|
HC HDR 2-12 CHANNELS
|
Facility
|
OP
|
$2,254.25
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$397.42 |
| Max. Negotiated Rate |
$2,028.83 |
| Rate for Payer: Aetna Commercial |
$1,916.11
|
| Rate for Payer: Aetna Medicare |
$586.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$704.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$704.45
|
| Rate for Payer: BCBS Complete |
$417.26
|
| Rate for Payer: BCBS MAPPO |
$563.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,853.22
|
| Rate for Payer: BCN Commercial |
$1,853.22
|
| Rate for Payer: BCN Medicare Advantage |
$563.56
|
| Rate for Payer: Cash Price |
$1,803.40
|
| Rate for Payer: Cofinity Commercial |
$1,938.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$563.56
|
| Rate for Payer: Healthscope Commercial |
$2,028.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,690.69
|
| Rate for Payer: Mclaren Medicaid |
$397.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$591.74
|
| Rate for Payer: Meridian Medicaid |
$417.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$648.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$619.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.11
|
| Rate for Payer: Nomi Health Commercial |
$1,848.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,690.69
|
| Rate for Payer: PACE Senior Care Partners |
$535.38
|
| Rate for Payer: PACE SWMI |
$563.56
|
| Rate for Payer: PHP Commercial |
$1,916.11
|
| Rate for Payer: PHP Medicare Advantage |
$563.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$397.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,961.20
|
| Rate for Payer: Priority Health Medicare |
$569.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,568.96
|
| Rate for Payer: Railroad Medicare Medicare |
$563.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,983.74
|
| Rate for Payer: UHC Core |
$1,882.30
|
| Rate for Payer: UHC Exchange |
$563.56
|
| Rate for Payer: UHC Medicaid |
$397.42
|
| Rate for Payer: UHC Medicare Advantage |
$563.56
|
| Rate for Payer: UHCCP Medicaid |
$397.42
|
| Rate for Payer: VA VA |
$563.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,690.69
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
IP
|
$2,254.25
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,568.96 |
| Max. Negotiated Rate |
$2,028.83 |
| Rate for Payer: Aetna Commercial |
$1,916.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,861.79
|
| Rate for Payer: BCN Commercial |
$1,861.79
|
| Rate for Payer: Cash Price |
$1,803.40
|
| Rate for Payer: Cofinity Commercial |
$1,938.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.40
|
| Rate for Payer: Healthscope Commercial |
$2,028.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,690.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.11
|
| Rate for Payer: Nomi Health Commercial |
$1,848.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,690.69
|
| Rate for Payer: PHP Commercial |
$1,916.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,961.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,568.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,983.74
|
| Rate for Payer: UHC Core |
$1,882.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,690.69
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
IP
|
$573.66
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.27 |
| Max. Negotiated Rate |
$516.29 |
| Rate for Payer: Aetna Commercial |
$487.61
|
| Rate for Payer: BCBS Trust/PPO |
$473.79
|
| Rate for Payer: BCN Commercial |
$473.79
|
| Rate for Payer: Cash Price |
$458.93
|
| Rate for Payer: Cofinity Commercial |
$493.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.93
|
| Rate for Payer: Healthscope Commercial |
$516.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.61
|
| Rate for Payer: Nomi Health Commercial |
$470.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.25
|
| Rate for Payer: PHP Commercial |
$487.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$499.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$399.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.82
|
| Rate for Payer: UHC Core |
$479.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.25
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
OP
|
$573.66
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.14 |
| Max. Negotiated Rate |
$516.29 |
| Rate for Payer: Aetna Commercial |
$487.61
|
| Rate for Payer: Aetna Medicare |
$149.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.27
|
| Rate for Payer: BCBS Complete |
$106.18
|
| Rate for Payer: BCBS MAPPO |
$143.41
|
| Rate for Payer: BCBS Trust/PPO |
$471.61
|
| Rate for Payer: BCN Commercial |
$471.61
|
| Rate for Payer: BCN Medicare Advantage |
$143.41
|
| Rate for Payer: Cash Price |
$458.93
|
| Rate for Payer: Cofinity Commercial |
$493.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.41
|
| Rate for Payer: Healthscope Commercial |
$516.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.25
|
| Rate for Payer: Mclaren Medicaid |
$101.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.59
|
| Rate for Payer: Meridian Medicaid |
$106.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$157.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.61
|
| Rate for Payer: Nomi Health Commercial |
$470.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.25
|
| Rate for Payer: PACE Senior Care Partners |
$136.24
|
| Rate for Payer: PACE SWMI |
$143.41
|
| Rate for Payer: PHP Commercial |
$487.61
|
| Rate for Payer: PHP Medicare Advantage |
$143.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$499.08
|
| Rate for Payer: Priority Health Medicare |
$144.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$399.27
|
| Rate for Payer: Railroad Medicare Medicare |
$143.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.82
|
| Rate for Payer: UHC Core |
$479.01
|
| Rate for Payer: UHC Exchange |
$143.41
|
| Rate for Payer: UHC Medicaid |
$101.14
|
| Rate for Payer: UHC Medicare Advantage |
$143.41
|
| Rate for Payer: UHCCP Medicaid |
$101.14
|
| Rate for Payer: VA VA |
$143.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.25
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
IP
|
$2,487.67
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,731.42 |
| Max. Negotiated Rate |
$2,238.90 |
| Rate for Payer: Aetna Commercial |
$2,114.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,054.57
|
| Rate for Payer: BCN Commercial |
$2,054.57
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cofinity Commercial |
$2,139.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,990.14
|
| Rate for Payer: Healthscope Commercial |
$2,238.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,865.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,114.52
|
| Rate for Payer: Nomi Health Commercial |
$2,039.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,865.75
|
| Rate for Payer: PHP Commercial |
$2,114.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,164.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,731.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,189.15
|
| Rate for Payer: UHC Core |
$2,077.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,865.75
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
OP
|
$2,487.67
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$438.58 |
| Max. Negotiated Rate |
$2,238.90 |
| Rate for Payer: Aetna Commercial |
$2,114.52
|
| Rate for Payer: Aetna Medicare |
$646.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$777.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$777.40
|
| Rate for Payer: BCBS Complete |
$460.47
|
| Rate for Payer: BCBS MAPPO |
$621.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,045.11
|
| Rate for Payer: BCN Commercial |
$2,045.11
|
| Rate for Payer: BCN Medicare Advantage |
$621.92
|
| Rate for Payer: Cash Price |
$1,990.14
|
| Rate for Payer: Cofinity Commercial |
$2,139.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,990.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.92
|
| Rate for Payer: Healthscope Commercial |
$2,238.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,865.75
|
| Rate for Payer: Mclaren Medicaid |
$438.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$653.01
|
| Rate for Payer: Meridian Medicaid |
$460.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$715.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$684.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,114.52
|
| Rate for Payer: Nomi Health Commercial |
$2,039.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,865.75
|
| Rate for Payer: PACE Senior Care Partners |
$590.82
|
| Rate for Payer: PACE SWMI |
$621.92
|
| Rate for Payer: PHP Commercial |
$2,114.52
|
| Rate for Payer: PHP Medicare Advantage |
$621.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$438.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,164.27
|
| Rate for Payer: Priority Health Medicare |
$628.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,731.42
|
| Rate for Payer: Railroad Medicare Medicare |
$621.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,189.15
|
| Rate for Payer: UHC Core |
$2,077.20
|
| Rate for Payer: UHC Exchange |
$621.92
|
| Rate for Payer: UHC Medicaid |
$438.58
|
| Rate for Payer: UHC Medicare Advantage |
$621.92
|
| Rate for Payer: UHCCP Medicaid |
$438.58
|
| Rate for Payer: VA VA |
$621.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,865.75
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
IP
|
$491.40
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$342.01 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: BCBS Trust/PPO |
$405.85
|
| Rate for Payer: BCN Commercial |
$405.85
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Nomi Health Commercial |
$402.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$427.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$342.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.43
|
| Rate for Payer: UHC Core |
$410.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.55
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
OP
|
$491.40
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$86.63 |
| Max. Negotiated Rate |
$442.26 |
| Rate for Payer: Aetna Commercial |
$417.69
|
| Rate for Payer: Aetna Medicare |
$127.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.56
|
| Rate for Payer: BCBS Complete |
$90.96
|
| Rate for Payer: BCBS MAPPO |
$122.85
|
| Rate for Payer: BCBS Trust/PPO |
$403.98
|
| Rate for Payer: BCN Commercial |
$403.98
|
| Rate for Payer: BCN Medicare Advantage |
$122.85
|
| Rate for Payer: Cash Price |
$393.12
|
| Rate for Payer: Cofinity Commercial |
$422.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.85
|
| Rate for Payer: Healthscope Commercial |
$442.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$368.55
|
| Rate for Payer: Mclaren Medicaid |
$86.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.99
|
| Rate for Payer: Meridian Medicaid |
$90.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.69
|
| Rate for Payer: Nomi Health Commercial |
$402.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$368.55
|
| Rate for Payer: PACE Senior Care Partners |
$116.71
|
| Rate for Payer: PACE SWMI |
$122.85
|
| Rate for Payer: PHP Commercial |
$417.69
|
| Rate for Payer: PHP Medicare Advantage |
$122.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$427.52
|
| Rate for Payer: Priority Health Medicare |
$124.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$342.01
|
| Rate for Payer: Railroad Medicare Medicare |
$122.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.43
|
| Rate for Payer: UHC Core |
$410.32
|
| Rate for Payer: UHC Exchange |
$122.85
|
| Rate for Payer: UHC Medicaid |
$86.63
|
| Rate for Payer: UHC Medicare Advantage |
$122.85
|
| Rate for Payer: UHCCP Medicaid |
$86.63
|
| Rate for Payer: VA VA |
$122.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$368.55
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
OP
|
$552.83
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$97.46 |
| Max. Negotiated Rate |
$497.55 |
| Rate for Payer: Aetna Commercial |
$469.91
|
| Rate for Payer: Aetna Medicare |
$143.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$172.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$172.76
|
| Rate for Payer: BCBS Complete |
$102.33
|
| Rate for Payer: BCBS MAPPO |
$138.21
|
| Rate for Payer: BCBS Trust/PPO |
$454.48
|
| Rate for Payer: BCN Commercial |
$454.48
|
| Rate for Payer: BCN Medicare Advantage |
$138.21
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Commercial |
$475.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.21
|
| Rate for Payer: Healthscope Commercial |
$497.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.62
|
| Rate for Payer: Mclaren Medicaid |
$97.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.12
|
| Rate for Payer: Meridian Medicaid |
$102.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$152.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.91
|
| Rate for Payer: Nomi Health Commercial |
$453.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: PACE Senior Care Partners |
$131.30
|
| Rate for Payer: PACE SWMI |
$138.21
|
| Rate for Payer: PHP Commercial |
$469.91
|
| Rate for Payer: PHP Medicare Advantage |
$138.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$480.96
|
| Rate for Payer: Priority Health Medicare |
$139.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$384.77
|
| Rate for Payer: Railroad Medicare Medicare |
$138.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.49
|
| Rate for Payer: UHC Core |
$461.61
|
| Rate for Payer: UHC Exchange |
$138.21
|
| Rate for Payer: UHC Medicaid |
$97.46
|
| Rate for Payer: UHC Medicare Advantage |
$138.21
|
| Rate for Payer: UHCCP Medicaid |
$97.46
|
| Rate for Payer: VA VA |
$138.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.62
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
IP
|
$552.83
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$384.77 |
| Max. Negotiated Rate |
$497.55 |
| Rate for Payer: Aetna Commercial |
$469.91
|
| Rate for Payer: BCBS Trust/PPO |
$456.58
|
| Rate for Payer: BCN Commercial |
$456.58
|
| Rate for Payer: Cash Price |
$442.26
|
| Rate for Payer: Cofinity Commercial |
$475.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.26
|
| Rate for Payer: Healthscope Commercial |
$497.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$414.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.91
|
| Rate for Payer: Nomi Health Commercial |
$453.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.62
|
| Rate for Payer: PHP Commercial |
$469.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$480.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$384.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.49
|
| Rate for Payer: UHC Core |
$461.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$414.62
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
OP
|
$125.23
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$112.71 |
| Rate for Payer: Aetna Commercial |
$106.45
|
| Rate for Payer: Aetna Medicare |
$32.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.13
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS MAPPO |
$31.31
|
| Rate for Payer: BCBS Trust/PPO |
$102.95
|
| Rate for Payer: BCN Commercial |
$102.95
|
| Rate for Payer: BCN Medicare Advantage |
$31.31
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Commercial |
$107.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.31
|
| Rate for Payer: Healthscope Commercial |
$112.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.92
|
| Rate for Payer: Mclaren Medicaid |
$22.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.87
|
| Rate for Payer: Meridian Medicaid |
$23.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Nomi Health Commercial |
$102.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PACE Senior Care Partners |
$29.74
|
| Rate for Payer: PACE SWMI |
$31.31
|
| Rate for Payer: PHP Commercial |
$106.45
|
| Rate for Payer: PHP Medicare Advantage |
$31.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.95
|
| Rate for Payer: Priority Health Medicare |
$31.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.16
|
| Rate for Payer: Railroad Medicare Medicare |
$31.31
|
| Rate for Payer: UHC Core |
$104.57
|
| Rate for Payer: UHC Exchange |
$31.31
|
| Rate for Payer: UHC Medicaid |
$22.08
|
| Rate for Payer: UHC Medicare Advantage |
$31.31
|
| Rate for Payer: UHCCP Medicaid |
$22.08
|
| Rate for Payer: VA VA |
$31.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.92
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
IP
|
$125.23
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$87.16 |
| Max. Negotiated Rate |
$112.71 |
| Rate for Payer: Aetna Commercial |
$106.45
|
| Rate for Payer: BCBS Trust/PPO |
$103.43
|
| Rate for Payer: BCN Commercial |
$103.43
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Commercial |
$107.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Healthscope Commercial |
$112.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Nomi Health Commercial |
$102.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PHP Commercial |
$106.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.16
|
| Rate for Payer: UHC Core |
$104.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.92
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
OP
|
$62.61
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$56.35 |
| Rate for Payer: Aetna Commercial |
$53.22
|
| Rate for Payer: Aetna Medicare |
$16.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.57
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: BCBS MAPPO |
$15.65
|
| Rate for Payer: BCBS Trust/PPO |
$51.47
|
| Rate for Payer: BCN Commercial |
$51.47
|
| Rate for Payer: BCN Medicare Advantage |
$15.65
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.65
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.96
|
| Rate for Payer: Mclaren Medicaid |
$11.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.44
|
| Rate for Payer: Meridian Medicaid |
$11.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Nomi Health Commercial |
$51.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: PACE Senior Care Partners |
$14.87
|
| Rate for Payer: PACE SWMI |
$15.65
|
| Rate for Payer: PHP Commercial |
$53.22
|
| Rate for Payer: PHP Medicare Advantage |
$15.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.47
|
| Rate for Payer: Priority Health Medicare |
$15.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.58
|
| Rate for Payer: Railroad Medicare Medicare |
$15.65
|
| Rate for Payer: UHC Core |
$52.28
|
| Rate for Payer: UHC Exchange |
$15.65
|
| Rate for Payer: UHC Medicaid |
$11.04
|
| Rate for Payer: UHC Medicare Advantage |
$15.65
|
| Rate for Payer: UHCCP Medicaid |
$11.04
|
| Rate for Payer: VA VA |
$15.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.96
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
IP
|
$62.61
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$56.35 |
| Rate for Payer: Aetna Commercial |
$53.22
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCN Commercial |
$51.71
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Nomi Health Commercial |
$51.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: PHP Commercial |
$53.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.58
|
| Rate for Payer: UHC Core |
$52.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.96
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
OP
|
$125.23
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$112.71 |
| Rate for Payer: Aetna Commercial |
$106.45
|
| Rate for Payer: Aetna Medicare |
$32.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.13
|
| Rate for Payer: BCBS Complete |
$23.18
|
| Rate for Payer: BCBS MAPPO |
$31.31
|
| Rate for Payer: BCBS Trust/PPO |
$102.95
|
| Rate for Payer: BCN Commercial |
$102.95
|
| Rate for Payer: BCN Medicare Advantage |
$31.31
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Commercial |
$107.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.31
|
| Rate for Payer: Healthscope Commercial |
$112.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.92
|
| Rate for Payer: Mclaren Medicaid |
$22.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.87
|
| Rate for Payer: Meridian Medicaid |
$23.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Nomi Health Commercial |
$102.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PACE Senior Care Partners |
$29.74
|
| Rate for Payer: PACE SWMI |
$31.31
|
| Rate for Payer: PHP Commercial |
$106.45
|
| Rate for Payer: PHP Medicare Advantage |
$31.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.95
|
| Rate for Payer: Priority Health Medicare |
$31.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.16
|
| Rate for Payer: Railroad Medicare Medicare |
$31.31
|
| Rate for Payer: UHC Core |
$104.57
|
| Rate for Payer: UHC Exchange |
$31.31
|
| Rate for Payer: UHC Medicaid |
$22.08
|
| Rate for Payer: UHC Medicare Advantage |
$31.31
|
| Rate for Payer: UHCCP Medicaid |
$22.08
|
| Rate for Payer: VA VA |
$31.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.92
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
IP
|
$125.23
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$87.16 |
| Max. Negotiated Rate |
$112.71 |
| Rate for Payer: Aetna Commercial |
$106.45
|
| Rate for Payer: BCBS Trust/PPO |
$103.43
|
| Rate for Payer: BCN Commercial |
$103.43
|
| Rate for Payer: Cash Price |
$100.18
|
| Rate for Payer: Cofinity Commercial |
$107.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.18
|
| Rate for Payer: Healthscope Commercial |
$112.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.45
|
| Rate for Payer: Nomi Health Commercial |
$102.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.92
|
| Rate for Payer: PHP Commercial |
$106.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.16
|
| Rate for Payer: UHC Core |
$104.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.92
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$16.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.51
|
| Rate for Payer: BCBS Complete |
$11.55
|
| Rate for Payer: BCBS MAPPO |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$51.32
|
| Rate for Payer: BCN Commercial |
$51.32
|
| Rate for Payer: BCN Medicare Advantage |
$15.61
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Mclaren Medicaid |
$11.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.39
|
| Rate for Payer: Meridian Medicaid |
$11.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PACE Senior Care Partners |
$14.82
|
| Rate for Payer: PACE SWMI |
$15.61
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$15.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Medicare |
$15.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.44
|
| Rate for Payer: Railroad Medicare Medicare |
$15.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: UHC Exchange |
$15.61
|
| Rate for Payer: UHC Medicaid |
$11.00
|
| Rate for Payer: UHC Medicare Advantage |
$15.61
|
| Rate for Payer: UHCCP Medicaid |
$11.00
|
| Rate for Payer: VA VA |
$15.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: BCBS Trust/PPO |
$51.55
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC HEARING AID CHECK MONAURAL
|
Facility
|
IP
|
$55.14
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
47100402
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$38.38 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: BCBS Trust/PPO |
$45.54
|
| Rate for Payer: BCN Commercial |
$45.54
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$49.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.35
|
| Rate for Payer: PHP Commercial |
$46.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.52
|
| Rate for Payer: UHC Core |
$46.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.35
|
|
|
HC HEARING AID CHECK MONAURAL
|
Facility
|
OP
|
$55.14
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
47100402
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Aetna Medicare |
$14.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.23
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS MAPPO |
$13.79
|
| Rate for Payer: BCBS Trust/PPO |
$45.33
|
| Rate for Payer: BCN Commercial |
$45.33
|
| Rate for Payer: BCN Medicare Advantage |
$13.79
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$49.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.35
|
| Rate for Payer: Mclaren Medicaid |
$9.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.47
|
| Rate for Payer: Meridian Medicaid |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.35
|
| Rate for Payer: PACE Senior Care Partners |
$13.10
|
| Rate for Payer: PACE SWMI |
$13.79
|
| Rate for Payer: PHP Commercial |
$46.87
|
| Rate for Payer: PHP Medicare Advantage |
$13.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.97
|
| Rate for Payer: Priority Health Medicare |
$13.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.38
|
| Rate for Payer: Railroad Medicare Medicare |
$13.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.52
|
| Rate for Payer: UHC Core |
$46.04
|
| Rate for Payer: UHC Exchange |
$13.79
|
| Rate for Payer: UHC Medicaid |
$9.72
|
| Rate for Payer: UHC Medicare Advantage |
$13.79
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$13.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.35
|
|
|
HC HEARING AID EXAM BOTH EARS
|
Facility
|
IP
|
$123.81
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$86.17 |
| Max. Negotiated Rate |
$111.43 |
| Rate for Payer: Aetna Commercial |
$105.24
|
| Rate for Payer: BCBS Trust/PPO |
$102.25
|
| Rate for Payer: BCN Commercial |
$102.25
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cofinity Commercial |
$106.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.05
|
| Rate for Payer: Healthscope Commercial |
$111.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.24
|
| Rate for Payer: Nomi Health Commercial |
$101.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.86
|
| Rate for Payer: PHP Commercial |
$105.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$107.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.95
|
| Rate for Payer: UHC Core |
$103.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.86
|
|
|
HC HEARING AID EXAM BOTH EARS
|
Facility
|
OP
|
$123.81
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$111.43 |
| Rate for Payer: Aetna Commercial |
$105.24
|
| Rate for Payer: Aetna Medicare |
$32.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.69
|
| Rate for Payer: BCBS Complete |
$22.92
|
| Rate for Payer: BCBS MAPPO |
$30.95
|
| Rate for Payer: BCBS Trust/PPO |
$101.78
|
| Rate for Payer: BCN Commercial |
$101.78
|
| Rate for Payer: BCN Medicare Advantage |
$30.95
|
| Rate for Payer: Cash Price |
$99.05
|
| Rate for Payer: Cofinity Commercial |
$106.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.95
|
| Rate for Payer: Healthscope Commercial |
$111.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.86
|
| Rate for Payer: Mclaren Medicaid |
$21.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.50
|
| Rate for Payer: Meridian Medicaid |
$22.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.24
|
| Rate for Payer: Nomi Health Commercial |
$101.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.86
|
| Rate for Payer: PACE Senior Care Partners |
$29.40
|
| Rate for Payer: PACE SWMI |
$30.95
|
| Rate for Payer: PHP Commercial |
$105.24
|
| Rate for Payer: PHP Medicare Advantage |
$30.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$107.71
|
| Rate for Payer: Priority Health Medicare |
$31.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.17
|
| Rate for Payer: Railroad Medicare Medicare |
$30.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.95
|
| Rate for Payer: UHC Core |
$103.38
|
| Rate for Payer: UHC Exchange |
$30.95
|
| Rate for Payer: UHC Medicaid |
$21.83
|
| Rate for Payer: UHC Medicare Advantage |
$30.95
|
| Rate for Payer: UHCCP Medicaid |
$21.83
|
| Rate for Payer: VA VA |
$30.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.86
|
|
|
HC HEARING AID EXAM ONE EAR
|
Facility
|
IP
|
$113.40
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$78.93 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: BCBS Trust/PPO |
$93.66
|
| Rate for Payer: BCN Commercial |
$93.66
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$97.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.72
|
| Rate for Payer: Healthscope Commercial |
$102.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.39
|
| Rate for Payer: Nomi Health Commercial |
$92.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.05
|
| Rate for Payer: PHP Commercial |
$96.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$98.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.79
|
| Rate for Payer: UHC Core |
$94.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.05
|
|
|
HC HEARING AID EXAM ONE EAR
|
Facility
|
OP
|
$113.40
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: Aetna Medicare |
$29.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.44
|
| Rate for Payer: BCBS Complete |
$20.99
|
| Rate for Payer: BCBS MAPPO |
$28.35
|
| Rate for Payer: BCBS Trust/PPO |
$93.23
|
| Rate for Payer: BCN Commercial |
$93.23
|
| Rate for Payer: BCN Medicare Advantage |
$28.35
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$97.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.35
|
| Rate for Payer: Healthscope Commercial |
$102.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.05
|
| Rate for Payer: Mclaren Medicaid |
$19.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.77
|
| Rate for Payer: Meridian Medicaid |
$20.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.39
|
| Rate for Payer: Nomi Health Commercial |
$92.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.05
|
| Rate for Payer: PACE Senior Care Partners |
$26.93
|
| Rate for Payer: PACE SWMI |
$28.35
|
| Rate for Payer: PHP Commercial |
$96.39
|
| Rate for Payer: PHP Medicare Advantage |
$28.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$98.66
|
| Rate for Payer: Priority Health Medicare |
$28.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.93
|
| Rate for Payer: Railroad Medicare Medicare |
$28.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.79
|
| Rate for Payer: UHC Core |
$94.69
|
| Rate for Payer: UHC Exchange |
$28.35
|
| Rate for Payer: UHC Medicaid |
$19.99
|
| Rate for Payer: UHC Medicare Advantage |
$28.35
|
| Rate for Payer: UHCCP Medicaid |
$19.99
|
| Rate for Payer: VA VA |
$28.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.05
|
|
|
HC HEART CATH CORONARIES CABG'S
|
Facility
|
IP
|
$12,456.64
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
48100018
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,669.82 |
| Max. Negotiated Rate |
$11,210.98 |
| Rate for Payer: Aetna Commercial |
$10,588.14
|
| Rate for Payer: BCBS Trust/PPO |
$10,287.94
|
| Rate for Payer: BCN Commercial |
$10,287.94
|
| Rate for Payer: Cash Price |
$9,965.31
|
| Rate for Payer: Cofinity Commercial |
$10,712.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,965.31
|
| Rate for Payer: Healthscope Commercial |
$11,210.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,342.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,588.14
|
| Rate for Payer: Nomi Health Commercial |
$10,214.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,342.48
|
| Rate for Payer: PHP Commercial |
$10,588.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10,837.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,669.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,961.84
|
| Rate for Payer: UHC Core |
$10,401.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,342.48
|
|
