|
HC ETHYL GLUCURONIDE SCREEN W/REFLEX, URINE
|
Facility
|
OP
|
$128.42
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100749
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$115.58 |
| Rate for Payer: Aetna Commercial |
$109.16
|
| Rate for Payer: Aetna Medicare |
$33.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.13
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$32.10
|
| Rate for Payer: BCBS Trust/PPO |
$105.57
|
| Rate for Payer: BCN Commercial |
$99.85
|
| Rate for Payer: BCN Medicare Advantage |
$32.10
|
| Rate for Payer: Cash Price |
$102.74
|
| Rate for Payer: Cash Price |
$102.74
|
| Rate for Payer: Cofinity Commercial |
$110.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.10
|
| Rate for Payer: Healthscope Commercial |
$115.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.32
|
| Rate for Payer: Mclaren Medicaid |
$44.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.71
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.16
|
| Rate for Payer: Nomi Health Commercial |
$105.30
|
| Rate for Payer: PACE Senior Care Partners |
$30.50
|
| Rate for Payer: PACE SWMI |
$32.10
|
| Rate for Payer: PHP Commercial |
$109.16
|
| Rate for Payer: PHP Medicare Advantage |
$32.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.47
|
| Rate for Payer: Priority Health HMO/PPO |
$111.73
|
| Rate for Payer: Priority Health Medicare |
$32.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.04
|
| Rate for Payer: Railroad Medicare Medicare |
$32.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.01
|
| Rate for Payer: UHC Core |
$107.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.10
|
| Rate for Payer: UHC Exchange |
$32.10
|
| Rate for Payer: UHC Medicare Advantage |
$32.10
|
| Rate for Payer: UHCCP Medicaid |
$44.93
|
| Rate for Payer: VA VA |
$32.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.32
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
IP
|
$1,546.41
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,005.17 |
| Max. Negotiated Rate |
$1,391.77 |
| Rate for Payer: Aetna Commercial |
$1,314.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.33
|
| Rate for Payer: BCN Commercial |
$1,195.07
|
| Rate for Payer: Cash Price |
$1,237.13
|
| Rate for Payer: Cofinity Commercial |
$1,329.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,237.13
|
| Rate for Payer: Healthscope Commercial |
$1,391.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.45
|
| Rate for Payer: Nomi Health Commercial |
$1,268.06
|
| Rate for Payer: PHP Commercial |
$1,314.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,345.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,036.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,360.84
|
| Rate for Payer: UHC Core |
$1,291.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.81
|
|
|
HC ETONOGESTREL IMPLANT SYSTEM
|
Facility
|
OP
|
$1,546.41
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
63600148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$367.27 |
| Max. Negotiated Rate |
$1,391.77 |
| Rate for Payer: Aetna Commercial |
$1,314.45
|
| Rate for Payer: Aetna Medicare |
$402.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$483.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$483.25
|
| Rate for Payer: BCBS Complete |
$618.56
|
| Rate for Payer: BCBS MAPPO |
$386.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.30
|
| Rate for Payer: BCN Commercial |
$1,202.33
|
| Rate for Payer: BCN Medicare Advantage |
$386.60
|
| Rate for Payer: Cash Price |
$1,237.13
|
| Rate for Payer: Cofinity Commercial |
$1,329.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,237.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.60
|
| Rate for Payer: Healthscope Commercial |
$1,391.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,159.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$405.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$444.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,314.45
|
| Rate for Payer: Nomi Health Commercial |
$1,268.06
|
| Rate for Payer: PACE Senior Care Partners |
$367.27
|
| Rate for Payer: PACE SWMI |
$386.60
|
| Rate for Payer: PHP Commercial |
$1,314.45
|
| Rate for Payer: PHP Medicare Advantage |
$386.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,345.38
|
| Rate for Payer: Priority Health Medicare |
$390.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,036.09
|
| Rate for Payer: Railroad Medicare Medicare |
$386.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,360.84
|
| Rate for Payer: UHC Core |
$1,291.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$386.60
|
| Rate for Payer: UHC Exchange |
$386.60
|
| Rate for Payer: UHC Medicare Advantage |
$386.60
|
| Rate for Payer: VA VA |
$386.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,159.81
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
OP
|
$300.99
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.49 |
| Max. Negotiated Rate |
$270.89 |
| Rate for Payer: Aetna Commercial |
$255.84
|
| Rate for Payer: Aetna Medicare |
$78.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.06
|
| Rate for Payer: BCBS Complete |
$91.62
|
| Rate for Payer: BCBS MAPPO |
$75.25
|
| Rate for Payer: BCBS Trust/PPO |
$247.44
|
| Rate for Payer: BCN Commercial |
$234.02
|
| Rate for Payer: BCN Medicare Advantage |
$75.25
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cofinity Commercial |
$258.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.25
|
| Rate for Payer: Healthscope Commercial |
$270.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.74
|
| Rate for Payer: Mclaren Medicaid |
$87.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.01
|
| Rate for Payer: Meridian Medicaid |
$91.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.84
|
| Rate for Payer: Nomi Health Commercial |
$246.81
|
| Rate for Payer: PACE Senior Care Partners |
$71.49
|
| Rate for Payer: PACE SWMI |
$75.25
|
| Rate for Payer: PHP Commercial |
$255.84
|
| Rate for Payer: PHP Medicare Advantage |
$75.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.64
|
| Rate for Payer: Priority Health HMO/PPO |
$261.86
|
| Rate for Payer: Priority Health Medicare |
$76.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.66
|
| Rate for Payer: Railroad Medicare Medicare |
$75.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.87
|
| Rate for Payer: UHC Core |
$251.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.25
|
| Rate for Payer: UHC Exchange |
$75.25
|
| Rate for Payer: UHC Medicare Advantage |
$75.25
|
| Rate for Payer: UHCCP Medicaid |
$87.25
|
| Rate for Payer: VA VA |
$75.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.74
|
|
|
HC EUFLEXXA INJ PER DOSE
|
Facility
|
IP
|
$300.99
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
63600145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.64 |
| Max. Negotiated Rate |
$270.89 |
| Rate for Payer: Aetna Commercial |
$255.84
|
| Rate for Payer: BCBS Trust/PPO |
$245.70
|
| Rate for Payer: BCN Commercial |
$232.61
|
| Rate for Payer: Cash Price |
$240.79
|
| Rate for Payer: Cofinity Commercial |
$258.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.79
|
| Rate for Payer: Healthscope Commercial |
$270.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.84
|
| Rate for Payer: Nomi Health Commercial |
$246.81
|
| Rate for Payer: PHP Commercial |
$255.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.64
|
| Rate for Payer: Priority Health HMO/PPO |
$261.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.87
|
| Rate for Payer: UHC Core |
$251.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.74
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$92.19
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$78.36
|
| Rate for Payer: Aetna Medicare |
$23.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.81
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: BCBS MAPPO |
$23.05
|
| Rate for Payer: BCBS Trust/PPO |
$75.79
|
| Rate for Payer: BCN Commercial |
$71.68
|
| Rate for Payer: BCN Medicare Advantage |
$23.05
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cofinity Commercial |
$79.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.05
|
| Rate for Payer: Healthscope Commercial |
$82.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.14
|
| Rate for Payer: Mclaren Medicaid |
$91.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.20
|
| Rate for Payer: Meridian Medicaid |
$95.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.36
|
| Rate for Payer: Nomi Health Commercial |
$75.60
|
| Rate for Payer: PACE Senior Care Partners |
$21.90
|
| Rate for Payer: PACE SWMI |
$23.05
|
| Rate for Payer: PHP Commercial |
$78.36
|
| Rate for Payer: PHP Medicare Advantage |
$23.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: Priority Health HMO/PPO |
$80.21
|
| Rate for Payer: Priority Health Medicare |
$23.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.77
|
| Rate for Payer: Railroad Medicare Medicare |
$23.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.13
|
| Rate for Payer: UHC Core |
$76.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.05
|
| Rate for Payer: UHC Exchange |
$23.05
|
| Rate for Payer: UHC Medicare Advantage |
$23.05
|
| Rate for Payer: UHCCP Medicaid |
$91.31
|
| Rate for Payer: VA VA |
$23.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.14
|
|
|
HC EVACUATION SUBUNGUAL HEMATOMA
|
Facility
|
IP
|
$92.19
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
76100113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$82.97 |
| Rate for Payer: Aetna Commercial |
$78.36
|
| Rate for Payer: BCBS Trust/PPO |
$75.25
|
| Rate for Payer: BCN Commercial |
$71.24
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Cofinity Commercial |
$79.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.75
|
| Rate for Payer: Healthscope Commercial |
$82.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.36
|
| Rate for Payer: Nomi Health Commercial |
$75.60
|
| Rate for Payer: PHP Commercial |
$78.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.92
|
| Rate for Payer: Priority Health HMO/PPO |
$80.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.13
|
| Rate for Payer: UHC Core |
$76.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.14
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
OP
|
$261.73
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$62.16 |
| Max. Negotiated Rate |
$235.56 |
| Rate for Payer: Aetna Commercial |
$222.47
|
| Rate for Payer: Aetna Medicare |
$68.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.79
|
| Rate for Payer: BCBS Complete |
$104.69
|
| Rate for Payer: BCBS MAPPO |
$65.43
|
| Rate for Payer: BCBS Trust/PPO |
$215.17
|
| Rate for Payer: BCN Commercial |
$203.50
|
| Rate for Payer: BCN Medicare Advantage |
$65.43
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cofinity Commercial |
$225.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.43
|
| Rate for Payer: Healthscope Commercial |
$235.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.47
|
| Rate for Payer: Nomi Health Commercial |
$214.62
|
| Rate for Payer: PACE Senior Care Partners |
$62.16
|
| Rate for Payer: PACE SWMI |
$65.43
|
| Rate for Payer: PHP Commercial |
$222.47
|
| Rate for Payer: PHP Medicare Advantage |
$65.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.12
|
| Rate for Payer: Priority Health HMO/PPO |
$227.71
|
| Rate for Payer: Priority Health Medicare |
$66.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.36
|
| Rate for Payer: Railroad Medicare Medicare |
$65.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.32
|
| Rate for Payer: UHC Core |
$218.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.43
|
| Rate for Payer: UHC Exchange |
$65.43
|
| Rate for Payer: UHC Medicare Advantage |
$65.43
|
| Rate for Payer: VA VA |
$65.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.30
|
|
|
HC EVAL APHASIA PER HR
|
Facility
|
IP
|
$261.73
|
|
|
Service Code
|
CPT 96105
|
| Hospital Charge Code |
44400013
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$170.12 |
| Max. Negotiated Rate |
$235.56 |
| Rate for Payer: Aetna Commercial |
$222.47
|
| Rate for Payer: BCBS Trust/PPO |
$213.65
|
| Rate for Payer: BCN Commercial |
$202.26
|
| Rate for Payer: Cash Price |
$209.38
|
| Rate for Payer: Cofinity Commercial |
$225.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.38
|
| Rate for Payer: Healthscope Commercial |
$235.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.47
|
| Rate for Payer: Nomi Health Commercial |
$214.62
|
| Rate for Payer: PHP Commercial |
$222.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.12
|
| Rate for Payer: Priority Health HMO/PPO |
$227.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.32
|
| Rate for Payer: UHC Core |
$218.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.30
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
47100017
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$372.30
|
| Rate for Payer: BCBS Trust/PPO |
$357.54
|
| Rate for Payer: BCN Commercial |
$338.49
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$376.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.40
|
| Rate for Payer: Healthscope Commercial |
$394.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.30
|
| Rate for Payer: Nomi Health Commercial |
$359.16
|
| Rate for Payer: PHP Commercial |
$372.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.70
|
| Rate for Payer: Priority Health HMO/PPO |
$381.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.44
|
| Rate for Payer: UHC Core |
$365.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.50
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 92626
|
| Hospital Charge Code |
47100017
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$372.30
|
| Rate for Payer: Aetna Medicare |
$113.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.88
|
| Rate for Payer: BCBS Complete |
$116.39
|
| Rate for Payer: BCBS MAPPO |
$109.50
|
| Rate for Payer: BCBS Trust/PPO |
$360.08
|
| Rate for Payer: BCN Commercial |
$340.54
|
| Rate for Payer: BCN Medicare Advantage |
$109.50
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$376.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.50
|
| Rate for Payer: Healthscope Commercial |
$394.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.50
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.98
|
| Rate for Payer: Meridian Medicaid |
$116.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.30
|
| Rate for Payer: Nomi Health Commercial |
$359.16
|
| Rate for Payer: PACE Senior Care Partners |
$104.02
|
| Rate for Payer: PACE SWMI |
$109.50
|
| Rate for Payer: PHP Commercial |
$372.30
|
| Rate for Payer: PHP Medicare Advantage |
$109.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.70
|
| Rate for Payer: Priority Health HMO/PPO |
$381.06
|
| Rate for Payer: Priority Health Medicare |
$110.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.46
|
| Rate for Payer: Railroad Medicare Medicare |
$109.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.44
|
| Rate for Payer: UHC Core |
$365.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.50
|
| Rate for Payer: UHC Exchange |
$109.50
|
| Rate for Payer: UHC Medicare Advantage |
$109.50
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$109.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.50
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
47100018
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.22
|
| Rate for Payer: BCN Commercial |
$57.96
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health HMO/PPO |
$65.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.00
|
| Rate for Payer: UHC Core |
$62.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 92627
|
| Hospital Charge Code |
47100018
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.44
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS MAPPO |
$18.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.66
|
| Rate for Payer: BCN Commercial |
$58.31
|
| Rate for Payer: BCN Medicare Advantage |
$18.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: PACE Senior Care Partners |
$17.81
|
| Rate for Payer: PACE SWMI |
$18.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: PHP Medicare Advantage |
$18.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health HMO/PPO |
$65.25
|
| Rate for Payer: Priority Health Medicare |
$18.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.25
|
| Rate for Payer: Railroad Medicare Medicare |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.00
|
| Rate for Payer: UHC Core |
$62.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.75
|
| Rate for Payer: UHC Exchange |
$18.75
|
| Rate for Payer: UHC Medicare Advantage |
$18.75
|
| Rate for Payer: VA VA |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
OP
|
$39.78
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$33.81
|
| Rate for Payer: Aetna Medicare |
$10.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.43
|
| Rate for Payer: BCBS Complete |
$15.91
|
| Rate for Payer: BCBS MAPPO |
$9.94
|
| Rate for Payer: BCBS Trust/PPO |
$32.70
|
| Rate for Payer: BCN Commercial |
$30.93
|
| Rate for Payer: BCN Medicare Advantage |
$9.94
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.94
|
| Rate for Payer: Healthscope Commercial |
$35.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: Nomi Health Commercial |
$32.62
|
| Rate for Payer: PACE Senior Care Partners |
$9.45
|
| Rate for Payer: PACE SWMI |
$9.94
|
| Rate for Payer: PHP Commercial |
$33.81
|
| Rate for Payer: PHP Medicare Advantage |
$9.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health HMO/PPO |
$34.61
|
| Rate for Payer: Priority Health Medicare |
$10.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.65
|
| Rate for Payer: Railroad Medicare Medicare |
$9.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.01
|
| Rate for Payer: UHC Core |
$33.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.94
|
| Rate for Payer: UHC Exchange |
$9.94
|
| Rate for Payer: UHC Medicare Advantage |
$9.94
|
| Rate for Payer: VA VA |
$9.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.84
|
|
|
HC EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Facility
|
IP
|
$39.78
|
|
|
Service Code
|
CPT 92621
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$33.81
|
| Rate for Payer: BCBS Trust/PPO |
$32.47
|
| Rate for Payer: BCN Commercial |
$30.74
|
| Rate for Payer: Cash Price |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$34.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$35.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.81
|
| Rate for Payer: Nomi Health Commercial |
$32.62
|
| Rate for Payer: PHP Commercial |
$33.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.86
|
| Rate for Payer: Priority Health HMO/PPO |
$34.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.01
|
| Rate for Payer: UHC Core |
$33.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.84
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
OP
|
$116.69
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$105.02 |
| Rate for Payer: Aetna Commercial |
$99.19
|
| Rate for Payer: Aetna Medicare |
$30.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.47
|
| Rate for Payer: BCBS Complete |
$46.68
|
| Rate for Payer: BCBS MAPPO |
$29.17
|
| Rate for Payer: BCBS Trust/PPO |
$95.93
|
| Rate for Payer: BCN Commercial |
$90.73
|
| Rate for Payer: BCN Medicare Advantage |
$29.17
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$100.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.17
|
| Rate for Payer: Healthscope Commercial |
$105.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.19
|
| Rate for Payer: Nomi Health Commercial |
$95.69
|
| Rate for Payer: PACE Senior Care Partners |
$27.71
|
| Rate for Payer: PACE SWMI |
$29.17
|
| Rate for Payer: PHP Commercial |
$99.19
|
| Rate for Payer: PHP Medicare Advantage |
$29.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health HMO/PPO |
$101.52
|
| Rate for Payer: Priority Health Medicare |
$29.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.18
|
| Rate for Payer: Railroad Medicare Medicare |
$29.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.69
|
| Rate for Payer: UHC Core |
$97.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.17
|
| Rate for Payer: UHC Exchange |
$29.17
|
| Rate for Payer: UHC Medicare Advantage |
$29.17
|
| Rate for Payer: VA VA |
$29.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.52
|
|
|
HC EVAL ORAL SPEECH ADDL 30 MIN
|
Facility
|
IP
|
$116.69
|
|
|
Service Code
|
CPT 92608
|
| Hospital Charge Code |
44400015
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$75.85 |
| Max. Negotiated Rate |
$105.02 |
| Rate for Payer: Aetna Commercial |
$99.19
|
| Rate for Payer: BCBS Trust/PPO |
$95.25
|
| Rate for Payer: BCN Commercial |
$90.18
|
| Rate for Payer: Cash Price |
$93.35
|
| Rate for Payer: Cofinity Commercial |
$100.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$105.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.19
|
| Rate for Payer: Nomi Health Commercial |
$95.69
|
| Rate for Payer: PHP Commercial |
$99.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.85
|
| Rate for Payer: Priority Health HMO/PPO |
$101.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.69
|
| Rate for Payer: UHC Core |
$97.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.52
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
OP
|
$302.96
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$71.95 |
| Max. Negotiated Rate |
$272.66 |
| Rate for Payer: Aetna Commercial |
$257.52
|
| Rate for Payer: Aetna Medicare |
$78.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.68
|
| Rate for Payer: BCBS Complete |
$121.18
|
| Rate for Payer: BCBS MAPPO |
$75.74
|
| Rate for Payer: BCBS Trust/PPO |
$249.06
|
| Rate for Payer: BCN Commercial |
$235.55
|
| Rate for Payer: BCN Medicare Advantage |
$75.74
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cofinity Commercial |
$260.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.74
|
| Rate for Payer: Healthscope Commercial |
$272.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.52
|
| Rate for Payer: Nomi Health Commercial |
$248.43
|
| Rate for Payer: PACE Senior Care Partners |
$71.95
|
| Rate for Payer: PACE SWMI |
$75.74
|
| Rate for Payer: PHP Commercial |
$257.52
|
| Rate for Payer: PHP Medicare Advantage |
$75.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.92
|
| Rate for Payer: Priority Health HMO/PPO |
$263.58
|
| Rate for Payer: Priority Health Medicare |
$76.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.98
|
| Rate for Payer: Railroad Medicare Medicare |
$75.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.60
|
| Rate for Payer: UHC Core |
$252.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.74
|
| Rate for Payer: UHC Exchange |
$75.74
|
| Rate for Payer: UHC Medicare Advantage |
$75.74
|
| Rate for Payer: VA VA |
$75.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.22
|
|
|
HC EVAL ORAL SPEECH DEVICE
|
Facility
|
IP
|
$302.96
|
|
|
Service Code
|
CPT 92607
|
| Hospital Charge Code |
44400014
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$196.92 |
| Max. Negotiated Rate |
$272.66 |
| Rate for Payer: Aetna Commercial |
$257.52
|
| Rate for Payer: BCBS Trust/PPO |
$247.31
|
| Rate for Payer: BCN Commercial |
$234.13
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cofinity Commercial |
$260.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.37
|
| Rate for Payer: Healthscope Commercial |
$272.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.52
|
| Rate for Payer: Nomi Health Commercial |
$248.43
|
| Rate for Payer: PHP Commercial |
$257.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.92
|
| Rate for Payer: Priority Health HMO/PPO |
$263.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.60
|
| Rate for Payer: UHC Core |
$252.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.22
|
|
|
HC EVENT MONITOR
|
Facility
|
OP
|
$510.24
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: Aetna Medicare |
$132.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.45
|
| Rate for Payer: BCBS Complete |
$27.74
|
| Rate for Payer: BCBS MAPPO |
$127.56
|
| Rate for Payer: BCBS Trust/PPO |
$419.47
|
| Rate for Payer: BCN Commercial |
$396.71
|
| Rate for Payer: BCN Medicare Advantage |
$127.56
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.56
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Mclaren Medicaid |
$26.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.94
|
| Rate for Payer: Meridian Medicaid |
$27.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: Nomi Health Commercial |
$418.40
|
| Rate for Payer: PACE Senior Care Partners |
$121.18
|
| Rate for Payer: PACE SWMI |
$127.56
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: PHP Medicare Advantage |
$127.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health HMO/PPO |
$443.91
|
| Rate for Payer: Priority Health Medicare |
$128.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.86
|
| Rate for Payer: Railroad Medicare Medicare |
$127.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.01
|
| Rate for Payer: UHC Core |
$426.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.56
|
| Rate for Payer: UHC Exchange |
$127.56
|
| Rate for Payer: UHC Medicare Advantage |
$127.56
|
| Rate for Payer: UHCCP Medicaid |
$26.42
|
| Rate for Payer: VA VA |
$127.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
HC EVENT MONITOR
|
Facility
|
IP
|
$510.24
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
48000003
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$331.66 |
| Max. Negotiated Rate |
$459.22 |
| Rate for Payer: Aetna Commercial |
$433.70
|
| Rate for Payer: BCBS Trust/PPO |
$416.51
|
| Rate for Payer: BCN Commercial |
$394.31
|
| Rate for Payer: Cash Price |
$408.19
|
| Rate for Payer: Cofinity Commercial |
$438.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.19
|
| Rate for Payer: Healthscope Commercial |
$459.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.70
|
| Rate for Payer: Nomi Health Commercial |
$418.40
|
| Rate for Payer: PHP Commercial |
$433.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.66
|
| Rate for Payer: Priority Health HMO/PPO |
$443.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.01
|
| Rate for Payer: UHC Core |
$426.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.68
|
|
|
HC EVEROLIMUS
|
Facility
|
OP
|
$69.71
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
30100626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna Medicare |
$18.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.78
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$17.43
|
| Rate for Payer: BCBS Trust/PPO |
$57.31
|
| Rate for Payer: BCN Commercial |
$54.20
|
| Rate for Payer: BCN Medicare Advantage |
$17.43
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.43
|
| Rate for Payer: Healthscope Commercial |
$62.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.28
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.30
|
| Rate for Payer: Meridian Medicaid |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: Nomi Health Commercial |
$57.16
|
| Rate for Payer: PACE Senior Care Partners |
$16.56
|
| Rate for Payer: PACE SWMI |
$17.43
|
| Rate for Payer: PHP Commercial |
$59.25
|
| Rate for Payer: PHP Medicare Advantage |
$17.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.31
|
| Rate for Payer: Priority Health HMO/PPO |
$60.65
|
| Rate for Payer: Priority Health Medicare |
$17.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.71
|
| Rate for Payer: Railroad Medicare Medicare |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.34
|
| Rate for Payer: UHC Core |
$58.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.43
|
| Rate for Payer: UHC Exchange |
$17.43
|
| Rate for Payer: UHC Medicare Advantage |
$17.43
|
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| Rate for Payer: VA VA |
$17.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.28
|
|
|
HC EVEROLIMUS
|
Facility
|
IP
|
$69.71
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
30100626
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.31 |
| Max. Negotiated Rate |
$62.74 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: BCBS Trust/PPO |
$56.90
|
| Rate for Payer: BCN Commercial |
$53.87
|
| Rate for Payer: Cash Price |
$55.77
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.77
|
| Rate for Payer: Healthscope Commercial |
$62.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.25
|
| Rate for Payer: Nomi Health Commercial |
$57.16
|
| Rate for Payer: PHP Commercial |
$59.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.31
|
| Rate for Payer: Priority Health HMO/PPO |
$60.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.34
|
| Rate for Payer: UHC Core |
$58.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.28
|
|
|
HC EVOKED AUDITORY TEST COMPLETE
|
Facility
|
OP
|
$286.62
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$68.07 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna Commercial |
$243.63
|
| Rate for Payer: Aetna Medicare |
$74.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.57
|
| Rate for Payer: BCBS Complete |
$231.63
|
| Rate for Payer: BCBS MAPPO |
$71.66
|
| Rate for Payer: BCBS Trust/PPO |
$235.63
|
| Rate for Payer: BCN Commercial |
$222.85
|
| Rate for Payer: BCN Medicare Advantage |
$71.66
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.66
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.96
|
| Rate for Payer: Mclaren Medicaid |
$220.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.24
|
| Rate for Payer: Meridian Medicaid |
$231.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.63
|
| Rate for Payer: Nomi Health Commercial |
$235.03
|
| Rate for Payer: PACE Senior Care Partners |
$68.07
|
| Rate for Payer: PACE SWMI |
$71.66
|
| Rate for Payer: PHP Commercial |
$243.63
|
| Rate for Payer: PHP Medicare Advantage |
$71.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.30
|
| Rate for Payer: Priority Health HMO/PPO |
$249.36
|
| Rate for Payer: Priority Health Medicare |
$72.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.04
|
| Rate for Payer: Railroad Medicare Medicare |
$71.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.23
|
| Rate for Payer: UHC Core |
$239.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.66
|
| Rate for Payer: UHC Exchange |
$71.66
|
| Rate for Payer: UHC Medicare Advantage |
$71.66
|
| Rate for Payer: UHCCP Medicaid |
$220.59
|
| Rate for Payer: VA VA |
$71.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.96
|
|
|
HC EVOKED AUDITORY TEST COMPLETE
|
Facility
|
IP
|
$286.62
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$186.30 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna Commercial |
$243.63
|
| Rate for Payer: BCBS Trust/PPO |
$233.97
|
| Rate for Payer: BCN Commercial |
$221.50
|
| Rate for Payer: Cash Price |
$229.30
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.30
|
| Rate for Payer: Healthscope Commercial |
$257.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.63
|
| Rate for Payer: Nomi Health Commercial |
$235.03
|
| Rate for Payer: PHP Commercial |
$243.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.30
|
| Rate for Payer: Priority Health HMO/PPO |
$249.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.23
|
| Rate for Payer: UHC Core |
$239.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.96
|
|
