|
HC NEUROLYSIS CELIAC PLEXUS
|
Facility
|
OP
|
$1,892.10
|
|
|
Service Code
|
CPT 64680
|
| Hospital Charge Code |
36100479
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$449.37 |
| Max. Negotiated Rate |
$1,702.89 |
| Rate for Payer: Aetna Commercial |
$1,608.28
|
| Rate for Payer: Aetna Medicare |
$491.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$591.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$591.28
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$473.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,471.11
|
| Rate for Payer: BCN Commercial |
$1,471.11
|
| Rate for Payer: BCN Medicare Advantage |
$473.02
|
| Rate for Payer: Cash Price |
$1,513.68
|
| Rate for Payer: Cash Price |
$1,513.68
|
| Rate for Payer: Cofinity Commercial |
$1,627.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,513.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$473.02
|
| Rate for Payer: Healthscope Commercial |
$1,702.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,419.08
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$496.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$543.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,608.28
|
| Rate for Payer: PACE Senior Care Partners |
$449.37
|
| Rate for Payer: PACE SWMI |
$473.02
|
| Rate for Payer: PHP Commercial |
$1,608.28
|
| Rate for Payer: PHP Medicare Advantage |
$473.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,324.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,646.13
|
| Rate for Payer: Priority Health Medicare |
$473.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,153.99
|
| Rate for Payer: Railroad Medicare Medicare |
$473.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,665.05
|
| Rate for Payer: UHC Core |
$1,579.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$473.02
|
| Rate for Payer: UHC Medicare Advantage |
$487.22
|
| Rate for Payer: VA VA |
$473.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,419.08
|
|
|
HC NEURONAL (V-G)K+ CHANNEL AB
|
Facility
|
IP
|
$67.32
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.06 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$57.22
|
| Rate for Payer: BCBS Trust/PPO |
$52.02
|
| Rate for Payer: BCN Commercial |
$52.02
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$57.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Healthscope Commercial |
$60.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.22
|
| Rate for Payer: PHP Commercial |
$57.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.24
|
| Rate for Payer: UHC Core |
$56.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.49
|
|
|
HC NEURONAL (V-G)K+ CHANNEL AB
|
Facility
|
OP
|
$67.32
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100607
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$57.22
|
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.04
|
| Rate for Payer: BCBS Complete |
$14.26
|
| Rate for Payer: BCBS MAPPO |
$16.83
|
| Rate for Payer: BCBS Trust/PPO |
$52.34
|
| Rate for Payer: BCN Commercial |
$52.34
|
| Rate for Payer: BCN Medicare Advantage |
$16.83
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$57.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.83
|
| Rate for Payer: Healthscope Commercial |
$60.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.49
|
| Rate for Payer: Mclaren Medicaid |
$13.58
|
| Rate for Payer: Meridian Medicaid |
$14.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.22
|
| Rate for Payer: PACE Senior Care Partners |
$15.99
|
| Rate for Payer: PACE SWMI |
$16.83
|
| Rate for Payer: PHP Commercial |
$57.22
|
| Rate for Payer: PHP Medicare Advantage |
$16.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.57
|
| Rate for Payer: Priority Health Medicare |
$16.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.06
|
| Rate for Payer: Railroad Medicare Medicare |
$16.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.24
|
| Rate for Payer: UHC Core |
$56.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.83
|
| Rate for Payer: UHC Medicare Advantage |
$17.33
|
| Rate for Payer: VA VA |
$16.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.49
|
|
|
HC NEURON SPECIFIC ENOLASE
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: BCBS Trust/PPO |
$53.60
|
| Rate for Payer: BCN Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.04
|
| Rate for Payer: UHC Core |
$57.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC NEURON SPECIFIC ENOLASE
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$18.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.68
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$53.93
|
| Rate for Payer: BCN Commercial |
$53.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.34
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Mclaren Medicaid |
$12.75
|
| Rate for Payer: Meridian Medicaid |
$13.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PACE Senior Care Partners |
$16.47
|
| Rate for Payer: PACE SWMI |
$17.34
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: PHP Medicare Advantage |
$17.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.34
|
| Rate for Payer: Priority Health Medicare |
$17.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.30
|
| Rate for Payer: Railroad Medicare Medicare |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.04
|
| Rate for Payer: UHC Core |
$57.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.34
|
| Rate for Payer: UHC Medicare Advantage |
$17.86
|
| Rate for Payer: VA VA |
$17.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC NEUROPSYCH TEST EVAL BY PHYS FIRST HR
|
Facility
|
OP
|
$68.34
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
91800007
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$369.18 |
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: Aetna Medicare |
$17.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.36
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$17.08
|
| Rate for Payer: BCBS Trust/PPO |
$53.13
|
| Rate for Payer: BCN Commercial |
$53.13
|
| Rate for Payer: BCN Medicare Advantage |
$17.08
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.08
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.26
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.09
|
| Rate for Payer: PACE Senior Care Partners |
$16.23
|
| Rate for Payer: PACE SWMI |
$17.08
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: PHP Medicare Advantage |
$17.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.46
|
| Rate for Payer: Priority Health Medicare |
$17.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.68
|
| Rate for Payer: Railroad Medicare Medicare |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.14
|
| Rate for Payer: UHC Core |
$57.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.08
|
| Rate for Payer: UHC Medicare Advantage |
$17.60
|
| Rate for Payer: VA VA |
$17.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.26
|
|
|
HC NEUROPSYCH TEST EVAL BY PHYS FIRST HR
|
Facility
|
IP
|
$68.34
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
91800007
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: BCBS Trust/PPO |
$52.81
|
| Rate for Payer: BCN Commercial |
$52.81
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.09
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.14
|
| Rate for Payer: UHC Core |
$57.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.26
|
|
|
HC NEUROPSYCH TEST EVAL EA ADDL HR
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
91800008
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: BCBS Trust/PPO |
$27.59
|
| Rate for Payer: BCN Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC NEUROPSYCH TEST EVAL EA ADDL HR
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
91800008
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$14.28
|
| Rate for Payer: BCBS MAPPO |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$27.76
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: BCN Medicare Advantage |
$8.92
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.92
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Senior Care Partners |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.92
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.06
|
| Rate for Payer: Priority Health Medicare |
$8.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: Railroad Medicare Medicare |
$8.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.92
|
| Rate for Payer: UHC Medicare Advantage |
$9.19
|
| Rate for Payer: VA VA |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 15
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.85 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.20
|
| Rate for Payer: BCN Commercial |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,290.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,275.00
|
| Rate for Payer: PHP Commercial |
$1,275.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,305.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$914.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,320.00
|
| Rate for Payer: UHC Core |
$1,252.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,125.00
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 15
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$356.25 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: Aetna Medicare |
$390.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$468.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$468.75
|
| Rate for Payer: BCBS Complete |
$600.00
|
| Rate for Payer: BCBS MAPPO |
$375.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,166.25
|
| Rate for Payer: BCN Commercial |
$1,166.25
|
| Rate for Payer: BCN Medicare Advantage |
$375.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,290.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,125.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$393.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$431.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,275.00
|
| Rate for Payer: PACE Senior Care Partners |
$356.25
|
| Rate for Payer: PACE SWMI |
$375.00
|
| Rate for Payer: PHP Commercial |
$1,275.00
|
| Rate for Payer: PHP Medicare Advantage |
$375.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,305.00
|
| Rate for Payer: Priority Health Medicare |
$375.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$914.85
|
| Rate for Payer: Railroad Medicare Medicare |
$375.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,320.00
|
| Rate for Payer: UHC Core |
$1,252.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$375.00
|
| Rate for Payer: UHC Medicare Advantage |
$386.25
|
| Rate for Payer: VA VA |
$375.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,125.00
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 25
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
27800138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,524.75 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$2,125.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,932.00
|
| Rate for Payer: BCN Commercial |
$1,932.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cofinity Commercial |
$2,150.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,000.00
|
| Rate for Payer: Healthscope Commercial |
$2,250.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,875.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,125.00
|
| Rate for Payer: PHP Commercial |
$2,125.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,750.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,175.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,524.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,200.00
|
| Rate for Payer: UHC Core |
$2,087.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,875.00
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 25
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
27800138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.75 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$2,125.00
|
| Rate for Payer: Aetna Medicare |
$650.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.25
|
| Rate for Payer: BCBS Complete |
$1,000.00
|
| Rate for Payer: BCBS MAPPO |
$625.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,943.75
|
| Rate for Payer: BCN Commercial |
$1,943.75
|
| Rate for Payer: BCN Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cofinity Commercial |
$2,150.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.00
|
| Rate for Payer: Healthscope Commercial |
$2,250.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,875.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,125.00
|
| Rate for Payer: PACE Senior Care Partners |
$593.75
|
| Rate for Payer: PACE SWMI |
$625.00
|
| Rate for Payer: PHP Commercial |
$2,125.00
|
| Rate for Payer: PHP Medicare Advantage |
$625.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,750.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,175.00
|
| Rate for Payer: Priority Health Medicare |
$625.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,524.75
|
| Rate for Payer: Railroad Medicare Medicare |
$625.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,200.00
|
| Rate for Payer: UHC Core |
$2,087.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.00
|
| Rate for Payer: UHC Medicare Advantage |
$643.75
|
| Rate for Payer: VA VA |
$625.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,875.00
|
|
|
HC NEUTROPHIL OXIDATIVE BURST
|
Facility
|
OP
|
$155.25
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.87 |
| Max. Negotiated Rate |
$247.59 |
| Rate for Payer: Aetna Commercial |
$131.96
|
| Rate for Payer: Aetna Medicare |
$40.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.52
|
| Rate for Payer: BCBS Complete |
$247.59
|
| Rate for Payer: BCBS MAPPO |
$38.81
|
| Rate for Payer: BCBS Trust/PPO |
$120.71
|
| Rate for Payer: BCN Commercial |
$120.71
|
| Rate for Payer: BCN Medicare Advantage |
$38.81
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cofinity Commercial |
$133.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.81
|
| Rate for Payer: Healthscope Commercial |
$139.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.44
|
| Rate for Payer: Mclaren Medicaid |
$235.80
|
| Rate for Payer: Meridian Medicaid |
$247.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.96
|
| Rate for Payer: PACE Senior Care Partners |
$36.87
|
| Rate for Payer: PACE SWMI |
$38.81
|
| Rate for Payer: PHP Commercial |
$131.96
|
| Rate for Payer: PHP Medicare Advantage |
$38.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.07
|
| Rate for Payer: Priority Health Medicare |
$38.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.69
|
| Rate for Payer: Railroad Medicare Medicare |
$38.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.62
|
| Rate for Payer: UHC Core |
$129.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.81
|
| Rate for Payer: UHC Medicare Advantage |
$39.98
|
| Rate for Payer: VA VA |
$38.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.44
|
|
|
HC NEUTROPHIL OXIDATIVE BURST
|
Facility
|
IP
|
$155.25
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$94.69 |
| Max. Negotiated Rate |
$139.72 |
| Rate for Payer: Aetna Commercial |
$131.96
|
| Rate for Payer: BCBS Trust/PPO |
$119.98
|
| Rate for Payer: BCN Commercial |
$119.98
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cofinity Commercial |
$133.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.20
|
| Rate for Payer: Healthscope Commercial |
$139.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.96
|
| Rate for Payer: PHP Commercial |
$131.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.62
|
| Rate for Payer: UHC Core |
$129.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.44
|
|
|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$14.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.21
|
| Rate for Payer: BCBS Complete |
$22.03
|
| Rate for Payer: BCBS MAPPO |
$13.77
|
| Rate for Payer: BCBS Trust/PPO |
$42.82
|
| Rate for Payer: BCN Commercial |
$42.82
|
| Rate for Payer: BCN Medicare Advantage |
$13.77
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.82
|
| Rate for Payer: PACE Senior Care Partners |
$13.08
|
| Rate for Payer: PACE SWMI |
$13.77
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: PHP Medicare Advantage |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.92
|
| Rate for Payer: Priority Health Medicare |
$13.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.59
|
| Rate for Payer: Railroad Medicare Medicare |
$13.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.47
|
| Rate for Payer: UHC Core |
$45.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.77
|
| Rate for Payer: UHC Medicare Advantage |
$14.18
|
| Rate for Payer: VA VA |
$13.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.31
|
|
|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.59 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: BCBS Trust/PPO |
$42.57
|
| Rate for Payer: BCN Commercial |
$42.57
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.82
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.47
|
| Rate for Payer: UHC Core |
$45.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.31
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
OP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.14 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Aetna Commercial |
$143.67
|
| Rate for Payer: Aetna Medicare |
$43.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.82
|
| Rate for Payer: BCBS Complete |
$67.61
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCBS Trust/PPO |
$131.41
|
| Rate for Payer: BCCCP Commercial |
$45.00
|
| Rate for Payer: BCN Commercial |
$131.41
|
| Rate for Payer: BCN Medicare Advantage |
$42.26
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$145.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.26
|
| Rate for Payer: Healthscope Commercial |
$152.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.67
|
| Rate for Payer: PACE Senior Care Partners |
$40.14
|
| Rate for Payer: PACE SWMI |
$42.26
|
| Rate for Payer: PHP Commercial |
$143.67
|
| Rate for Payer: PHP Medicare Advantage |
$42.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.05
|
| Rate for Payer: Priority Health Medicare |
$42.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.09
|
| Rate for Payer: Railroad Medicare Medicare |
$42.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.74
|
| Rate for Payer: UHC Core |
$141.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$43.52
|
| Rate for Payer: VA VA |
$42.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.76
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
IP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.09 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Aetna Commercial |
$143.67
|
| Rate for Payer: BCBS Trust/PPO |
$130.62
|
| Rate for Payer: BCN Commercial |
$130.62
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$145.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$152.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.67
|
| Rate for Payer: PHP Commercial |
$143.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.74
|
| Rate for Payer: UHC Core |
$141.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.76
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
OP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.71 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Aetna Commercial |
$174.34
|
| Rate for Payer: Aetna Medicare |
$53.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.09
|
| Rate for Payer: BCBS Complete |
$82.04
|
| Rate for Payer: BCBS MAPPO |
$51.28
|
| Rate for Payer: BCBS Trust/PPO |
$159.47
|
| Rate for Payer: BCCCP Commercial |
$107.15
|
| Rate for Payer: BCN Commercial |
$159.47
|
| Rate for Payer: BCN Medicare Advantage |
$51.28
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$176.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.28
|
| Rate for Payer: Healthscope Commercial |
$184.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.34
|
| Rate for Payer: PACE Senior Care Partners |
$48.71
|
| Rate for Payer: PACE SWMI |
$51.28
|
| Rate for Payer: PHP Commercial |
$174.34
|
| Rate for Payer: PHP Medicare Advantage |
$51.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.44
|
| Rate for Payer: Priority Health Medicare |
$51.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.09
|
| Rate for Payer: Railroad Medicare Medicare |
$51.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.49
|
| Rate for Payer: UHC Core |
$171.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.28
|
| Rate for Payer: UHC Medicare Advantage |
$52.81
|
| Rate for Payer: VA VA |
$51.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.82
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
IP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.09 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Aetna Commercial |
$174.34
|
| Rate for Payer: BCBS Trust/PPO |
$158.50
|
| Rate for Payer: BCN Commercial |
$158.50
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$176.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$184.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.34
|
| Rate for Payer: PHP Commercial |
$174.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.49
|
| Rate for Payer: UHC Core |
$171.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.82
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
IP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.63 |
| Max. Negotiated Rate |
$265.08 |
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: BCBS Trust/PPO |
$227.61
|
| Rate for Payer: BCN Commercial |
$227.61
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$265.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.35
|
| Rate for Payer: PHP Commercial |
$250.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.19
|
| Rate for Payer: UHC Core |
$245.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.90
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
OP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.95 |
| Max. Negotiated Rate |
$265.08 |
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: Aetna Medicare |
$76.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.04
|
| Rate for Payer: BCBS Complete |
$117.81
|
| Rate for Payer: BCBS MAPPO |
$73.63
|
| Rate for Payer: BCBS Trust/PPO |
$229.00
|
| Rate for Payer: BCCCP Commercial |
$107.15
|
| Rate for Payer: BCN Commercial |
$229.00
|
| Rate for Payer: BCN Medicare Advantage |
$73.63
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.63
|
| Rate for Payer: Healthscope Commercial |
$265.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.35
|
| Rate for Payer: PACE Senior Care Partners |
$69.95
|
| Rate for Payer: PACE SWMI |
$73.63
|
| Rate for Payer: PHP Commercial |
$250.35
|
| Rate for Payer: PHP Medicare Advantage |
$73.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.24
|
| Rate for Payer: Priority Health Medicare |
$73.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.63
|
| Rate for Payer: Railroad Medicare Medicare |
$73.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.19
|
| Rate for Payer: UHC Core |
$245.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.63
|
| Rate for Payer: UHC Medicare Advantage |
$75.84
|
| Rate for Payer: VA VA |
$73.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.90
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
OP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$441.39 |
| Rate for Payer: Aetna Commercial |
$416.87
|
| Rate for Payer: Aetna Medicare |
$127.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.26
|
| Rate for Payer: BCBS Complete |
$196.17
|
| Rate for Payer: BCBS MAPPO |
$122.61
|
| Rate for Payer: BCBS Trust/PPO |
$381.31
|
| Rate for Payer: BCCCP Commercial |
$107.15
|
| Rate for Payer: BCN Commercial |
$381.31
|
| Rate for Payer: BCN Medicare Advantage |
$122.61
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$421.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$441.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.87
|
| Rate for Payer: PACE Senior Care Partners |
$116.48
|
| Rate for Payer: PACE SWMI |
$122.61
|
| Rate for Payer: PHP Commercial |
$416.87
|
| Rate for Payer: PHP Medicare Advantage |
$122.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$426.67
|
| Rate for Payer: Priority Health Medicare |
$122.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.11
|
| Rate for Payer: Railroad Medicare Medicare |
$122.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.58
|
| Rate for Payer: UHC Core |
$409.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.61
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: VA VA |
$122.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.82
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
IP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.11 |
| Max. Negotiated Rate |
$441.39 |
| Rate for Payer: Aetna Commercial |
$416.87
|
| Rate for Payer: BCBS Trust/PPO |
$379.00
|
| Rate for Payer: BCN Commercial |
$379.00
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$421.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$441.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.87
|
| Rate for Payer: PHP Commercial |
$416.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$426.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.58
|
| Rate for Payer: UHC Core |
$409.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.82
|
|
