|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
IP
|
$272.53
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.22 |
| Max. Negotiated Rate |
$245.28 |
| Rate for Payer: Aetna Commercial |
$231.65
|
| Rate for Payer: BCBS Trust/PPO |
$210.61
|
| Rate for Payer: BCN Commercial |
$210.61
|
| Rate for Payer: Cash Price |
$218.02
|
| Rate for Payer: Cofinity Commercial |
$234.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.02
|
| Rate for Payer: Healthscope Commercial |
$245.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.65
|
| Rate for Payer: PHP Commercial |
$231.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.83
|
| Rate for Payer: UHC Core |
$227.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.40
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE
|
Facility
|
IP
|
$2,410.57
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,470.21 |
| Max. Negotiated Rate |
$2,169.51 |
| Rate for Payer: Aetna Commercial |
$2,048.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,862.89
|
| Rate for Payer: BCN Commercial |
$1,862.89
|
| Rate for Payer: Cash Price |
$1,928.46
|
| Rate for Payer: Cofinity Commercial |
$2,073.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,928.46
|
| Rate for Payer: Healthscope Commercial |
$2,169.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,807.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,048.98
|
| Rate for Payer: PHP Commercial |
$2,048.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,687.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,097.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,470.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,121.30
|
| Rate for Payer: UHC Core |
$2,012.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,807.93
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE
|
Facility
|
OP
|
$2,410.57
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.51 |
| Max. Negotiated Rate |
$2,169.51 |
| Rate for Payer: Aetna Commercial |
$2,048.98
|
| Rate for Payer: Aetna Medicare |
$626.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$753.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$753.30
|
| Rate for Payer: BCBS Complete |
$1,256.10
|
| Rate for Payer: BCBS MAPPO |
$602.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,874.22
|
| Rate for Payer: BCN Commercial |
$1,874.22
|
| Rate for Payer: BCN Medicare Advantage |
$602.64
|
| Rate for Payer: Cash Price |
$1,928.46
|
| Rate for Payer: Cash Price |
$1,928.46
|
| Rate for Payer: Cofinity Commercial |
$2,073.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,928.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.64
|
| Rate for Payer: Healthscope Commercial |
$2,169.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,807.93
|
| Rate for Payer: Mclaren Medicaid |
$1,196.28
|
| Rate for Payer: Meridian Medicaid |
$1,256.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$632.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$693.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,048.98
|
| Rate for Payer: PACE Senior Care Partners |
$572.51
|
| Rate for Payer: PACE SWMI |
$602.64
|
| Rate for Payer: PHP Commercial |
$2,048.98
|
| Rate for Payer: PHP Medicare Advantage |
$602.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,687.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,097.20
|
| Rate for Payer: Priority Health Medicare |
$602.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,470.21
|
| Rate for Payer: Railroad Medicare Medicare |
$602.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,121.30
|
| Rate for Payer: UHC Core |
$2,012.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.64
|
| Rate for Payer: UHC Medicare Advantage |
$620.72
|
| Rate for Payer: VA VA |
$602.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,807.93
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK
|
Facility
|
IP
|
$3,156.22
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,924.98 |
| Max. Negotiated Rate |
$2,840.60 |
| Rate for Payer: Aetna Commercial |
$2,682.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,439.13
|
| Rate for Payer: BCN Commercial |
$2,439.13
|
| Rate for Payer: Cash Price |
$2,524.98
|
| Rate for Payer: Cofinity Commercial |
$2,714.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,524.98
|
| Rate for Payer: Healthscope Commercial |
$2,840.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,367.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,682.79
|
| Rate for Payer: PHP Commercial |
$2,682.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,209.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,745.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,924.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,777.47
|
| Rate for Payer: UHC Core |
$2,635.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,367.16
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK
|
Facility
|
OP
|
$3,156.22
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$749.60 |
| Max. Negotiated Rate |
$2,840.60 |
| Rate for Payer: Aetna Commercial |
$2,682.79
|
| Rate for Payer: Aetna Medicare |
$820.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$986.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$986.32
|
| Rate for Payer: BCBS Complete |
$1,256.10
|
| Rate for Payer: BCBS MAPPO |
$789.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,453.96
|
| Rate for Payer: BCN Commercial |
$2,453.96
|
| Rate for Payer: BCN Medicare Advantage |
$789.06
|
| Rate for Payer: Cash Price |
$2,524.98
|
| Rate for Payer: Cash Price |
$2,524.98
|
| Rate for Payer: Cofinity Commercial |
$2,714.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,524.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$789.06
|
| Rate for Payer: Healthscope Commercial |
$2,840.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,367.16
|
| Rate for Payer: Mclaren Medicaid |
$1,196.28
|
| Rate for Payer: Meridian Medicaid |
$1,256.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$828.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$907.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,682.79
|
| Rate for Payer: PACE Senior Care Partners |
$749.60
|
| Rate for Payer: PACE SWMI |
$789.06
|
| Rate for Payer: PHP Commercial |
$2,682.79
|
| Rate for Payer: PHP Medicare Advantage |
$789.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,209.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,745.91
|
| Rate for Payer: Priority Health Medicare |
$789.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,924.98
|
| Rate for Payer: Railroad Medicare Medicare |
$789.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,777.47
|
| Rate for Payer: UHC Core |
$2,635.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$789.06
|
| Rate for Payer: UHC Medicare Advantage |
$812.73
|
| Rate for Payer: VA VA |
$789.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,367.16
|
|
|
HC GRAM STAIN
|
Facility
|
IP
|
$50.30
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.68 |
| Max. Negotiated Rate |
$45.27 |
| Rate for Payer: Aetna Commercial |
$42.76
|
| Rate for Payer: BCBS Trust/PPO |
$38.87
|
| Rate for Payer: BCN Commercial |
$38.87
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cofinity Commercial |
$43.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.24
|
| Rate for Payer: Healthscope Commercial |
$45.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.76
|
| Rate for Payer: PHP Commercial |
$42.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.26
|
| Rate for Payer: UHC Core |
$42.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.72
|
|
|
HC GRAM STAIN
|
Facility
|
OP
|
$50.30
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$45.27 |
| Rate for Payer: Aetna Commercial |
$42.76
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.72
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS MAPPO |
$12.58
|
| Rate for Payer: BCBS Trust/PPO |
$39.11
|
| Rate for Payer: BCN Commercial |
$39.11
|
| Rate for Payer: BCN Medicare Advantage |
$12.58
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cofinity Commercial |
$43.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$45.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.72
|
| Rate for Payer: Mclaren Medicaid |
$3.15
|
| Rate for Payer: Meridian Medicaid |
$3.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.76
|
| Rate for Payer: PACE Senior Care Partners |
$11.95
|
| Rate for Payer: PACE SWMI |
$12.58
|
| Rate for Payer: PHP Commercial |
$42.76
|
| Rate for Payer: PHP Medicare Advantage |
$12.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.76
|
| Rate for Payer: Priority Health Medicare |
$12.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.68
|
| Rate for Payer: Railroad Medicare Medicare |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.26
|
| Rate for Payer: UHC Core |
$42.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.58
|
| Rate for Payer: UHC Medicare Advantage |
$12.95
|
| Rate for Payer: VA VA |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.72
|
|
|
HC GRANULOCYTES
|
Facility
|
OP
|
$1,888.00
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
39000057
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$448.40 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,604.80
|
| Rate for Payer: Aetna Medicare |
$490.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$590.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$590.00
|
| Rate for Payer: BCBS Complete |
$755.20
|
| Rate for Payer: BCBS MAPPO |
$472.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,467.92
|
| Rate for Payer: BCN Commercial |
$1,467.92
|
| Rate for Payer: BCN Medicare Advantage |
$472.00
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cofinity Commercial |
$1,623.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,510.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.00
|
| Rate for Payer: Healthscope Commercial |
$1,699.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$495.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$542.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,604.80
|
| Rate for Payer: PACE Senior Care Partners |
$448.40
|
| Rate for Payer: PACE SWMI |
$472.00
|
| Rate for Payer: PHP Commercial |
$1,604.80
|
| Rate for Payer: PHP Medicare Advantage |
$472.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,642.56
|
| Rate for Payer: Priority Health Medicare |
$472.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,151.49
|
| Rate for Payer: Railroad Medicare Medicare |
$472.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,661.44
|
| Rate for Payer: UHC Core |
$1,576.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$472.00
|
| Rate for Payer: UHC Medicare Advantage |
$486.16
|
| Rate for Payer: VA VA |
$472.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.00
|
|
|
HC GRANULOCYTES
|
Facility
|
IP
|
$1,888.00
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
39000057
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,151.49 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,604.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,459.05
|
| Rate for Payer: BCN Commercial |
$1,459.05
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cofinity Commercial |
$1,623.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,510.40
|
| Rate for Payer: Healthscope Commercial |
$1,699.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,604.80
|
| Rate for Payer: PHP Commercial |
$1,604.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,642.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,151.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,661.44
|
| Rate for Payer: UHC Core |
$1,576.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.00
|
|
|
HC GRASS ALLERGEN PANEL
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200122
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC GRASS ALLERGEN PANEL
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200122
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC GREAT LAKES DISABILITY FILM(EACH)
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$15.46
|
| Rate for Payer: BCN Commercial |
$15.46
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.60
|
| Rate for Payer: UHC Core |
$16.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
HC GREAT LAKES DISABILITY FILM(EACH)
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.25
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$15.55
|
| Rate for Payer: BCN Commercial |
$15.55
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.00
|
| Rate for Payer: PACE Senior Care Partners |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.40
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.60
|
| Rate for Payer: UHC Core |
$16.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.15
|
| Rate for Payer: VA VA |
$5.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
HC GROIN/PSEUDO IMAGING BILATERAL
|
Facility
|
OP
|
$1,415.42
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$1,273.88 |
| Rate for Payer: Aetna Commercial |
$1,203.11
|
| Rate for Payer: Aetna Medicare |
$368.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.32
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$353.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.49
|
| Rate for Payer: BCN Commercial |
$1,100.49
|
| Rate for Payer: BCN Medicare Advantage |
$353.86
|
| Rate for Payer: Cash Price |
$1,132.34
|
| Rate for Payer: Cash Price |
$1,132.34
|
| Rate for Payer: Cofinity Commercial |
$1,217.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,132.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.86
|
| Rate for Payer: Healthscope Commercial |
$1,273.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.56
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$371.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$406.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,203.11
|
| Rate for Payer: PACE Senior Care Partners |
$336.16
|
| Rate for Payer: PACE SWMI |
$353.86
|
| Rate for Payer: PHP Commercial |
$1,203.11
|
| Rate for Payer: PHP Medicare Advantage |
$353.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,231.42
|
| Rate for Payer: Priority Health Medicare |
$353.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$863.26
|
| Rate for Payer: Railroad Medicare Medicare |
$353.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,245.57
|
| Rate for Payer: UHC Core |
$1,181.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$353.86
|
| Rate for Payer: UHC Medicare Advantage |
$364.47
|
| Rate for Payer: VA VA |
$353.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.56
|
|
|
HC GROIN/PSEUDO IMAGING BILATERAL
|
Facility
|
IP
|
$1,415.42
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$863.26 |
| Max. Negotiated Rate |
$1,273.88 |
| Rate for Payer: Aetna Commercial |
$1,203.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,093.84
|
| Rate for Payer: BCN Commercial |
$1,093.84
|
| Rate for Payer: Cash Price |
$1,132.34
|
| Rate for Payer: Cofinity Commercial |
$1,217.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,132.34
|
| Rate for Payer: Healthscope Commercial |
$1,273.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,203.11
|
| Rate for Payer: PHP Commercial |
$1,203.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,231.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$863.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,245.57
|
| Rate for Payer: UHC Core |
$1,181.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.56
|
|
|
HC GROIN/PSEUDO IMAGING (R OR L)
|
Facility
|
OP
|
$904.13
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$813.72 |
| Rate for Payer: Aetna Commercial |
$768.51
|
| Rate for Payer: Aetna Medicare |
$235.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$282.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$282.54
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$226.03
|
| Rate for Payer: BCBS Trust/PPO |
$702.96
|
| Rate for Payer: BCN Commercial |
$702.96
|
| Rate for Payer: BCN Medicare Advantage |
$226.03
|
| Rate for Payer: Cash Price |
$723.30
|
| Rate for Payer: Cash Price |
$723.30
|
| Rate for Payer: Cofinity Commercial |
$777.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.03
|
| Rate for Payer: Healthscope Commercial |
$813.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$678.10
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.51
|
| Rate for Payer: PACE Senior Care Partners |
$214.73
|
| Rate for Payer: PACE SWMI |
$226.03
|
| Rate for Payer: PHP Commercial |
$768.51
|
| Rate for Payer: PHP Medicare Advantage |
$226.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$786.59
|
| Rate for Payer: Priority Health Medicare |
$226.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$551.43
|
| Rate for Payer: Railroad Medicare Medicare |
$226.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$795.63
|
| Rate for Payer: UHC Core |
$754.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.03
|
| Rate for Payer: UHC Medicare Advantage |
$232.81
|
| Rate for Payer: VA VA |
$226.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$678.10
|
|
|
HC GROIN/PSEUDO IMAGING (R OR L)
|
Facility
|
IP
|
$904.13
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$551.43 |
| Max. Negotiated Rate |
$813.72 |
| Rate for Payer: Aetna Commercial |
$768.51
|
| Rate for Payer: BCBS Trust/PPO |
$698.71
|
| Rate for Payer: BCN Commercial |
$698.71
|
| Rate for Payer: Cash Price |
$723.30
|
| Rate for Payer: Cofinity Commercial |
$777.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$723.30
|
| Rate for Payer: Healthscope Commercial |
$813.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$678.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$768.51
|
| Rate for Payer: PHP Commercial |
$768.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$786.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$551.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$795.63
|
| Rate for Payer: UHC Core |
$754.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$678.10
|
|
|
HC GROSHONG REPAIR KIT
|
Facility
|
OP
|
$455.08
|
|
| Hospital Charge Code |
27200125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$409.57 |
| Rate for Payer: Aetna Commercial |
$386.82
|
| Rate for Payer: Aetna Medicare |
$118.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.21
|
| Rate for Payer: BCBS Complete |
$182.03
|
| Rate for Payer: BCBS MAPPO |
$113.77
|
| Rate for Payer: BCBS Trust/PPO |
$353.82
|
| Rate for Payer: BCN Commercial |
$353.82
|
| Rate for Payer: BCN Medicare Advantage |
$113.77
|
| Rate for Payer: Cash Price |
$364.06
|
| Rate for Payer: Cofinity Commercial |
$391.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.77
|
| Rate for Payer: Healthscope Commercial |
$409.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.82
|
| Rate for Payer: PACE Senior Care Partners |
$108.08
|
| Rate for Payer: PACE SWMI |
$113.77
|
| Rate for Payer: PHP Commercial |
$386.82
|
| Rate for Payer: PHP Medicare Advantage |
$113.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$395.92
|
| Rate for Payer: Priority Health Medicare |
$113.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.55
|
| Rate for Payer: Railroad Medicare Medicare |
$113.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.47
|
| Rate for Payer: UHC Core |
$379.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.77
|
| Rate for Payer: UHC Medicare Advantage |
$117.18
|
| Rate for Payer: VA VA |
$113.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.31
|
|
|
HC GROSHONG REPAIR KIT
|
Facility
|
IP
|
$455.08
|
|
| Hospital Charge Code |
27200125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.55 |
| Max. Negotiated Rate |
$409.57 |
| Rate for Payer: Aetna Commercial |
$386.82
|
| Rate for Payer: BCBS Trust/PPO |
$351.69
|
| Rate for Payer: BCN Commercial |
$351.69
|
| Rate for Payer: Cash Price |
$364.06
|
| Rate for Payer: Cofinity Commercial |
$391.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.06
|
| Rate for Payer: Healthscope Commercial |
$409.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.82
|
| Rate for Payer: PHP Commercial |
$386.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$395.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.47
|
| Rate for Payer: UHC Core |
$379.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.31
|
|
|
HC GROUP B STREP, AMPLIFIED
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
30600210
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.88
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$79.30
|
| Rate for Payer: BCN Commercial |
$79.30
|
| Rate for Payer: BCN Medicare Advantage |
$25.50
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.50
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PACE Senior Care Partners |
$24.22
|
| Rate for Payer: PACE SWMI |
$25.50
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$25.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.74
|
| Rate for Payer: Priority Health Medicare |
$25.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.21
|
| Rate for Payer: Railroad Medicare Medicare |
$25.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.50
|
| Rate for Payer: UHC Medicare Advantage |
$26.26
|
| Rate for Payer: VA VA |
$25.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC GROUP B STREP, AMPLIFIED
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
30600210
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: BCBS Trust/PPO |
$78.83
|
| Rate for Payer: BCN Commercial |
$78.83
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC GROUP CAREGIVER TRAINING
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 97552
|
| Hospital Charge Code |
42000067
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: Aetna Medicare |
$13.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.25
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS MAPPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$40.43
|
| Rate for Payer: BCN Commercial |
$40.43
|
| Rate for Payer: BCN Medicare Advantage |
$13.00
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.20
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.00
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: PHP Medicare Advantage |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.24
|
| Rate for Payer: Priority Health Medicare |
$13.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.71
|
| Rate for Payer: Railroad Medicare Medicare |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.76
|
| Rate for Payer: UHC Core |
$43.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.00
|
| Rate for Payer: UHC Medicare Advantage |
$13.39
|
| Rate for Payer: VA VA |
$13.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.00
|
|
|
HC GROUP CAREGIVER TRAINING
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 97552
|
| Hospital Charge Code |
42000067
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Commercial |
$44.20
|
| Rate for Payer: BCBS Trust/PPO |
$40.19
|
| Rate for Payer: BCN Commercial |
$40.19
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$44.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.60
|
| Rate for Payer: Healthscope Commercial |
$46.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.20
|
| Rate for Payer: PHP Commercial |
$44.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.76
|
| Rate for Payer: UHC Core |
$43.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.00
|
|
|
HC GROUP PSYCHOTHERAPY
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
91500001
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: BCBS Trust/PPO |
$74.88
|
| Rate for Payer: BCN Commercial |
$74.88
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.27
|
| Rate for Payer: UHC Core |
$80.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.68
|
|
|
HC GROUP PSYCHOTHERAPY
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
91500001
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$25.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.28
|
| Rate for Payer: BCBS Complete |
$61.40
|
| Rate for Payer: BCBS MAPPO |
$24.22
|
| Rate for Payer: BCBS Trust/PPO |
$75.34
|
| Rate for Payer: BCN Commercial |
$75.34
|
| Rate for Payer: BCN Medicare Advantage |
$24.22
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.22
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.68
|
| Rate for Payer: Mclaren Medicaid |
$58.47
|
| Rate for Payer: Meridian Medicaid |
$61.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PACE Senior Care Partners |
$23.01
|
| Rate for Payer: PACE SWMI |
$24.22
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: PHP Medicare Advantage |
$24.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.30
|
| Rate for Payer: Priority Health Medicare |
$24.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.10
|
| Rate for Payer: Railroad Medicare Medicare |
$24.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.27
|
| Rate for Payer: UHC Core |
$80.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.22
|
| Rate for Payer: UHC Medicare Advantage |
$24.95
|
| Rate for Payer: VA VA |
$24.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.68
|
|
