|
HC HDR 2-12 CHANNELS
|
Facility
|
OP
|
$2,166.72
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$470.33 |
| Max. Negotiated Rate |
$1,950.05 |
| Rate for Payer: Aetna Commercial |
$1,841.71
|
| Rate for Payer: Aetna Commercial |
$1,553.80
|
| Rate for Payer: Aetna Medicare |
$475.28
|
| Rate for Payer: Aetna Medicare |
$563.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$677.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$571.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$677.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$571.25
|
| Rate for Payer: BCBS Complete |
$493.85
|
| Rate for Payer: BCBS Complete |
$493.85
|
| Rate for Payer: BCBS MAPPO |
$541.68
|
| Rate for Payer: BCBS MAPPO |
$457.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,421.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,684.62
|
| Rate for Payer: BCN Commercial |
$1,421.27
|
| Rate for Payer: BCN Commercial |
$1,684.62
|
| Rate for Payer: BCN Medicare Advantage |
$457.00
|
| Rate for Payer: BCN Medicare Advantage |
$541.68
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Cash Price |
$1,733.38
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Cash Price |
$1,733.38
|
| Rate for Payer: Cofinity Commercial |
$1,572.08
|
| Rate for Payer: Cofinity Commercial |
$1,863.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,733.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.00
|
| Rate for Payer: Healthscope Commercial |
$1,645.20
|
| Rate for Payer: Healthscope Commercial |
$1,950.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,625.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,371.00
|
| Rate for Payer: Mclaren Medicaid |
$470.33
|
| Rate for Payer: Mclaren Medicaid |
$470.33
|
| Rate for Payer: Meridian Medicaid |
$493.85
|
| Rate for Payer: Meridian Medicaid |
$493.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$479.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$568.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$525.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,841.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,553.80
|
| Rate for Payer: PACE Senior Care Partners |
$434.15
|
| Rate for Payer: PACE Senior Care Partners |
$514.60
|
| Rate for Payer: PACE SWMI |
$541.68
|
| Rate for Payer: PACE SWMI |
$457.00
|
| Rate for Payer: PHP Commercial |
$1,553.80
|
| Rate for Payer: PHP Commercial |
$1,841.71
|
| Rate for Payer: PHP Medicare Advantage |
$457.00
|
| Rate for Payer: PHP Medicare Advantage |
$541.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,590.36
|
| Rate for Payer: Priority Health Medicare |
$457.00
|
| Rate for Payer: Priority Health Medicare |
$541.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,114.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,321.48
|
| Rate for Payer: Railroad Medicare Medicare |
$541.68
|
| Rate for Payer: Railroad Medicare Medicare |
$457.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,608.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,906.71
|
| Rate for Payer: UHC Core |
$1,526.38
|
| Rate for Payer: UHC Core |
$1,809.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$457.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$541.68
|
| Rate for Payer: UHC Medicare Advantage |
$557.93
|
| Rate for Payer: UHC Medicare Advantage |
$470.71
|
| Rate for Payer: VA VA |
$457.00
|
| Rate for Payer: VA VA |
$541.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,371.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,625.04
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
IP
|
$1,828.00
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,114.90 |
| Max. Negotiated Rate |
$1,645.20 |
| Rate for Payer: Aetna Commercial |
$1,553.80
|
| Rate for Payer: Aetna Commercial |
$1,841.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,674.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,412.68
|
| Rate for Payer: BCN Commercial |
$1,674.44
|
| Rate for Payer: BCN Commercial |
$1,412.68
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Cash Price |
$1,733.38
|
| Rate for Payer: Cofinity Commercial |
$1,572.08
|
| Rate for Payer: Cofinity Commercial |
$1,863.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,733.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.40
|
| Rate for Payer: Healthscope Commercial |
$1,645.20
|
| Rate for Payer: Healthscope Commercial |
$1,950.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,371.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,625.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,841.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,553.80
|
| Rate for Payer: PHP Commercial |
$1,841.71
|
| Rate for Payer: PHP Commercial |
$1,553.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,279.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,590.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,114.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,321.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,608.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,906.71
|
| Rate for Payer: UHC Core |
$1,526.38
|
| Rate for Payer: UHC Core |
$1,809.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,371.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,625.04
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
IP
|
$551.38
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.29 |
| Max. Negotiated Rate |
$496.24 |
| Rate for Payer: Aetna Commercial |
$468.67
|
| Rate for Payer: BCBS Trust/PPO |
$426.11
|
| Rate for Payer: BCN Commercial |
$426.11
|
| Rate for Payer: Cash Price |
$441.10
|
| Rate for Payer: Cofinity Commercial |
$474.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.10
|
| Rate for Payer: Healthscope Commercial |
$496.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$413.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$468.67
|
| Rate for Payer: PHP Commercial |
$468.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$485.21
|
| Rate for Payer: UHC Core |
$460.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$413.54
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
OP
|
$551.38
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.95 |
| Max. Negotiated Rate |
$496.24 |
| Rate for Payer: Aetna Commercial |
$468.67
|
| Rate for Payer: Aetna Medicare |
$143.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$172.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$172.31
|
| Rate for Payer: BCBS Complete |
$250.84
|
| Rate for Payer: BCBS MAPPO |
$137.84
|
| Rate for Payer: BCBS Trust/PPO |
$428.70
|
| Rate for Payer: BCN Commercial |
$428.70
|
| Rate for Payer: BCN Medicare Advantage |
$137.84
|
| Rate for Payer: Cash Price |
$441.10
|
| Rate for Payer: Cash Price |
$441.10
|
| Rate for Payer: Cofinity Commercial |
$474.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$441.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.84
|
| Rate for Payer: Healthscope Commercial |
$496.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$413.54
|
| Rate for Payer: Mclaren Medicaid |
$238.89
|
| Rate for Payer: Meridian Medicaid |
$250.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$144.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$468.67
|
| Rate for Payer: PACE Senior Care Partners |
$130.95
|
| Rate for Payer: PACE SWMI |
$137.84
|
| Rate for Payer: PHP Commercial |
$468.67
|
| Rate for Payer: PHP Medicare Advantage |
$137.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$238.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.70
|
| Rate for Payer: Priority Health Medicare |
$137.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.29
|
| Rate for Payer: Railroad Medicare Medicare |
$137.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$485.21
|
| Rate for Payer: UHC Core |
$460.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.84
|
| Rate for Payer: UHC Medicare Advantage |
$141.98
|
| Rate for Payer: VA VA |
$137.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$413.54
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
OP
|
$2,680.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$470.33 |
| Max. Negotiated Rate |
$2,412.00 |
| Rate for Payer: Aetna Commercial |
$2,278.00
|
| Rate for Payer: Aetna Commercial |
$2,032.41
|
| Rate for Payer: Aetna Medicare |
$696.80
|
| Rate for Payer: Aetna Medicare |
$621.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$837.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$747.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$747.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$837.50
|
| Rate for Payer: BCBS Complete |
$493.85
|
| Rate for Payer: BCBS Complete |
$493.85
|
| Rate for Payer: BCBS MAPPO |
$670.00
|
| Rate for Payer: BCBS MAPPO |
$597.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,859.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,083.70
|
| Rate for Payer: BCN Commercial |
$2,083.70
|
| Rate for Payer: BCN Commercial |
$1,859.06
|
| Rate for Payer: BCN Medicare Advantage |
$597.77
|
| Rate for Payer: BCN Medicare Advantage |
$670.00
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$1,912.86
|
| Rate for Payer: Cash Price |
$1,912.86
|
| Rate for Payer: Cofinity Commercial |
$2,056.32
|
| Rate for Payer: Cofinity Commercial |
$2,304.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,144.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,912.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$670.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.77
|
| Rate for Payer: Healthscope Commercial |
$2,412.00
|
| Rate for Payer: Healthscope Commercial |
$2,151.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,010.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,793.30
|
| Rate for Payer: Mclaren Medicaid |
$470.33
|
| Rate for Payer: Mclaren Medicaid |
$470.33
|
| Rate for Payer: Meridian Medicaid |
$493.85
|
| Rate for Payer: Meridian Medicaid |
$493.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$703.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$627.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$770.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$687.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,032.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,278.00
|
| Rate for Payer: PACE Senior Care Partners |
$636.50
|
| Rate for Payer: PACE Senior Care Partners |
$567.88
|
| Rate for Payer: PACE SWMI |
$597.77
|
| Rate for Payer: PACE SWMI |
$670.00
|
| Rate for Payer: PHP Commercial |
$2,278.00
|
| Rate for Payer: PHP Commercial |
$2,032.41
|
| Rate for Payer: PHP Medicare Advantage |
$597.77
|
| Rate for Payer: PHP Medicare Advantage |
$670.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,673.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,080.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,331.60
|
| Rate for Payer: Priority Health Medicare |
$597.77
|
| Rate for Payer: Priority Health Medicare |
$670.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,458.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,634.53
|
| Rate for Payer: Railroad Medicare Medicare |
$670.00
|
| Rate for Payer: Railroad Medicare Medicare |
$597.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,104.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,358.40
|
| Rate for Payer: UHC Core |
$2,237.80
|
| Rate for Payer: UHC Core |
$1,996.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$670.00
|
| Rate for Payer: UHC Medicare Advantage |
$615.70
|
| Rate for Payer: UHC Medicare Advantage |
$690.10
|
| Rate for Payer: VA VA |
$670.00
|
| Rate for Payer: VA VA |
$597.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,793.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,010.00
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
IP
|
$2,680.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,634.53 |
| Max. Negotiated Rate |
$2,412.00 |
| Rate for Payer: Aetna Commercial |
$2,278.00
|
| Rate for Payer: Aetna Commercial |
$2,032.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,071.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.82
|
| Rate for Payer: BCN Commercial |
$2,071.10
|
| Rate for Payer: BCN Commercial |
$1,847.82
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$1,912.86
|
| Rate for Payer: Cofinity Commercial |
$2,056.32
|
| Rate for Payer: Cofinity Commercial |
$2,304.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,912.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,144.00
|
| Rate for Payer: Healthscope Commercial |
$2,412.00
|
| Rate for Payer: Healthscope Commercial |
$2,151.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,010.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,793.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,278.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,032.41
|
| Rate for Payer: PHP Commercial |
$2,278.00
|
| Rate for Payer: PHP Commercial |
$2,032.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,673.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,331.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,080.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,634.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,458.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,104.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,358.40
|
| Rate for Payer: UHC Core |
$1,996.54
|
| Rate for Payer: UHC Core |
$2,237.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,793.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,010.00
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
IP
|
$472.31
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$288.06 |
| Max. Negotiated Rate |
$425.08 |
| Rate for Payer: Aetna Commercial |
$401.46
|
| Rate for Payer: BCBS Trust/PPO |
$365.00
|
| Rate for Payer: BCN Commercial |
$365.00
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$406.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.85
|
| Rate for Payer: Healthscope Commercial |
$425.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: PHP Commercial |
$401.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.63
|
| Rate for Payer: UHC Core |
$394.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.23
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
OP
|
$472.31
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$112.17 |
| Max. Negotiated Rate |
$425.08 |
| Rate for Payer: Aetna Commercial |
$401.46
|
| Rate for Payer: Aetna Medicare |
$122.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.60
|
| Rate for Payer: BCBS Complete |
$185.11
|
| Rate for Payer: BCBS MAPPO |
$118.08
|
| Rate for Payer: BCBS Trust/PPO |
$367.22
|
| Rate for Payer: BCN Commercial |
$367.22
|
| Rate for Payer: BCN Medicare Advantage |
$118.08
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$406.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.08
|
| Rate for Payer: Healthscope Commercial |
$425.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.23
|
| Rate for Payer: Mclaren Medicaid |
$176.29
|
| Rate for Payer: Meridian Medicaid |
$185.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: PACE Senior Care Partners |
$112.17
|
| Rate for Payer: PACE SWMI |
$118.08
|
| Rate for Payer: PHP Commercial |
$401.46
|
| Rate for Payer: PHP Medicare Advantage |
$118.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.91
|
| Rate for Payer: Priority Health Medicare |
$118.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.06
|
| Rate for Payer: Railroad Medicare Medicare |
$118.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.63
|
| Rate for Payer: UHC Core |
$394.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.08
|
| Rate for Payer: UHC Medicare Advantage |
$121.62
|
| Rate for Payer: VA VA |
$118.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.23
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
IP
|
$531.36
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$324.08 |
| Max. Negotiated Rate |
$478.22 |
| Rate for Payer: Aetna Commercial |
$451.66
|
| Rate for Payer: BCBS Trust/PPO |
$410.64
|
| Rate for Payer: BCN Commercial |
$410.64
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cofinity Commercial |
$456.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.09
|
| Rate for Payer: Healthscope Commercial |
$478.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.66
|
| Rate for Payer: PHP Commercial |
$451.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$462.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.60
|
| Rate for Payer: UHC Core |
$443.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.52
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
OP
|
$531.36
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$126.20 |
| Max. Negotiated Rate |
$478.22 |
| Rate for Payer: Aetna Commercial |
$451.66
|
| Rate for Payer: Aetna Medicare |
$138.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$166.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$166.05
|
| Rate for Payer: BCBS Complete |
$185.11
|
| Rate for Payer: BCBS MAPPO |
$132.84
|
| Rate for Payer: BCBS Trust/PPO |
$413.13
|
| Rate for Payer: BCN Commercial |
$413.13
|
| Rate for Payer: BCN Medicare Advantage |
$132.84
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cofinity Commercial |
$456.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.84
|
| Rate for Payer: Healthscope Commercial |
$478.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.52
|
| Rate for Payer: Mclaren Medicaid |
$176.29
|
| Rate for Payer: Meridian Medicaid |
$185.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$139.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.66
|
| Rate for Payer: PACE Senior Care Partners |
$126.20
|
| Rate for Payer: PACE SWMI |
$132.84
|
| Rate for Payer: PHP Commercial |
$451.66
|
| Rate for Payer: PHP Medicare Advantage |
$132.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$462.28
|
| Rate for Payer: Priority Health Medicare |
$132.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.08
|
| Rate for Payer: Railroad Medicare Medicare |
$132.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.60
|
| Rate for Payer: UHC Core |
$443.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.84
|
| Rate for Payer: UHC Medicare Advantage |
$136.83
|
| Rate for Payer: VA VA |
$132.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.52
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
IP
|
$120.36
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$73.41 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.31
|
| Rate for Payer: BCBS Trust/PPO |
$93.01
|
| Rate for Payer: BCN Commercial |
$93.01
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$103.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.31
|
| Rate for Payer: PHP Commercial |
$102.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.92
|
| Rate for Payer: UHC Core |
$100.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.27
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
OP
|
$120.36
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.31
|
| Rate for Payer: Aetna Medicare |
$31.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.61
|
| Rate for Payer: BCBS Complete |
$61.40
|
| Rate for Payer: BCBS MAPPO |
$30.09
|
| Rate for Payer: BCBS Trust/PPO |
$93.58
|
| Rate for Payer: BCN Commercial |
$93.58
|
| Rate for Payer: BCN Medicare Advantage |
$30.09
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$103.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.09
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.27
|
| Rate for Payer: Mclaren Medicaid |
$58.47
|
| Rate for Payer: Meridian Medicaid |
$61.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.31
|
| Rate for Payer: PACE Senior Care Partners |
$28.59
|
| Rate for Payer: PACE SWMI |
$30.09
|
| Rate for Payer: PHP Commercial |
$102.31
|
| Rate for Payer: PHP Medicare Advantage |
$30.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.71
|
| Rate for Payer: Priority Health Medicare |
$30.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.41
|
| Rate for Payer: Railroad Medicare Medicare |
$30.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.92
|
| Rate for Payer: UHC Core |
$100.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.09
|
| Rate for Payer: UHC Medicare Advantage |
$30.99
|
| Rate for Payer: VA VA |
$30.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.27
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
OP
|
$60.18
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$24.07
|
| Rate for Payer: BCBS MAPPO |
$15.04
|
| Rate for Payer: BCBS Trust/PPO |
$46.79
|
| Rate for Payer: BCN Commercial |
$46.79
|
| Rate for Payer: BCN Medicare Advantage |
$15.04
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.04
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: PACE Senior Care Partners |
$14.29
|
| Rate for Payer: PACE SWMI |
$15.04
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: PHP Medicare Advantage |
$15.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.36
|
| Rate for Payer: Priority Health Medicare |
$15.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.70
|
| Rate for Payer: Railroad Medicare Medicare |
$15.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.96
|
| Rate for Payer: UHC Core |
$50.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.04
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: VA VA |
$15.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.14
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
IP
|
$60.18
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$36.70 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: BCBS Trust/PPO |
$46.51
|
| Rate for Payer: BCN Commercial |
$46.51
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.14
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.96
|
| Rate for Payer: UHC Core |
$50.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.14
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
IP
|
$120.36
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$73.41 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.31
|
| Rate for Payer: BCBS Trust/PPO |
$93.01
|
| Rate for Payer: BCN Commercial |
$93.01
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$103.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.31
|
| Rate for Payer: PHP Commercial |
$102.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.92
|
| Rate for Payer: UHC Core |
$100.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.27
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
OP
|
$120.36
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$109.82 |
| Rate for Payer: Aetna Commercial |
$102.31
|
| Rate for Payer: Aetna Medicare |
$31.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.61
|
| Rate for Payer: BCBS Complete |
$109.82
|
| Rate for Payer: BCBS MAPPO |
$30.09
|
| Rate for Payer: BCBS Trust/PPO |
$93.58
|
| Rate for Payer: BCN Commercial |
$93.58
|
| Rate for Payer: BCN Medicare Advantage |
$30.09
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cash Price |
$96.29
|
| Rate for Payer: Cofinity Commercial |
$103.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.09
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.27
|
| Rate for Payer: Mclaren Medicaid |
$104.59
|
| Rate for Payer: Meridian Medicaid |
$109.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.31
|
| Rate for Payer: PACE Senior Care Partners |
$28.59
|
| Rate for Payer: PACE SWMI |
$30.09
|
| Rate for Payer: PHP Commercial |
$102.31
|
| Rate for Payer: PHP Medicare Advantage |
$30.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.71
|
| Rate for Payer: Priority Health Medicare |
$30.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.41
|
| Rate for Payer: Railroad Medicare Medicare |
$30.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.92
|
| Rate for Payer: UHC Core |
$100.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.09
|
| Rate for Payer: UHC Medicare Advantage |
$30.99
|
| Rate for Payer: VA VA |
$30.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.27
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$15.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.75
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS MAPPO |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.65
|
| Rate for Payer: BCN Commercial |
$46.65
|
| Rate for Payer: BCN Medicare Advantage |
$15.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PACE Senior Care Partners |
$14.25
|
| Rate for Payer: PACE SWMI |
$15.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: PHP Medicare Advantage |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.20
|
| Rate for Payer: Priority Health Medicare |
$15.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.59
|
| Rate for Payer: Railroad Medicare Medicare |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.00
|
| Rate for Payer: UHC Medicare Advantage |
$15.45
|
| Rate for Payer: VA VA |
$15.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$36.59 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.37
|
| Rate for Payer: BCN Commercial |
$46.37
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC HEARING AID CHECK MONAURAL
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
47100402
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna Commercial |
$45.05
|
| Rate for Payer: BCBS Trust/PPO |
$40.96
|
| Rate for Payer: BCN Commercial |
$40.96
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$45.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Healthscope Commercial |
$47.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.05
|
| Rate for Payer: PHP Commercial |
$45.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.64
|
| Rate for Payer: UHC Core |
$44.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.75
|
|
|
HC HEARING AID CHECK MONAURAL
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
47100402
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna Commercial |
$45.05
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$41.21
|
| Rate for Payer: BCN Commercial |
$41.21
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$45.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$47.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.05
|
| Rate for Payer: PACE Senior Care Partners |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$45.05
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.11
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.32
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.64
|
| Rate for Payer: UHC Core |
$44.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.65
|
| Rate for Payer: VA VA |
$13.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.75
|
|
|
HC HEARING AID EXAM BOTH EARS
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$101.15
|
| Rate for Payer: Aetna Medicare |
$30.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.19
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS MAPPO |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$92.52
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: BCN Medicare Advantage |
$29.75
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$102.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.75
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.15
|
| Rate for Payer: PACE Senior Care Partners |
$28.26
|
| Rate for Payer: PACE SWMI |
$29.75
|
| Rate for Payer: PHP Commercial |
$101.15
|
| Rate for Payer: PHP Medicare Advantage |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.53
|
| Rate for Payer: Priority Health Medicare |
$29.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.58
|
| Rate for Payer: Railroad Medicare Medicare |
$29.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.72
|
| Rate for Payer: UHC Core |
$99.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.75
|
| Rate for Payer: UHC Medicare Advantage |
$30.64
|
| Rate for Payer: VA VA |
$29.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.25
|
|
|
HC HEARING AID EXAM BOTH EARS
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$101.15
|
| Rate for Payer: BCBS Trust/PPO |
$91.96
|
| Rate for Payer: BCN Commercial |
$91.96
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$102.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.20
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.15
|
| Rate for Payer: PHP Commercial |
$101.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.72
|
| Rate for Payer: UHC Core |
$99.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.25
|
|
|
HC HEARING AID EXAM ONE EAR
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: Aetna Medicare |
$28.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.06
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS MAPPO |
$27.25
|
| Rate for Payer: BCBS Trust/PPO |
$84.75
|
| Rate for Payer: BCN Commercial |
$84.75
|
| Rate for Payer: BCN Medicare Advantage |
$27.25
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.25
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.65
|
| Rate for Payer: PACE Senior Care Partners |
$25.89
|
| Rate for Payer: PACE SWMI |
$27.25
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: PHP Medicare Advantage |
$27.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.83
|
| Rate for Payer: Priority Health Medicare |
$27.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.48
|
| Rate for Payer: Railroad Medicare Medicare |
$27.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.92
|
| Rate for Payer: UHC Core |
$91.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.25
|
| Rate for Payer: UHC Medicare Advantage |
$28.07
|
| Rate for Payer: VA VA |
$27.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.75
|
|
|
HC HEARING AID EXAM ONE EAR
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$66.48 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna Commercial |
$92.65
|
| Rate for Payer: BCBS Trust/PPO |
$84.24
|
| Rate for Payer: BCN Commercial |
$84.24
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$98.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.65
|
| Rate for Payer: PHP Commercial |
$92.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.92
|
| Rate for Payer: UHC Core |
$91.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.75
|
|
|
HC HEART CATH CORONARIES CABG'S
|
Facility
|
OP
|
$11,972.93
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100018
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,137.59 |
| Max. Negotiated Rate |
$10,775.64 |
| Rate for Payer: Aetna Commercial |
$10,176.99
|
| Rate for Payer: Aetna Medicare |
$3,112.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,741.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,741.54
|
| Rate for Payer: BCBS Complete |
$2,244.47
|
| Rate for Payer: BCBS MAPPO |
$2,993.23
|
| Rate for Payer: BCBS Trust/PPO |
$9,308.95
|
| Rate for Payer: BCN Commercial |
$9,308.95
|
| Rate for Payer: BCN Medicare Advantage |
$2,993.23
|
| Rate for Payer: Cash Price |
$9,578.34
|
| Rate for Payer: Cash Price |
$9,578.34
|
| Rate for Payer: Cofinity Commercial |
$10,296.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,578.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,993.23
|
| Rate for Payer: Healthscope Commercial |
$10,775.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,979.70
|
| Rate for Payer: Mclaren Medicaid |
$2,137.59
|
| Rate for Payer: Meridian Medicaid |
$2,244.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,142.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,442.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,176.99
|
| Rate for Payer: PACE Senior Care Partners |
$2,843.57
|
| Rate for Payer: PACE SWMI |
$2,993.23
|
| Rate for Payer: PHP Commercial |
$10,176.99
|
| Rate for Payer: PHP Medicare Advantage |
$2,993.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,137.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,381.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,416.45
|
| Rate for Payer: Priority Health Medicare |
$2,993.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,302.29
|
| Rate for Payer: Railroad Medicare Medicare |
$2,993.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,536.18
|
| Rate for Payer: UHC Core |
$9,997.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,993.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.03
|
| Rate for Payer: VA VA |
$2,993.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,979.70
|
|
