAPPO |
$384.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.67
|
| Rate for Payer: BCN Commercial |
$1,195.12
|
| Rate for Payer: BCN Medicare Advantage |
$384.28
|
| Rate for Payer: Cash Price |
$1,229.70
|
| Rate for Payer: Cofinity Commercial |
$1,321.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,229.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.28
|
| Rate for Payer: Healthscope Commercial |
$1,383.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,152.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$441.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.56
|
| Rate for Payer: Nomi Health Commercial |
$1,260.45
|
| Rate for Payer: PACE Senior Care Partners |
$365.07
|
| Rate for Payer: PACE SWMI |
$384.28
|
| Rate for Payer: PHP Commercial |
$1,306.56
|
| Rate for Payer: PHP Medicare Advantage |
$384.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,337.30
|
| Rate for Payer: Priority Health Medicare |
$388.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,029.88
|
| Rate for Payer: Railroad Medicare Medicare |
$384.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,352.67
|
| Rate for Payer: UHC Core |
$1,283.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$384.28
|
| Rate for Payer: UHC Exchange |
$384.28
|
| Rate for Payer: UHC Medicare Advantage |
$384.28
|
| Rate for Payer: VA VA |
$384.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,152.85
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.88
|
| Rate for Payer: BCBS Complete |
$8.97
|
| Rate for Payer: BCBS MAPPO |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$12.83
|
| Rate for Payer: BCN Commercial |
$12.14
|
| Rate for Payer: BCN Medicare Advantage |
$3.90
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Mclaren Medicaid |
$8.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.10
|
| Rate for Payer: Meridian Medicaid |
$8.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PACE Senior Care Partners |
$3.71
|
| Rate for Payer: PACE SWMI |
$3.90
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: PHP Medicare Advantage |
$3.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Medicare |
$3.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.90
|
| Rate for Payer: UHC Exchange |
$3.90
|
| Rate for Payer: UHC Medicare Advantage |
$3.90
|
| Rate for Payer: UHCCP Medicaid |
$8.55
|
| Rate for Payer: VA VA |
$3.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$12.74
|
| Rate for Payer: BCN Commercial |
$12.06
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM IGM
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
30200243
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$12.74
|
| Rate for Payer: BCN Commercial |
$12.06
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM IGM
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
30200243
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.88
|
| Rate for Payer: BCBS Complete |
$9.63
|
| Rate for Payer: BCBS MAPPO |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$12.83
|
| Rate for Payer: BCN Commercial |
$12.14
|
| Rate for Payer: BCN Medicare Advantage |
$3.90
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Mclaren Medicaid |
$9.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.10
|
| Rate for Payer: Meridian Medicaid |
$9.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PACE Senior Care Partners |
$3.71
|
| Rate for Payer: PACE SWMI |
$3.90
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: PHP Medicare Advantage |
$3.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Medicare |
$3.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.90
|
| Rate for Payer: UHC Exchange |
$3.90
|
| Rate for Payer: UHC Medicare Advantage |
$3.90
|
| Rate for Payer: UHCCP Medicaid |
$9.17
|
| Rate for Payer: VA VA |
$3.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
|
HC ATYPICAL PNEUMO EVAL L PNEUM
|
Facility
|
OP
|
$21.85
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna Medicare |
$5.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.83
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS MAPPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: BCN Medicare Advantage |
$5.46
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.39
|
| Rate for Payer: Mclaren Medicaid |
$11.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.74
|
| Rate for Payer: Meridian Medicaid |
$11.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$17.92
|
| Rate for Payer: PACE Senior Care Partners |
$5.19
|
| Rate for Payer: PACE SWMI |
$5.46
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: PHP Medicare Advantage |
$5.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health HMO/PPO |
$19.01
|
| Rate for Payer: Priority Health Medicare |
$5.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.64
|
| Rate for Payer: Railroad Medicare Medicare |
$5.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.23
|
| Rate for Payer: UHC Core |
$18.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.46
|
| Rate for Payer: UHC Exchange |
$5.46
|
| Rate for Payer: UHC Medicare Advantage |
$5.46
|
| Rate for Payer: UHCCP Medicaid |
$11.06
|
| Rate for Payer: VA VA |
$5.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.39
|
|
|
HC ATYPICAL PNEUMO EVAL L PNEUM
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: BCBS Trust/PPO |
$17.84
|
| Rate for Payer: BCN Commercial |
$16.89
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$17.92
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health HMO/PPO |
$19.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.23
|
| Rate for Payer: UHC Core |
$18.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.39
|
|
|
HC ATYPICAL PNEUMO EVAL M PNEUM
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.55
|
| Rate for Payer: BCBS Complete |
$10.05
|
| Rate for Payer: BCBS MAPPO |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.98
|
| Rate for Payer: BCN Commercial |
$11.33
|
| Rate for Payer: BCN Medicare Advantage |
$3.64
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Mclaren Medicaid |
$9.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.82
|
| Rate for Payer: Meridian Medicaid |
$10.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PACE Senior Care Partners |
$3.46
|
| Rate for Payer: PACE SWMI |
$3.64
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: PHP Medicare Advantage |
$3.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.68
|
| Rate for Payer: Priority Health Medicare |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: Railroad Medicare Medicare |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$12.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.64
|
| Rate for Payer: UHC Exchange |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.64
|
| Rate for Payer: UHCCP Medicaid |
$9.57
|
| Rate for Payer: VA VA |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC ATYPICAL PNEUMO EVAL M PNEUM
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$11.89
|
| Rate for Payer: BCN Commercial |
$11.26
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC ATYPICAL PNEUMO EVALUATION
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200241
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.88
|
| Rate for Payer: BCBS Complete |
$8.97
|
| Rate for Payer: BCBS MAPPO |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$12.83
|
| Rate for Payer: BCN Commercial |
$12.14
|
| Rate for Payer: BCN Medicare Advantage |
$3.90
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Mclaren Medicaid |
$8.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.10
|
| Rate for Payer: Meridian Medicaid |
$8.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PACE Senior Care Partners |
$3.71
|
| Rate for Payer: PACE SWMI |
$3.90
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: PHP Medicare Advantage |
$3.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Medicare |
$3.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.90
|
| Rate for Payer: UHC Exchange |
$3.90
|
| Rate for Payer: UHC Medicare Advantage |
$3.90
|
| Rate for Payer: UHCCP Medicaid |
$8.55
|
| Rate for Payer: VA VA |
$3.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
|
HC ATYPICAL PNEUMO EVALUATION
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200241
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$12.74
|
| Rate for Payer: BCN Commercial |
$12.06
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
IP
|
$212.17
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$137.91 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: BCBS Trust/PPO |
$173.19
|
| Rate for Payer: BCN Commercial |
$163.96
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$182.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Healthscope Commercial |
$190.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health HMO/PPO |
$184.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.71
|
| Rate for Payer: UHC Core |
$177.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.13
|
|
|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
OP
|
$212.17
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: Aetna Medicare |
$55.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.30
|
| Rate for Payer: BCBS Complete |
$116.39
|
| Rate for Payer: BCBS MAPPO |
$53.04
|
| Rate for Payer: BCBS Trust/PPO |
$174.42
|
| Rate for Payer: BCN Commercial |
$164.96
|
| Rate for Payer: BCN Medicare Advantage |
$53.04
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$182.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$190.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.13
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.69
|
| Rate for Payer: Meridian Medicaid |
$116.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: PACE Senior Care Partners |
$50.39
|
| Rate for Payer: PACE SWMI |
$53.04
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: PHP Medicare Advantage |
$53.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health HMO/PPO |
$184.59
|
| Rate for Payer: Priority Health Medicare |
$53.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.15
|
| Rate for Payer: Railroad Medicare Medicare |
$53.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.71
|
| Rate for Payer: UHC Core |
$177.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.04
|
| Rate for Payer: UHC Exchange |
$53.04
|
| Rate for Payer: UHC Medicare Advantage |
$53.04
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$53.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.13
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
IP
|
$256.13
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$166.48 |
| Max. Negotiated Rate |
$230.52 |
| Rate for Payer: Aetna Commercial |
$217.71
|
| Rate for Payer: BCBS Trust/PPO |
$209.08
|
| Rate for Payer: BCN Commercial |
$197.94
|
| Rate for Payer: Cash Price |
$204.90
|
| Rate for Payer: Cofinity Commercial |
$220.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.90
|
| Rate for Payer: Healthscope Commercial |
$230.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.71
|
| Rate for Payer: Nomi Health Commercial |
$210.03
|
| Rate for Payer: PHP Commercial |
$217.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.48
|
| Rate for Payer: Priority Health HMO/PPO |
$222.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.39
|
| Rate for Payer: UHC Core |
$213.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.10
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
OP
|
$256.13
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$60.83 |
| Max. Negotiated Rate |
$230.52 |
| Rate for Payer: Aetna Commercial |
$217.71
|
| Rate for Payer: Aetna Medicare |
$66.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.04
|
| Rate for Payer: BCBS Complete |
$102.45
|
| Rate for Payer: BCBS MAPPO |
$64.03
|
| Rate for Payer: BCBS Trust/PPO |
$210.56
|
| Rate for Payer: BCN Commercial |
$199.14
|
| Rate for Payer: BCN Medicare Advantage |
$64.03
|
| Rate for Payer: Cash Price |
$204.90
|
| Rate for Payer: Cofinity Commercial |
$220.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.03
|
| Rate for Payer: Healthscope Commercial |
$230.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.71
|
| Rate for Payer: Nomi Health Commercial |
$210.03
|
| Rate for Payer: PACE Senior Care Partners |
$60.83
|
| Rate for Payer: PACE SWMI |
$64.03
|
| Rate for Payer: PHP Commercial |
$217.71
|
| Rate for Payer: PHP Medicare Advantage |
$64.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.48
|
| Rate for Payer: Priority Health HMO/PPO |
$222.83
|
| Rate for Payer: Priority Health Medicare |
$64.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.61
|
| Rate for Payer: Railroad Medicare Medicare |
$64.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.39
|
| Rate for Payer: UHC Core |
$213.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.03
|
| Rate for Payer: UHC Exchange |
$64.03
|
| Rate for Payer: UHC Medicare Advantage |
$64.03
|
| Rate for Payer: VA VA |
$64.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.10
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
OP
|
$687.84
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$163.36 |
| Max. Negotiated Rate |
$619.06 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: Aetna Medicare |
$178.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.95
|
| Rate for Payer: BCBS Complete |
$231.63
|
| Rate for Payer: BCBS MAPPO |
$171.96
|
| Rate for Payer: BCBS Trust/PPO |
$565.47
|
| Rate for Payer: BCN Commercial |
$534.80
|
| Rate for Payer: BCN Medicare Advantage |
$171.96
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$591.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.96
|
| Rate for Payer: Healthscope Commercial |
$619.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.88
|
| Rate for Payer: Mclaren Medicaid |
$220.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.56
|
| Rate for Payer: Meridian Medicaid |
$231.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Nomi Health Commercial |
$564.03
|
| Rate for Payer: PACE Senior Care Partners |
$163.36
|
| Rate for Payer: PACE SWMI |
$171.96
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: PHP Medicare Advantage |
$171.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health HMO/PPO |
$598.42
|
| Rate for Payer: Priority Health Medicare |
$173.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$460.85
|
| Rate for Payer: Railroad Medicare Medicare |
$171.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.30
|
| Rate for Payer: UHC Core |
$574.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.96
|
| Rate for Payer: UHC Exchange |
$171.96
|
| Rate for Payer: UHC Medicare Advantage |
$171.96
|
| Rate for Payer: UHCCP Medicaid |
$220.59
|
| Rate for Payer: VA VA |
$171.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.88
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
IP
|
$687.84
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$447.10 |
| Max. Negotiated Rate |
$619.06 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: BCBS Trust/PPO |
$561.48
|
| Rate for Payer: BCN Commercial |
$531.56
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$591.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Healthscope Commercial |
$619.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Nomi Health Commercial |
$564.03
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health HMO/PPO |
$598.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$460.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.30
|
| Rate for Payer: UHC Core |
$574.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.88
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
IP
|
$687.84
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$447.10 |
| Max. Negotiated Rate |
$619.06 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: BCBS Trust/PPO |
$561.48
|
| Rate for Payer: BCN Commercial |
$531.56
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$591.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Healthscope Commercial |
$619.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Nomi Health Commercial |
$564.03
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health HMO/PPO |
$598.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$460.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.30
|
| Rate for Payer: UHC Core |
$574.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.88
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
OP
|
$687.84
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$163.36 |
| Max. Negotiated Rate |
$619.06 |
| Rate for Payer: Aetna Commercial |
$584.66
|
| Rate for Payer: Aetna Medicare |
$178.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.95
|
| Rate for Payer: BCBS Complete |
$231.63
|
| Rate for Payer: BCBS MAPPO |
$171.96
|
| Rate for Payer: BCBS Trust/PPO |
$565.47
|
| Rate for Payer: BCN Commercial |
$534.80
|
| Rate for Payer: BCN Medicare Advantage |
$171.96
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cash Price |
$550.27
|
| Rate for Payer: Cofinity Commercial |
$591.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.96
|
| Rate for Payer: Healthscope Commercial |
$619.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.88
|
| Rate for Payer: Mclaren Medicaid |
$220.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.56
|
| Rate for Payer: Meridian Medicaid |
$231.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$584.66
|
| Rate for Payer: Nomi Health Commercial |
$564.03
|
| Rate for Payer: PACE Senior Care Partners |
$163.36
|
| Rate for Payer: PACE SWMI |
$171.96
|
| Rate for Payer: PHP Commercial |
$584.66
|
| Rate for Payer: PHP Medicare Advantage |
$171.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.10
|
| Rate for Payer: Priority Health HMO/PPO |
$598.42
|
| Rate for Payer: Priority Health Medicare |
$173.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$460.85
|
| Rate for Payer: Railroad Medicare Medicare |
$171.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.30
|
| Rate for Payer: UHC Core |
$574.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.96
|
| Rate for Payer: UHC Exchange |
$171.96
|
| Rate for Payer: UHC Medicare Advantage |
$171.96
|
| Rate for Payer: UHCCP Medicaid |
$220.59
|
| Rate for Payer: VA VA |
$171.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.88
|
|
