|
HC ETHYLENE GLYCOL
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 82693
|
| Hospital Charge Code |
30100197
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna Medicare |
$41.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.31
|
| Rate for Payer: BCBS Complete |
$11.55
|
| Rate for Payer: BCBS MAPPO |
$40.25
|
| Rate for Payer: BCBS Trust/PPO |
$125.18
|
| Rate for Payer: BCN Commercial |
$125.18
|
| Rate for Payer: BCN Medicare Advantage |
$40.25
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.25
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.75
|
| Rate for Payer: Mclaren Medicaid |
$11.00
|
| Rate for Payer: Meridian Medicaid |
$11.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.85
|
| Rate for Payer: PACE Senior Care Partners |
$38.24
|
| Rate for Payer: PACE SWMI |
$40.25
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: PHP Medicare Advantage |
$40.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.07
|
| Rate for Payer: Priority Health Medicare |
$40.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.19
|
| Rate for Payer: Railroad Medicare Medicare |
$40.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.68
|
| Rate for Payer: UHC Core |
$134.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.25
|
| Rate for Payer: UHC Medicare Advantage |
$41.46
|
| Rate for Payer: VA VA |
$40.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.75
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
OP
|
$125.90
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$113.31 |
| Rate for Payer: Aetna Commercial |
$107.02
|
| Rate for Payer: Aetna Medicare |
$32.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.34
|
| Rate for Payer: BCBS Complete |
$48.15
|
| Rate for Payer: BCBS MAPPO |
$31.48
|
| Rate for Payer: BCBS Trust/PPO |
$97.89
|
| Rate for Payer: BCN Commercial |
$97.89
|
| Rate for Payer: BCN Medicare Advantage |
$31.48
|
| Rate for Payer: Cash Price |
$100.72
|
| Rate for Payer: Cash Price |
$100.72
|
| Rate for Payer: Cofinity Commercial |
$108.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.48
|
| Rate for Payer: Healthscope Commercial |
$113.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.42
|
| Rate for Payer: Mclaren Medicaid |
$45.86
|
| Rate for Payer: Meridian Medicaid |
$48.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.02
|
| Rate for Payer: PACE Senior Care Partners |
$29.90
|
| Rate for Payer: PACE SWMI |
$31.48
|
| Rate for Payer: PHP Commercial |
$107.02
|
| Rate for Payer: PHP Medicare Advantage |
$31.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.53
|
| Rate for Payer: Priority Health Medicare |
$31.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.79
|
| Rate for Payer: Railroad Medicare Medicare |
$31.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.79
|
| Rate for Payer: UHC Core |
$105.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.48
|
| Rate for Payer: UHC Medicare Advantage |
$32.42
|
| Rate for Payer: VA VA |
$31.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.42
|
|
|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
IP
|
$125.90
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.79 |
| Max. Negotiated Rate |
$113.31 |
| Rate for Payer: Aetna Commercial |
$107.02
|
| Rate for Payer: BCBS Trust/PPO |
$97.30
|
| Rate for Payer: BCN Commercial |
$97.30
|
| Rate for Payer: Cash Price |
$100.72
|
| Rate for Payer: Cofinity Commercial |
$108.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.72
|
| Rate for Payer: Healthscope Commercial |
$113.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.02
|
| Rate for Payer: PHP Commercial |
$107.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.79
|
| Rate for Payer: UHC Core |
$105.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.42
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
OP
|
$1,516.09
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$360.07 |
| Max. Negotiated Rate |
$1,364.48 |
| Rate for Payer: Aetna Commercial |
$1,288.68
|
| Rate for Payer: Aetna Medicare |
$394.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$473.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$473.78
|
| Rate for Payer: BCBS Complete |
$606.44
|
| Rate for Payer: BCBS MAPPO |
$379.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,178.76
|
| Rate for Payer: BCN Commercial |
$1,178.76
|
| Rate for Payer: BCN Medicare Advantage |
$379.02
|
| Rate for Payer: Cash Price |
$1,212.87
|
| Rate for Payer: Cofinity Commercial |
$1,303.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,212.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.02
|
| Rate for Payer: Healthscope Commercial |
$1,364.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,137.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$397.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$435.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,288.68
|
| Rate for Payer: PACE Senior Care Partners |
$360.07
|
| Rate for Payer: PACE SWMI |
$379.02
|
| Rate for Payer: PHP Commercial |
$1,288.68
|
| Rate for Payer: PHP Medicare Advantage |
$379.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,319.00
|
| Rate for Payer: Priority Health Medicare |
$379.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$924.66
|
| Rate for Payer: Railroad Medicare Medicare |
$379.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,334.16
|
| Rate for Payer: UHC Core |
$1,265.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.02
|
| Rate for Payer: UHC Medicare Advantage |
$390.39
|
| Rate for Payer: VA VA |
$379.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,137.07
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
IP
|
$1,516.09
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$924.66 |
| Max. Negotiated Rate |
$1,364.48 |
| Rate for Payer: Aetna Commercial |
$1,288.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,171.63
|
| Rate for Payer: BCN Commercial |
$1,171.63
|
| Rate for Payer: Cash Price |
$1,212.87
|
| Rate for Payer: Cofinity Commercial |
$1,303.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,212.87
|
| Rate for Payer: Healthscope Commercial |
$1,364.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,137.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,288.68
|
| Rate for Payer: PHP Commercial |
$1,288.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,319.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$924.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,334.16
|
| Rate for Payer: UHC Core |
$1,265.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,137.07
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
IP
|
$295.09
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.98 |
| Max. Negotiated Rate |
$265.58 |
| Rate for Payer: Aetna Commercial |
$250.83
|
| Rate for Payer: BCBS Trust/PPO |
$228.05
|
| Rate for Payer: BCN Commercial |
$228.05
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cofinity Commercial |
$253.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.07
|
| Rate for Payer: Healthscope Commercial |
$265.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.83
|
| Rate for Payer: PHP Commercial |
$250.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.68
|
| Rate for Payer: UHC Core |
$246.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.32
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
OP
|
$295.09
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$265.58 |
| Rate for Payer: Aetna Commercial |
$250.83
|
| Rate for Payer: Aetna Medicare |
$76.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.22
|
| Rate for Payer: BCBS Complete |
$98.64
|
| Rate for Payer: BCBS MAPPO |
$73.77
|
| Rate for Payer: BCBS Trust/PPO |
$229.43
|
| Rate for Payer: BCN Commercial |
$229.43
|
| Rate for Payer: BCN Medicare Advantage |
$73.77
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cofinity Commercial |
$253.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.77
|
| Rate for Payer: Healthscope Commercial |
$265.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.32
|
| Rate for Payer: Mclaren Medicaid |
$93.95
|
| Rate for Payer: Meridian Medicaid |
$98.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.83
|
| Rate for Payer: PACE Senior Care Partners |
$70.08
|
| Rate for Payer: PACE SWMI |
$73.77
|
| Rate for Payer: PHP Commercial |
$250.83
|
| Rate for Payer: PHP Medicare Advantage |
$73.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.73
|
| Rate for Payer: Priority Health Medicare |
$73.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.98
|
| Rate for Payer: Railroad Medicare Medicare |
$73.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.68
|
| Rate for Payer: UHC Core |
$246.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.77
|
| Rate for Payer: UHC Medicare Advantage |
$75.99
|
| Rate for Payer: VA VA |
$73.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.32
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$90.38
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.12 |
| Max. Negotiated Rate |
$81.34 |
| Rate for Payer: Aetna Commercial |
$76.82
|
| Rate for Payer: BCBS Trust/PPO |
$69.85
|
| Rate for Payer: BCN Commercial |
$69.85
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cofinity Commercial |
$77.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.30
|
| Rate for Payer: Healthscope Commercial |
$81.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.82
|
| Rate for Payer: PHP Commercial |
$76.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.53
|
| Rate for Payer: UHC Core |
$75.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.78
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$90.38
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$87.99 |
| Rate for Payer: Aetna Commercial |
$76.82
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.24
|
| Rate for Payer: BCBS Complete |
$87.99
|
| Rate for Payer: BCBS MAPPO |
$22.60
|
| Rate for Payer: BCBS Trust/PPO |
$70.27
|
| Rate for Payer: BCN Commercial |
$70.27
|
| Rate for Payer: BCN Medicare Advantage |
$22.60
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cofinity Commercial |
$77.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$81.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.78
|
| Rate for Payer: Mclaren Medicaid |
$83.80
|
| Rate for Payer: Meridian Medicaid |
$87.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.82
|
| Rate for Payer: PACE Senior Care Partners |
$21.47
|
| Rate for Payer: PACE SWMI |
$22.60
|
| Rate for Payer: PHP Commercial |
$76.82
|
| Rate for Payer: PHP Medicare Advantage |
$22.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.63
|
| Rate for Payer: Priority Health Medicare |
$22.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.12
|
| Rate for Payer: Railroad Medicare Medicare |
$22.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.53
|
| Rate for Payer: UHC Core |
$75.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.60
|
| Rate for Payer: UHC Medicare Advantage |
$23.27
|
| Rate for Payer: VA VA |
$22.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.78
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
OP
|
$256.60
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$60.94 |
| Max. Negotiated Rate |
$230.94 |
| Rate for Payer: Aetna Commercial |
$218.11
|
| Rate for Payer: Aetna Medicare |
$66.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.19
|
| Rate for Payer: BCBS Complete |
$102.64
|
| Rate for Payer: BCBS MAPPO |
$64.15
|
| Rate for Payer: BCBS Trust/PPO |
$199.51
|
| Rate for Payer: BCN Commercial |
$199.51
|
| Rate for Payer: BCN Medicare Advantage |
$64.15
|
| Rate for Payer: Cash Price |
$205.28
|
| Rate for Payer: Cofinity Commercial |
$220.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.15
|
| Rate for Payer: Healthscope Commercial |
$230.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.11
|
| Rate for Payer: PACE Senior Care Partners |
$60.94
|
| Rate for Payer: PACE SWMI |
$64.15
|
| Rate for Payer: PHP Commercial |
$218.11
|
| Rate for Payer: PHP Medicare Advantage |
$64.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.24
|
| Rate for Payer: Priority Health Medicare |
$64.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.50
|
| Rate for Payer: Railroad Medicare Medicare |
$64.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.81
|
| Rate for Payer: UHC Core |
$214.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.15
|
| Rate for Payer: UHC Medicare Advantage |
$66.07
|
| Rate for Payer: VA VA |
$64.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.45
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
IP
|
$256.60
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$156.50 |
| Max. Negotiated Rate |
$230.94 |
| Rate for Payer: Aetna Commercial |
$218.11
|
| Rate for Payer: BCBS Trust/PPO |
$198.30
|
| Rate for Payer: BCN Commercial |
$198.30
|
| Rate for Payer: Cash Price |
$205.28
|
| Rate for Payer: Cofinity Commercial |
$220.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.28
|
| Rate for Payer: Healthscope Commercial |
$230.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.11
|
| Rate for Payer: PHP Commercial |
$218.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.81
|
| Rate for Payer: UHC Core |
$214.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.45
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: BCBS Trust/PPO |
$30.14
|
| Rate for Payer: BCN Commercial |
$30.14
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.32
|
| Rate for Payer: UHC Core |
$32.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.25
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Commercial |
$33.15
|
| Rate for Payer: Aetna Medicare |
$10.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.19
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$9.75
|
| Rate for Payer: BCBS Trust/PPO |
$30.32
|
| Rate for Payer: BCN Commercial |
$30.32
|
| Rate for Payer: BCN Medicare Advantage |
$9.75
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.75
|
| Rate for Payer: Healthscope Commercial |
$35.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.15
|
| Rate for Payer: PACE Senior Care Partners |
$9.26
|
| Rate for Payer: PACE SWMI |
$9.75
|
| Rate for Payer: PHP Commercial |
$33.15
|
| Rate for Payer: PHP Medicare Advantage |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.93
|
| Rate for Payer: Priority Health Medicare |
$9.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.32
|
| Rate for Payer: UHC Core |
$32.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.75
|
| Rate for Payer: UHC Medicare Advantage |
$10.04
|
| Rate for Payer: VA VA |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.25
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
IP
|
$114.40
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$69.77 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: Aetna Commercial |
$97.24
|
| Rate for Payer: BCBS Trust/PPO |
$88.41
|
| Rate for Payer: BCN Commercial |
$88.41
|
| Rate for Payer: Cash Price |
$91.52
|
| Rate for Payer: Cofinity Commercial |
$98.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.52
|
| Rate for Payer: Healthscope Commercial |
$102.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.24
|
| Rate for Payer: PHP Commercial |
$97.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.67
|
| Rate for Payer: UHC Core |
$95.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.80
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
OP
|
$114.40
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$102.96 |
| Rate for Payer: Aetna Commercial |
$97.24
|
| Rate for Payer: Aetna Medicare |
$29.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.75
|
| Rate for Payer: BCBS Complete |
$45.76
|
| Rate for Payer: BCBS MAPPO |
$28.60
|
| Rate for Payer: BCBS Trust/PPO |
$88.95
|
| Rate for Payer: BCN Commercial |
$88.95
|
| Rate for Payer: BCN Medicare Advantage |
$28.60
|
| Rate for Payer: Cash Price |
$91.52
|
| Rate for Payer: Cofinity Commercial |
$98.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.60
|
| Rate for Payer: Healthscope Commercial |
$102.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.24
|
| Rate for Payer: PACE Senior Care Partners |
$27.17
|
| Rate for Payer: PACE SWMI |
$28.60
|
| Rate for Payer: PHP Commercial |
$97.24
|
| Rate for Payer: PHP Medicare Advantage |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.53
|
| Rate for Payer: Priority Health Medicare |
$28.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.77
|
| Rate for Payer: Railroad Medicare Medicare |
$28.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.67
|
| Rate for Payer: UHC Core |
$95.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.60
|
| Rate for Payer: UHC Medicare Advantage |
$29.46
|
| Rate for Payer: VA VA |
$28.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.80
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
OP
|
$297.02
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$70.54 |
| Max. Negotiated Rate |
$267.32 |
| Rate for Payer: Aetna Commercial |
$252.47
|
| Rate for Payer: Aetna Medicare |
$77.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.82
|
| Rate for Payer: BCBS Complete |
$118.81
|
| Rate for Payer: BCBS MAPPO |
$74.26
|
| Rate for Payer: BCBS Trust/PPO |
$230.93
|
| Rate for Payer: BCN Commercial |
$230.93
|
| Rate for Payer: BCN Medicare Advantage |
$74.26
|
| Rate for Payer: Cash Price |
$237.62
|
| Rate for Payer: Cofinity Commercial |
$255.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.26
|
| Rate for Payer: Healthscope Commercial |
$267.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$252.47
|
| Rate for Payer: PACE Senior Care Partners |
$70.54
|
| Rate for Payer: PACE SWMI |
$74.26
|
| Rate for Payer: PHP Commercial |
$252.47
|
| Rate for Payer: PHP Medicare Advantage |
$74.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.41
|
| Rate for Payer: Priority Health Medicare |
$74.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.15
|
| Rate for Payer: Railroad Medicare Medicare |
$74.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.38
|
| Rate for Payer: UHC Core |
$248.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.26
|
| Rate for Payer: UHC Medicare Advantage |
$76.48
|
| Rate for Payer: VA VA |
$74.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.76
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
IP
|
$297.02
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$181.15 |
| Max. Negotiated Rate |
$267.32 |
| Rate for Payer: Aetna Commercial |
$252.47
|
| Rate for Payer: BCBS Trust/PPO |
$229.54
|
| Rate for Payer: BCN Commercial |
$229.54
|
| Rate for Payer: Cash Price |
$237.62
|
| Rate for Payer: Cofinity Commercial |
$255.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.62
|
| Rate for Payer: Healthscope Commercial |
$267.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$252.47
|
| Rate for Payer: PHP Commercial |
$252.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.38
|
| Rate for Payer: UHC Core |
$248.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.76
|
|
|
HC EVENT MONITOR
|
Facility
|
OP
|
$500.24
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$24.74 |
| Max. Negotiated Rate |
$450.22 |
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: Aetna Medicare |
$130.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.32
|
| Rate for Payer: BCBS Complete |
$25.97
|
| Rate for Payer: BCBS MAPPO |
$125.06
|
| Rate for Payer: BCBS Trust/PPO |
$388.94
|
| Rate for Payer: BCN Commercial |
$388.94
|
| Rate for Payer: BCN Medicare Advantage |
$125.06
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cofinity Commercial |
$430.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.06
|
| Rate for Payer: Healthscope Commercial |
$450.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.18
|
| Rate for Payer: Mclaren Medicaid |
$24.74
|
| Rate for Payer: Meridian Medicaid |
$25.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.20
|
| Rate for Payer: PACE Senior Care Partners |
$118.81
|
| Rate for Payer: PACE SWMI |
$125.06
|
| Rate for Payer: PHP Commercial |
$425.20
|
| Rate for Payer: PHP Medicare Advantage |
$125.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.21
|
| Rate for Payer: Priority Health Medicare |
$125.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.10
|
| Rate for Payer: Railroad Medicare Medicare |
$125.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.21
|
| Rate for Payer: UHC Core |
$417.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.06
|
| Rate for Payer: UHC Medicare Advantage |
$128.81
|
| Rate for Payer: VA VA |
$125.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.18
|
|
|
HC EVENT MONITOR
|
Facility
|
IP
|
$500.24
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$305.10 |
| Max. Negotiated Rate |
$450.22 |
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: BCBS Trust/PPO |
$386.59
|
| Rate for Payer: BCN Commercial |
$386.59
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cofinity Commercial |
$430.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Healthscope Commercial |
$450.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.20
|
| Rate for Payer: PHP Commercial |
$425.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.21
|
| Rate for Payer: UHC Core |
$417.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.18
|
|
|
HC EVEROLIMUS
|
Facility
|
IP
|
$68.34
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
30100626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: BCBS Trust/PPO |
$52.81
|
| Rate for Payer: BCN Commercial |
$52.81
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.09
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.14
|
| Rate for Payer: UHC Core |
$57.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.26
|
|
|
HC EVEROLIMUS
|
Facility
|
OP
|
$68.34
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
30100626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: Aetna Medicare |
$17.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.36
|
| Rate for Payer: BCBS Complete |
$10.64
|
| Rate for Payer: BCBS MAPPO |
$17.08
|
| Rate for Payer: BCBS Trust/PPO |
$53.13
|
| Rate for Payer: BCN Commercial |
$53.13
|
| Rate for Payer: BCN Medicare Advantage |
$17.08
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.08
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.26
|
| Rate for Payer: Mclaren Medicaid |
$10.13
|
| Rate for Payer: Meridian Medicaid |
$10.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.09
|
| Rate for Payer: PACE Senior Care Partners |
$16.23
|
| Rate for Payer: PACE SWMI |
$17.08
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: PHP Medicare Advantage |
$17.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.46
|
| Rate for Payer: Priority Health Medicare |
$17.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.68
|
| Rate for Payer: Railroad Medicare Medicare |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.14
|
| Rate for Payer: UHC Core |
$57.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.08
|
| Rate for Payer: UHC Medicare Advantage |
$17.60
|
| Rate for Payer: VA VA |
$17.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.26
|
|
|
HC EVOKED AUDITORY TEST COMPLETE
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: BCBS Trust/PPO |
$217.16
|
| Rate for Payer: BCN Commercial |
$217.16
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.85
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.28
|
| Rate for Payer: UHC Core |
$234.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.75
|
|
|
HC EVOKED AUDITORY TEST COMPLETE
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: Aetna Medicare |
$73.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.81
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$70.25
|
| Rate for Payer: BCBS Trust/PPO |
$218.48
|
| Rate for Payer: BCN Commercial |
$218.48
|
| Rate for Payer: BCN Medicare Advantage |
$70.25
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.25
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.75
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.85
|
| Rate for Payer: PACE Senior Care Partners |
$66.74
|
| Rate for Payer: PACE SWMI |
$70.25
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: PHP Medicare Advantage |
$70.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.47
|
| Rate for Payer: Priority Health Medicare |
$70.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.38
|
| Rate for Payer: Railroad Medicare Medicare |
$70.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.28
|
| Rate for Payer: UHC Core |
$234.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.25
|
| Rate for Payer: UHC Medicare Advantage |
$72.36
|
| Rate for Payer: VA VA |
$70.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.75
|
|
|
HC EVOKED AUDITORY TEST LIMITED
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$66.74 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: Aetna Medicare |
$73.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.81
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$70.25
|
| Rate for Payer: BCBS Trust/PPO |
$218.48
|
| Rate for Payer: BCN Commercial |
$218.48
|
| Rate for Payer: BCN Medicare Advantage |
$70.25
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.25
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.75
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.85
|
| Rate for Payer: PACE Senior Care Partners |
$66.74
|
| Rate for Payer: PACE SWMI |
$70.25
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: PHP Medicare Advantage |
$70.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.47
|
| Rate for Payer: Priority Health Medicare |
$70.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.38
|
| Rate for Payer: Railroad Medicare Medicare |
$70.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.28
|
| Rate for Payer: UHC Core |
$234.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.25
|
| Rate for Payer: UHC Medicare Advantage |
$72.36
|
| Rate for Payer: VA VA |
$70.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.75
|
|
|
HC EVOKED AUDITORY TEST LIMITED
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 92587
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$252.90 |
| Rate for Payer: Aetna Commercial |
$238.85
|
| Rate for Payer: BCBS Trust/PPO |
$217.16
|
| Rate for Payer: BCN Commercial |
$217.16
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$241.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.80
|
| Rate for Payer: Healthscope Commercial |
$252.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.85
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.28
|
| Rate for Payer: UHC Core |
$234.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.75
|
|
