|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
IP
|
$283.54
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$197.34 |
| Max. Negotiated Rate |
$255.19 |
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: BCBS Trust/PPO |
$234.18
|
| Rate for Payer: BCN Commercial |
$234.18
|
| Rate for Payer: Cash Price |
$226.83
|
| Rate for Payer: Cofinity Commercial |
$243.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.83
|
| Rate for Payer: Healthscope Commercial |
$255.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.01
|
| Rate for Payer: Nomi Health Commercial |
$232.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$212.66
|
| Rate for Payer: PHP Commercial |
$241.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$246.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.52
|
| Rate for Payer: UHC Core |
$236.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.66
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE
|
Facility
|
IP
|
$2,507.96
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,745.54 |
| Max. Negotiated Rate |
$2,257.16 |
| Rate for Payer: Aetna Commercial |
$2,131.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,071.32
|
| Rate for Payer: BCN Commercial |
$2,071.32
|
| Rate for Payer: Cash Price |
$2,006.37
|
| Rate for Payer: Cofinity Commercial |
$2,156.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.37
|
| Rate for Payer: Healthscope Commercial |
$2,257.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,880.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,131.77
|
| Rate for Payer: Nomi Health Commercial |
$2,056.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,880.97
|
| Rate for Payer: PHP Commercial |
$2,131.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,181.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,745.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,207.00
|
| Rate for Payer: UHC Core |
$2,094.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,880.97
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM FEET, HANDS, FACE
|
Facility
|
OP
|
$2,507.96
|
|
|
Service Code
|
CPT 15115
|
| Hospital Charge Code |
76100067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.15 |
| Max. Negotiated Rate |
$2,257.16 |
| Rate for Payer: Aetna Commercial |
$2,131.77
|
| Rate for Payer: Aetna Medicare |
$652.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$783.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$783.74
|
| Rate for Payer: BCBS Complete |
$464.22
|
| Rate for Payer: BCBS MAPPO |
$626.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,061.79
|
| Rate for Payer: BCN Commercial |
$2,061.79
|
| Rate for Payer: BCN Medicare Advantage |
$626.99
|
| Rate for Payer: Cash Price |
$2,006.37
|
| Rate for Payer: Cofinity Commercial |
$2,156.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,006.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.99
|
| Rate for Payer: Healthscope Commercial |
$2,257.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,880.97
|
| Rate for Payer: Mclaren Medicaid |
$442.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$658.34
|
| Rate for Payer: Meridian Medicaid |
$464.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$721.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$689.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,131.77
|
| Rate for Payer: Nomi Health Commercial |
$2,056.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,880.97
|
| Rate for Payer: PACE Senior Care Partners |
$595.64
|
| Rate for Payer: PACE SWMI |
$626.99
|
| Rate for Payer: PHP Commercial |
$2,131.77
|
| Rate for Payer: PHP Medicare Advantage |
$626.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,181.93
|
| Rate for Payer: Priority Health Medicare |
$633.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,745.54
|
| Rate for Payer: Railroad Medicare Medicare |
$626.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,207.00
|
| Rate for Payer: UHC Core |
$2,094.15
|
| Rate for Payer: UHC Exchange |
$626.99
|
| Rate for Payer: UHC Medicaid |
$442.15
|
| Rate for Payer: UHC Medicare Advantage |
$626.99
|
| Rate for Payer: UHCCP Medicaid |
$442.15
|
| Rate for Payer: VA VA |
$626.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,880.97
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK
|
Facility
|
IP
|
$3,283.73
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,285.48 |
| Max. Negotiated Rate |
$2,955.36 |
| Rate for Payer: Aetna Commercial |
$2,791.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,712.03
|
| Rate for Payer: BCN Commercial |
$2,712.03
|
| Rate for Payer: Cash Price |
$2,626.98
|
| Rate for Payer: Cofinity Commercial |
$2,824.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,626.98
|
| Rate for Payer: Healthscope Commercial |
$2,955.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,462.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,791.17
|
| Rate for Payer: Nomi Health Commercial |
$2,692.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,462.80
|
| Rate for Payer: PHP Commercial |
$2,791.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,856.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,285.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,889.68
|
| Rate for Payer: UHC Core |
$2,741.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,462.80
|
|
|
HC GRAFT EPIDERMAL 1ST 100 SQ CM LEGS, ARMS, TRUNK
|
Facility
|
OP
|
$3,283.73
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
76100066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$578.92 |
| Max. Negotiated Rate |
$2,955.36 |
| Rate for Payer: Aetna Commercial |
$2,791.17
|
| Rate for Payer: Aetna Medicare |
$853.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,026.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,026.17
|
| Rate for Payer: BCBS Complete |
$607.82
|
| Rate for Payer: BCBS MAPPO |
$820.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,699.55
|
| Rate for Payer: BCN Commercial |
$2,699.55
|
| Rate for Payer: BCN Medicare Advantage |
$820.93
|
| Rate for Payer: Cash Price |
$2,626.98
|
| Rate for Payer: Cofinity Commercial |
$2,824.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,626.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$820.93
|
| Rate for Payer: Healthscope Commercial |
$2,955.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,462.80
|
| Rate for Payer: Mclaren Medicaid |
$578.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$861.98
|
| Rate for Payer: Meridian Medicaid |
$607.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$944.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$903.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,791.17
|
| Rate for Payer: Nomi Health Commercial |
$2,692.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,462.80
|
| Rate for Payer: PACE Senior Care Partners |
$779.89
|
| Rate for Payer: PACE SWMI |
$820.93
|
| Rate for Payer: PHP Commercial |
$2,791.17
|
| Rate for Payer: PHP Medicare Advantage |
$820.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,856.85
|
| Rate for Payer: Priority Health Medicare |
$829.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,285.48
|
| Rate for Payer: Railroad Medicare Medicare |
$820.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,889.68
|
| Rate for Payer: UHC Core |
$2,741.91
|
| Rate for Payer: UHC Exchange |
$820.93
|
| Rate for Payer: UHC Medicaid |
$578.92
|
| Rate for Payer: UHC Medicare Advantage |
$820.93
|
| Rate for Payer: UHCCP Medicaid |
$578.92
|
| Rate for Payer: VA VA |
$820.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,462.80
|
|
|
HC GRAM STAIN
|
Facility
|
IP
|
$52.34
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: BCBS Trust/PPO |
$43.23
|
| Rate for Payer: BCN Commercial |
$43.23
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$42.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.06
|
| Rate for Payer: UHC Core |
$43.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.26
|
|
|
HC GRAM STAIN
|
Facility
|
OP
|
$52.34
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
30600104
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare |
$13.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.36
|
| Rate for Payer: BCBS Complete |
$9.69
|
| Rate for Payer: BCBS MAPPO |
$13.09
|
| Rate for Payer: BCBS Trust/PPO |
$43.03
|
| Rate for Payer: BCN Commercial |
$43.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.09
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.26
|
| Rate for Payer: Mclaren Medicaid |
$9.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.74
|
| Rate for Payer: Meridian Medicaid |
$9.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$42.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PACE Senior Care Partners |
$12.43
|
| Rate for Payer: PACE SWMI |
$13.09
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: PHP Medicare Advantage |
$13.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.54
|
| Rate for Payer: Priority Health Medicare |
$13.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.43
|
| Rate for Payer: Railroad Medicare Medicare |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.06
|
| Rate for Payer: UHC Core |
$43.70
|
| Rate for Payer: UHC Exchange |
$13.09
|
| Rate for Payer: UHC Medicaid |
$9.23
|
| Rate for Payer: UHC Medicare Advantage |
$13.09
|
| Rate for Payer: UHCCP Medicaid |
$9.23
|
| Rate for Payer: VA VA |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.26
|
|
|
HC GRANULOCYTES
|
Facility
|
OP
|
$1,964.28
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
39000057
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$346.30 |
| Max. Negotiated Rate |
$1,767.85 |
| Rate for Payer: Aetna Commercial |
$1,669.64
|
| Rate for Payer: Aetna Medicare |
$510.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.84
|
| Rate for Payer: BCBS Complete |
$363.59
|
| Rate for Payer: BCBS MAPPO |
$491.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,614.83
|
| Rate for Payer: BCN Commercial |
$1,614.83
|
| Rate for Payer: BCN Medicare Advantage |
$491.07
|
| Rate for Payer: Cash Price |
$1,571.42
|
| Rate for Payer: Cofinity Commercial |
$1,689.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$491.07
|
| Rate for Payer: Healthscope Commercial |
$1,767.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.21
|
| Rate for Payer: Mclaren Medicaid |
$346.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.62
|
| Rate for Payer: Meridian Medicaid |
$363.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$540.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.64
|
| Rate for Payer: Nomi Health Commercial |
$1,610.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.21
|
| Rate for Payer: PACE Senior Care Partners |
$466.52
|
| Rate for Payer: PACE SWMI |
$491.07
|
| Rate for Payer: PHP Commercial |
$1,669.64
|
| Rate for Payer: PHP Medicare Advantage |
$491.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,708.92
|
| Rate for Payer: Priority Health Medicare |
$495.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,367.14
|
| Rate for Payer: Railroad Medicare Medicare |
$491.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,728.57
|
| Rate for Payer: UHC Core |
$1,640.17
|
| Rate for Payer: UHC Exchange |
$491.07
|
| Rate for Payer: UHC Medicaid |
$346.30
|
| Rate for Payer: UHC Medicare Advantage |
$491.07
|
| Rate for Payer: UHCCP Medicaid |
$346.30
|
| Rate for Payer: VA VA |
$491.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.21
|
|
|
HC GRANULOCYTES
|
Facility
|
IP
|
$1,964.28
|
|
|
Service Code
|
HCPCS P9050
|
| Hospital Charge Code |
39000057
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,367.14 |
| Max. Negotiated Rate |
$1,767.85 |
| Rate for Payer: Aetna Commercial |
$1,669.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,622.30
|
| Rate for Payer: BCN Commercial |
$1,622.30
|
| Rate for Payer: Cash Price |
$1,571.42
|
| Rate for Payer: Cofinity Commercial |
$1,689.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.42
|
| Rate for Payer: Healthscope Commercial |
$1,767.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,473.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.64
|
| Rate for Payer: Nomi Health Commercial |
$1,610.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,473.21
|
| Rate for Payer: PHP Commercial |
$1,669.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,708.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,367.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,728.57
|
| Rate for Payer: UHC Core |
$1,640.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,473.21
|
|
|
HC GRASS ALLERGEN PANEL
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200122
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC GRASS ALLERGEN PANEL
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200122
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC GREAT LAKES DISABILITY FILM(EACH)
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3.53 |
| 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 |
$3.70
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.44
|
| Rate for Payer: BCN Commercial |
$16.44
|
| 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: Mclaren Medicaid |
$3.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: Meridian Medicaid |
$3.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Nomi Health Commercial |
$16.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.00
|
| 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 Choice Medicaid |
$3.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.40
|
| Rate for Payer: Priority Health Medicare |
$5.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.92
|
| 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 Exchange |
$5.00
|
| Rate for Payer: UHC Medicaid |
$3.53
|
| Rate for Payer: UHC Medicare Advantage |
$5.00
|
| Rate for Payer: UHCCP Medicaid |
$3.53
|
| Rate for Payer: VA VA |
$5.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
HC GREAT LAKES DISABILITY FILM(EACH)
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
32000267
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.52
|
| Rate for Payer: BCN Commercial |
$16.52
|
| 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 Commercial |
$17.00
|
| Rate for Payer: Nomi Health Commercial |
$16.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.92
|
| 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 GROIN/PSEUDO IMAGING BILATERAL
|
Facility
|
OP
|
$1,472.60
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$259.62 |
| Max. Negotiated Rate |
$1,325.34 |
| Rate for Payer: Aetna Commercial |
$1,251.71
|
| Rate for Payer: Aetna Medicare |
$382.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$460.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$460.19
|
| Rate for Payer: BCBS Complete |
$272.58
|
| Rate for Payer: BCBS MAPPO |
$368.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,210.62
|
| Rate for Payer: BCN Commercial |
$1,210.62
|
| Rate for Payer: BCN Medicare Advantage |
$368.15
|
| Rate for Payer: Cash Price |
$1,178.08
|
| Rate for Payer: Cofinity Commercial |
$1,266.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,178.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$368.15
|
| Rate for Payer: Healthscope Commercial |
$1,325.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,104.45
|
| Rate for Payer: Mclaren Medicaid |
$259.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$386.56
|
| Rate for Payer: Meridian Medicaid |
$272.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$423.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$404.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,251.71
|
| Rate for Payer: Nomi Health Commercial |
$1,207.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,104.45
|
| Rate for Payer: PACE Senior Care Partners |
$349.74
|
| Rate for Payer: PACE SWMI |
$368.15
|
| Rate for Payer: PHP Commercial |
$1,251.71
|
| Rate for Payer: PHP Medicare Advantage |
$368.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,281.16
|
| Rate for Payer: Priority Health Medicare |
$371.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,024.93
|
| Rate for Payer: Railroad Medicare Medicare |
$368.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,295.89
|
| Rate for Payer: UHC Core |
$1,229.62
|
| Rate for Payer: UHC Exchange |
$368.15
|
| Rate for Payer: UHC Medicaid |
$259.62
|
| Rate for Payer: UHC Medicare Advantage |
$368.15
|
| Rate for Payer: UHCCP Medicaid |
$259.62
|
| Rate for Payer: VA VA |
$368.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,104.45
|
|
|
HC GROIN/PSEUDO IMAGING BILATERAL
|
Facility
|
IP
|
$1,472.60
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
92100027
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,024.93 |
| Max. Negotiated Rate |
$1,325.34 |
| Rate for Payer: Aetna Commercial |
$1,251.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,216.22
|
| Rate for Payer: BCN Commercial |
$1,216.22
|
| Rate for Payer: Cash Price |
$1,178.08
|
| Rate for Payer: Cofinity Commercial |
$1,266.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,178.08
|
| Rate for Payer: Healthscope Commercial |
$1,325.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,104.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,251.71
|
| Rate for Payer: Nomi Health Commercial |
$1,207.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,104.45
|
| Rate for Payer: PHP Commercial |
$1,251.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,281.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,024.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,295.89
|
| Rate for Payer: UHC Core |
$1,229.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,104.45
|
|
|
HC GROIN/PSEUDO IMAGING (R OR L)
|
Facility
|
OP
|
$940.65
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$165.84 |
| Max. Negotiated Rate |
$846.59 |
| Rate for Payer: Aetna Commercial |
$799.55
|
| Rate for Payer: Aetna Medicare |
$244.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.95
|
| Rate for Payer: BCBS Complete |
$174.11
|
| Rate for Payer: BCBS MAPPO |
$235.16
|
| Rate for Payer: BCBS Trust/PPO |
$773.31
|
| Rate for Payer: BCN Commercial |
$773.31
|
| Rate for Payer: BCN Medicare Advantage |
$235.16
|
| Rate for Payer: Cash Price |
$752.52
|
| Rate for Payer: Cofinity Commercial |
$808.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.16
|
| Rate for Payer: Healthscope Commercial |
$846.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.49
|
| Rate for Payer: Mclaren Medicaid |
$165.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.92
|
| Rate for Payer: Meridian Medicaid |
$174.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$258.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.55
|
| Rate for Payer: Nomi Health Commercial |
$771.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.49
|
| Rate for Payer: PACE Senior Care Partners |
$223.40
|
| Rate for Payer: PACE SWMI |
$235.16
|
| Rate for Payer: PHP Commercial |
$799.55
|
| Rate for Payer: PHP Medicare Advantage |
$235.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$818.37
|
| Rate for Payer: Priority Health Medicare |
$237.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$654.69
|
| Rate for Payer: Railroad Medicare Medicare |
$235.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.77
|
| Rate for Payer: UHC Core |
$785.44
|
| Rate for Payer: UHC Exchange |
$235.16
|
| Rate for Payer: UHC Medicaid |
$165.84
|
| Rate for Payer: UHC Medicare Advantage |
$235.16
|
| Rate for Payer: UHCCP Medicaid |
$165.84
|
| Rate for Payer: VA VA |
$235.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.49
|
|
|
HC GROIN/PSEUDO IMAGING (R OR L)
|
Facility
|
IP
|
$940.65
|
|
|
Service Code
|
CPT 93926
|
| Hospital Charge Code |
92100026
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$654.69 |
| Max. Negotiated Rate |
$846.59 |
| Rate for Payer: Aetna Commercial |
$799.55
|
| Rate for Payer: BCBS Trust/PPO |
$776.88
|
| Rate for Payer: BCN Commercial |
$776.88
|
| Rate for Payer: Cash Price |
$752.52
|
| Rate for Payer: Cofinity Commercial |
$808.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.52
|
| Rate for Payer: Healthscope Commercial |
$846.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$705.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.55
|
| Rate for Payer: Nomi Health Commercial |
$771.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.49
|
| Rate for Payer: PHP Commercial |
$799.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$818.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$654.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.77
|
| Rate for Payer: UHC Core |
$785.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$705.49
|
|
|
HC GROSHONG REPAIR KIT
|
Facility
|
OP
|
$473.46
|
|
| Hospital Charge Code |
27200125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$426.11 |
| Rate for Payer: Aetna Commercial |
$402.44
|
| Rate for Payer: Aetna Medicare |
$123.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.96
|
| Rate for Payer: BCBS Complete |
$87.64
|
| Rate for Payer: BCBS MAPPO |
$118.36
|
| Rate for Payer: BCBS Trust/PPO |
$389.23
|
| Rate for Payer: BCN Commercial |
$389.23
|
| Rate for Payer: BCN Medicare Advantage |
$118.36
|
| Rate for Payer: Cash Price |
$378.77
|
| Rate for Payer: Cofinity Commercial |
$407.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.36
|
| Rate for Payer: Healthscope Commercial |
$426.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.10
|
| Rate for Payer: Mclaren Medicaid |
$83.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.28
|
| Rate for Payer: Meridian Medicaid |
$87.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.44
|
| Rate for Payer: Nomi Health Commercial |
$388.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$355.10
|
| Rate for Payer: PACE Senior Care Partners |
$112.45
|
| Rate for Payer: PACE SWMI |
$118.36
|
| Rate for Payer: PHP Commercial |
$402.44
|
| Rate for Payer: PHP Medicare Advantage |
$118.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$411.91
|
| Rate for Payer: Priority Health Medicare |
$119.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$329.53
|
| Rate for Payer: Railroad Medicare Medicare |
$118.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.64
|
| Rate for Payer: UHC Core |
$395.34
|
| Rate for Payer: UHC Exchange |
$118.36
|
| Rate for Payer: UHC Medicaid |
$83.47
|
| Rate for Payer: UHC Medicare Advantage |
$118.36
|
| Rate for Payer: UHCCP Medicaid |
$83.47
|
| Rate for Payer: VA VA |
$118.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.10
|
|
|
HC GROSHONG REPAIR KIT
|
Facility
|
IP
|
$473.46
|
|
| Hospital Charge Code |
27200125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$329.53 |
| Max. Negotiated Rate |
$426.11 |
| Rate for Payer: Aetna Commercial |
$402.44
|
| Rate for Payer: BCBS Trust/PPO |
$391.03
|
| Rate for Payer: BCN Commercial |
$391.03
|
| Rate for Payer: Cash Price |
$378.77
|
| Rate for Payer: Cofinity Commercial |
$407.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.77
|
| Rate for Payer: Healthscope Commercial |
$426.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$355.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.44
|
| Rate for Payer: Nomi Health Commercial |
$388.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$355.10
|
| Rate for Payer: PHP Commercial |
$402.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$411.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$329.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$416.64
|
| Rate for Payer: UHC Core |
$395.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$355.10
|
|
|
HC GROUP B STREP, AMPLIFIED
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
30600210
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$73.86 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: BCBS Trust/PPO |
$87.64
|
| Rate for Payer: BCN Commercial |
$87.64
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.39
|
| Rate for Payer: UHC Core |
$88.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.59
|
|
|
HC GROUP B STREP, AMPLIFIED
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
30600210
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna Medicare |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.16
|
| Rate for Payer: BCBS Complete |
$19.64
|
| Rate for Payer: BCBS MAPPO |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$87.24
|
| Rate for Payer: BCN Commercial |
$87.24
|
| Rate for Payer: BCN Medicare Advantage |
$26.53
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.53
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.59
|
| Rate for Payer: Mclaren Medicaid |
$18.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.86
|
| Rate for Payer: Meridian Medicaid |
$19.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PACE Senior Care Partners |
$25.20
|
| Rate for Payer: PACE SWMI |
$26.53
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: PHP Medicare Advantage |
$26.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.32
|
| Rate for Payer: Priority Health Medicare |
$26.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.86
|
| Rate for Payer: Railroad Medicare Medicare |
$26.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.39
|
| Rate for Payer: UHC Core |
$88.61
|
| Rate for Payer: UHC Exchange |
$26.53
|
| Rate for Payer: UHC Medicaid |
$18.71
|
| Rate for Payer: UHC Medicare Advantage |
$26.53
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: VA VA |
$26.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.59
|
|
|
HC GROUP PSYCHOTHERAPY
|
Facility
|
IP
|
$100.82
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
91500001
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$70.17 |
| Max. Negotiated Rate |
$90.74 |
| Rate for Payer: Aetna Commercial |
$85.70
|
| Rate for Payer: BCBS Trust/PPO |
$83.27
|
| Rate for Payer: BCN Commercial |
$83.27
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Commercial |
$86.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$90.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PHP Commercial |
$85.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.17
|
| Rate for Payer: UHC Core |
$84.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.61
|
|
|
HC GROUP PSYCHOTHERAPY
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
91500001
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$17.77 |
| Max. Negotiated Rate |
$90.74 |
| Rate for Payer: Aetna Commercial |
$85.70
|
| Rate for Payer: Aetna Medicare |
$26.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.51
|
| Rate for Payer: BCBS Complete |
$18.66
|
| Rate for Payer: BCBS MAPPO |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$82.88
|
| Rate for Payer: BCN Commercial |
$82.88
|
| Rate for Payer: BCN Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Commercial |
$86.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$90.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.61
|
| Rate for Payer: Mclaren Medicaid |
$17.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.47
|
| Rate for Payer: Meridian Medicaid |
$18.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PACE Senior Care Partners |
$23.94
|
| Rate for Payer: PACE SWMI |
$25.20
|
| Rate for Payer: PHP Commercial |
$85.70
|
| Rate for Payer: PHP Medicare Advantage |
$25.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.71
|
| Rate for Payer: Priority Health Medicare |
$25.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.17
|
| Rate for Payer: Railroad Medicare Medicare |
$25.20
|
| Rate for Payer: UHC Core |
$84.18
|
| Rate for Payer: UHC Exchange |
$25.20
|
| Rate for Payer: UHC Medicaid |
$17.77
|
| Rate for Payer: UHC Medicare Advantage |
$25.20
|
| Rate for Payer: UHCCP Medicaid |
$17.77
|
| Rate for Payer: VA VA |
$25.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.61
|
|
|
HC GROUP SESSION 30 MIN RD G0109
|
Facility
|
OP
|
$64.35
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200028
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$57.91 |
| Rate for Payer: Aetna Commercial |
$54.70
|
| Rate for Payer: Aetna Medicare |
$16.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.11
|
| Rate for Payer: BCBS Complete |
$11.91
|
| Rate for Payer: BCBS MAPPO |
$16.09
|
| Rate for Payer: BCBS Trust/PPO |
$52.90
|
| Rate for Payer: BCN Commercial |
$52.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.09
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cofinity Commercial |
$55.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.09
|
| Rate for Payer: Healthscope Commercial |
$57.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.26
|
| Rate for Payer: Mclaren Medicaid |
$11.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.89
|
| Rate for Payer: Meridian Medicaid |
$11.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.70
|
| Rate for Payer: Nomi Health Commercial |
$52.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.26
|
| Rate for Payer: PACE Senior Care Partners |
$15.28
|
| Rate for Payer: PACE SWMI |
$16.09
|
| Rate for Payer: PHP Commercial |
$54.70
|
| Rate for Payer: PHP Medicare Advantage |
$16.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.98
|
| Rate for Payer: Priority Health Medicare |
$16.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.79
|
| Rate for Payer: Railroad Medicare Medicare |
$16.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.63
|
| Rate for Payer: UHC Core |
$53.73
|
| Rate for Payer: UHC Exchange |
$16.09
|
| Rate for Payer: UHC Medicaid |
$11.34
|
| Rate for Payer: UHC Medicare Advantage |
$16.09
|
| Rate for Payer: UHCCP Medicaid |
$11.34
|
| Rate for Payer: VA VA |
$16.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.26
|
|
|
HC GROUP SESSION 30 MIN RD G0109
|
Facility
|
IP
|
$64.35
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
94200028
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$57.91 |
| Rate for Payer: Aetna Commercial |
$54.70
|
| Rate for Payer: BCBS Trust/PPO |
$53.15
|
| Rate for Payer: BCN Commercial |
$53.15
|
| Rate for Payer: Cash Price |
$51.48
|
| Rate for Payer: Cofinity Commercial |
$55.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.48
|
| Rate for Payer: Healthscope Commercial |
$57.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.70
|
| Rate for Payer: Nomi Health Commercial |
$52.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.26
|
| Rate for Payer: PHP Commercial |
$54.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.63
|
| Rate for Payer: UHC Core |
$53.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.26
|
|
