|
HC HDR 1 CHANNEL
|
Facility
|
IP
|
$1,989.66
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,293.28 |
| Max. Negotiated Rate |
$1,790.69 |
| Rate for Payer: Aetna Commercial |
$1,691.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,624.16
|
| Rate for Payer: BCN Commercial |
$1,537.61
|
| Rate for Payer: Cash Price |
$1,591.73
|
| Rate for Payer: Cofinity Commercial |
$1,711.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,591.73
|
| Rate for Payer: Healthscope Commercial |
$1,790.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,492.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,691.21
|
| Rate for Payer: Nomi Health Commercial |
$1,631.52
|
| Rate for Payer: PHP Commercial |
$1,691.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,293.28
|
| Rate for Payer: Priority Health HMO/PPO |
$1,731.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,333.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,750.90
|
| Rate for Payer: UHC Core |
$1,661.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,492.24
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
OP
|
$2,210.05
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$491.48 |
| Max. Negotiated Rate |
$1,989.04 |
| Rate for Payer: Aetna Commercial |
$1,878.54
|
| Rate for Payer: Aetna Medicare |
$574.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$690.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$690.64
|
| Rate for Payer: BCBS Complete |
$516.09
|
| Rate for Payer: BCBS MAPPO |
$552.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,816.88
|
| Rate for Payer: BCN Commercial |
$1,718.31
|
| Rate for Payer: BCN Medicare Advantage |
$552.51
|
| Rate for Payer: Cash Price |
$1,768.04
|
| Rate for Payer: Cash Price |
$1,768.04
|
| Rate for Payer: Cofinity Commercial |
$1,900.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,768.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.51
|
| Rate for Payer: Healthscope Commercial |
$1,989.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,657.54
|
| Rate for Payer: Mclaren Medicaid |
$491.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$580.14
|
| Rate for Payer: Meridian Medicaid |
$516.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$635.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,878.54
|
| Rate for Payer: Nomi Health Commercial |
$1,812.24
|
| Rate for Payer: PACE Senior Care Partners |
$524.89
|
| Rate for Payer: PACE SWMI |
$552.51
|
| Rate for Payer: PHP Commercial |
$1,878.54
|
| Rate for Payer: PHP Medicare Advantage |
$552.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$491.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,436.53
|
| Rate for Payer: Priority Health HMO/PPO |
$1,922.74
|
| Rate for Payer: Priority Health Medicare |
$558.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,480.73
|
| Rate for Payer: Railroad Medicare Medicare |
$552.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,944.84
|
| Rate for Payer: UHC Core |
$1,845.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.51
|
| Rate for Payer: UHC Exchange |
$552.51
|
| Rate for Payer: UHC Medicare Advantage |
$552.51
|
| Rate for Payer: UHCCP Medicaid |
$491.48
|
| Rate for Payer: VA VA |
$552.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,657.54
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
IP
|
$2,210.05
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,436.53 |
| Max. Negotiated Rate |
$1,989.04 |
| Rate for Payer: Aetna Commercial |
$1,878.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,804.06
|
| Rate for Payer: BCN Commercial |
$1,707.93
|
| Rate for Payer: Cash Price |
$1,768.04
|
| Rate for Payer: Cofinity Commercial |
$1,900.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,768.04
|
| Rate for Payer: Healthscope Commercial |
$1,989.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,657.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,878.54
|
| Rate for Payer: Nomi Health Commercial |
$1,812.24
|
| Rate for Payer: PHP Commercial |
$1,878.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,436.53
|
| Rate for Payer: Priority Health HMO/PPO |
$1,922.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,480.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,944.84
|
| Rate for Payer: UHC Core |
$1,845.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,657.54
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
IP
|
$562.41
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.57 |
| Max. Negotiated Rate |
$506.17 |
| Rate for Payer: Aetna Commercial |
$478.05
|
| Rate for Payer: BCBS Trust/PPO |
$459.10
|
| Rate for Payer: BCN Commercial |
$434.63
|
| Rate for Payer: Cash Price |
$449.93
|
| Rate for Payer: Cofinity Commercial |
$483.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.93
|
| Rate for Payer: Healthscope Commercial |
$506.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.05
|
| Rate for Payer: Nomi Health Commercial |
$461.18
|
| Rate for Payer: PHP Commercial |
$478.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.57
|
| Rate for Payer: Priority Health HMO/PPO |
$489.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.92
|
| Rate for Payer: UHC Core |
$469.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.81
|
|
|
HC HDR IR 192 BRACHY SOURCE NSTRD
|
Facility
|
OP
|
$562.41
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27800090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.57 |
| Max. Negotiated Rate |
$506.17 |
| Rate for Payer: Aetna Commercial |
$478.05
|
| Rate for Payer: Aetna Medicare |
$146.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.75
|
| Rate for Payer: BCBS Complete |
$254.69
|
| Rate for Payer: BCBS MAPPO |
$140.60
|
| Rate for Payer: BCBS Trust/PPO |
$462.36
|
| Rate for Payer: BCN Commercial |
$437.27
|
| Rate for Payer: BCN Medicare Advantage |
$140.60
|
| Rate for Payer: Cash Price |
$449.93
|
| Rate for Payer: Cash Price |
$449.93
|
| Rate for Payer: Cofinity Commercial |
$483.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.60
|
| Rate for Payer: Healthscope Commercial |
$506.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.81
|
| Rate for Payer: Mclaren Medicaid |
$242.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.63
|
| Rate for Payer: Meridian Medicaid |
$254.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.05
|
| Rate for Payer: Nomi Health Commercial |
$461.18
|
| Rate for Payer: PACE Senior Care Partners |
$133.57
|
| Rate for Payer: PACE SWMI |
$140.60
|
| Rate for Payer: PHP Commercial |
$478.05
|
| Rate for Payer: PHP Medicare Advantage |
$140.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.57
|
| Rate for Payer: Priority Health HMO/PPO |
$489.30
|
| Rate for Payer: Priority Health Medicare |
$142.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.81
|
| Rate for Payer: Railroad Medicare Medicare |
$140.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.92
|
| Rate for Payer: UHC Core |
$469.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.60
|
| Rate for Payer: UHC Exchange |
$140.60
|
| Rate for Payer: UHC Medicare Advantage |
$140.60
|
| Rate for Payer: UHCCP Medicaid |
$242.54
|
| Rate for Payer: VA VA |
$140.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.81
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
OP
|
$2,438.89
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$491.48 |
| Max. Negotiated Rate |
$2,195.00 |
| Rate for Payer: Aetna Commercial |
$2,073.06
|
| Rate for Payer: Aetna Medicare |
$634.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$762.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$762.15
|
| Rate for Payer: BCBS Complete |
$516.09
|
| Rate for Payer: BCBS MAPPO |
$609.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,005.01
|
| Rate for Payer: BCN Commercial |
$1,896.24
|
| Rate for Payer: BCN Medicare Advantage |
$609.72
|
| Rate for Payer: Cash Price |
$1,951.11
|
| Rate for Payer: Cash Price |
$1,951.11
|
| Rate for Payer: Cofinity Commercial |
$2,097.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,951.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$609.72
|
| Rate for Payer: Healthscope Commercial |
$2,195.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,829.17
|
| Rate for Payer: Mclaren Medicaid |
$491.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$640.21
|
| Rate for Payer: Meridian Medicaid |
$516.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$701.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,073.06
|
| Rate for Payer: Nomi Health Commercial |
$1,999.89
|
| Rate for Payer: PACE Senior Care Partners |
$579.24
|
| Rate for Payer: PACE SWMI |
$609.72
|
| Rate for Payer: PHP Commercial |
$2,073.06
|
| Rate for Payer: PHP Medicare Advantage |
$609.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$491.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,585.28
|
| Rate for Payer: Priority Health HMO/PPO |
$2,121.83
|
| Rate for Payer: Priority Health Medicare |
$615.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,634.06
|
| Rate for Payer: Railroad Medicare Medicare |
$609.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,146.22
|
| Rate for Payer: UHC Core |
$2,036.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$609.72
|
| Rate for Payer: UHC Exchange |
$609.72
|
| Rate for Payer: UHC Medicare Advantage |
$609.72
|
| Rate for Payer: UHCCP Medicaid |
$491.48
|
| Rate for Payer: VA VA |
$609.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,829.17
|
|
|
HC HDR OVER 12 CHANNELS
|
Facility
|
IP
|
$2,438.89
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
33300057
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,585.28 |
| Max. Negotiated Rate |
$2,195.00 |
| Rate for Payer: Aetna Commercial |
$2,073.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,990.87
|
| Rate for Payer: BCN Commercial |
$1,884.77
|
| Rate for Payer: Cash Price |
$1,951.11
|
| Rate for Payer: Cofinity Commercial |
$2,097.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,951.11
|
| Rate for Payer: Healthscope Commercial |
$2,195.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,829.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,073.06
|
| Rate for Payer: Nomi Health Commercial |
$1,999.89
|
| Rate for Payer: PHP Commercial |
$2,073.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,585.28
|
| Rate for Payer: Priority Health HMO/PPO |
$2,121.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,634.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,146.22
|
| Rate for Payer: UHC Core |
$2,036.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,829.17
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
IP
|
$481.76
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$313.14 |
| Max. Negotiated Rate |
$433.58 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: BCBS Trust/PPO |
$393.26
|
| Rate for Payer: BCN Commercial |
$372.30
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: PHP Commercial |
$409.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health HMO/PPO |
$419.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$322.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.95
|
| Rate for Payer: UHC Core |
$402.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.32
|
|
|
HC HDR SKIN SURFACE 1 CHANNEL
|
Facility
|
OP
|
$481.76
|
|
|
Service Code
|
CPT 77767
|
| Hospital Charge Code |
33300053
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$114.42 |
| Max. Negotiated Rate |
$433.58 |
| Rate for Payer: Aetna Commercial |
$409.50
|
| Rate for Payer: Aetna Medicare |
$125.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.55
|
| Rate for Payer: BCBS Complete |
$195.62
|
| Rate for Payer: BCBS MAPPO |
$120.44
|
| Rate for Payer: BCBS Trust/PPO |
$396.05
|
| Rate for Payer: BCN Commercial |
$374.57
|
| Rate for Payer: BCN Medicare Advantage |
$120.44
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cash Price |
$385.41
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.44
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.32
|
| Rate for Payer: Mclaren Medicaid |
$186.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.46
|
| Rate for Payer: Meridian Medicaid |
$195.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Nomi Health Commercial |
$395.04
|
| Rate for Payer: PACE Senior Care Partners |
$114.42
|
| Rate for Payer: PACE SWMI |
$120.44
|
| Rate for Payer: PHP Commercial |
$409.50
|
| Rate for Payer: PHP Medicare Advantage |
$120.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health HMO/PPO |
$419.13
|
| Rate for Payer: Priority Health Medicare |
$121.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$322.78
|
| Rate for Payer: Railroad Medicare Medicare |
$120.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.95
|
| Rate for Payer: UHC Core |
$402.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.44
|
| Rate for Payer: UHC Exchange |
$120.44
|
| Rate for Payer: UHC Medicare Advantage |
$120.44
|
| Rate for Payer: UHCCP Medicaid |
$186.29
|
| Rate for Payer: VA VA |
$120.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.32
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
OP
|
$541.99
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$128.72 |
| Max. Negotiated Rate |
$487.79 |
| Rate for Payer: Aetna Commercial |
$460.69
|
| Rate for Payer: Aetna Medicare |
$140.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.37
|
| Rate for Payer: BCBS Complete |
$195.62
|
| Rate for Payer: BCBS MAPPO |
$135.50
|
| Rate for Payer: BCBS Trust/PPO |
$445.57
|
| Rate for Payer: BCN Commercial |
$421.40
|
| Rate for Payer: BCN Medicare Advantage |
$135.50
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cofinity Commercial |
$466.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.50
|
| Rate for Payer: Healthscope Commercial |
$487.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.49
|
| Rate for Payer: Mclaren Medicaid |
$186.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.27
|
| Rate for Payer: Meridian Medicaid |
$195.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.69
|
| Rate for Payer: Nomi Health Commercial |
$444.43
|
| Rate for Payer: PACE Senior Care Partners |
$128.72
|
| Rate for Payer: PACE SWMI |
$135.50
|
| Rate for Payer: PHP Commercial |
$460.69
|
| Rate for Payer: PHP Medicare Advantage |
$135.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.29
|
| Rate for Payer: Priority Health HMO/PPO |
$471.53
|
| Rate for Payer: Priority Health Medicare |
$136.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.13
|
| Rate for Payer: Railroad Medicare Medicare |
$135.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.95
|
| Rate for Payer: UHC Core |
$452.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.50
|
| Rate for Payer: UHC Exchange |
$135.50
|
| Rate for Payer: UHC Medicare Advantage |
$135.50
|
| Rate for Payer: UHCCP Medicaid |
$186.29
|
| Rate for Payer: VA VA |
$135.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.49
|
|
|
HC HDR SKIN SURFACE 2 OR MORE CHANNELS
|
Facility
|
IP
|
$541.99
|
|
|
Service Code
|
CPT 77768
|
| Hospital Charge Code |
33300054
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$352.29 |
| Max. Negotiated Rate |
$487.79 |
| Rate for Payer: Aetna Commercial |
$460.69
|
| Rate for Payer: BCBS Trust/PPO |
$442.43
|
| Rate for Payer: BCN Commercial |
$418.85
|
| Rate for Payer: Cash Price |
$433.59
|
| Rate for Payer: Cofinity Commercial |
$466.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.59
|
| Rate for Payer: Healthscope Commercial |
$487.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$460.69
|
| Rate for Payer: Nomi Health Commercial |
$444.43
|
| Rate for Payer: PHP Commercial |
$460.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.29
|
| Rate for Payer: Priority Health HMO/PPO |
$471.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.95
|
| Rate for Payer: UHC Core |
$452.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.49
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
OP
|
$122.77
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$29.16 |
| Max. Negotiated Rate |
$110.49 |
| Rate for Payer: Aetna Commercial |
$104.35
|
| Rate for Payer: Aetna Medicare |
$31.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.37
|
| Rate for Payer: BCBS Complete |
$68.81
|
| Rate for Payer: BCBS MAPPO |
$30.69
|
| Rate for Payer: BCBS Trust/PPO |
$100.93
|
| Rate for Payer: BCN Commercial |
$95.45
|
| Rate for Payer: BCN Medicare Advantage |
$30.69
|
| Rate for Payer: Cash Price |
$98.22
|
| Rate for Payer: Cash Price |
$98.22
|
| Rate for Payer: Cofinity Commercial |
$105.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.69
|
| Rate for Payer: Healthscope Commercial |
$110.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.08
|
| Rate for Payer: Mclaren Medicaid |
$65.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.23
|
| Rate for Payer: Meridian Medicaid |
$68.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: Nomi Health Commercial |
$100.67
|
| Rate for Payer: PACE Senior Care Partners |
$29.16
|
| Rate for Payer: PACE SWMI |
$30.69
|
| Rate for Payer: PHP Commercial |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$30.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
| Rate for Payer: Priority Health HMO/PPO |
$106.81
|
| Rate for Payer: Priority Health Medicare |
$31.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.26
|
| Rate for Payer: Railroad Medicare Medicare |
$30.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.04
|
| Rate for Payer: UHC Core |
$102.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.69
|
| Rate for Payer: UHC Exchange |
$30.69
|
| Rate for Payer: UHC Medicare Advantage |
$30.69
|
| Rate for Payer: UHCCP Medicaid |
$65.53
|
| Rate for Payer: VA VA |
$30.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.08
|
|
|
HC HEALTH & BEHAV ASSESS OR REASSESS
|
Facility
|
IP
|
$122.77
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
91400009
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$110.49 |
| Rate for Payer: Aetna Commercial |
$104.35
|
| Rate for Payer: BCBS Trust/PPO |
$100.22
|
| Rate for Payer: BCN Commercial |
$94.88
|
| Rate for Payer: Cash Price |
$98.22
|
| Rate for Payer: Cofinity Commercial |
$105.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.22
|
| Rate for Payer: Healthscope Commercial |
$110.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: Nomi Health Commercial |
$100.67
|
| Rate for Payer: PHP Commercial |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
| Rate for Payer: Priority Health HMO/PPO |
$106.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.04
|
| Rate for Payer: UHC Core |
$102.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.08
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
IP
|
$61.38
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$55.24 |
| Rate for Payer: Aetna Commercial |
$52.17
|
| Rate for Payer: BCBS Trust/PPO |
$50.10
|
| Rate for Payer: BCN Commercial |
$47.43
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$52.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Healthscope Commercial |
$55.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Nomi Health Commercial |
$50.33
|
| Rate for Payer: PHP Commercial |
$52.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO |
$53.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.01
|
| Rate for Payer: UHC Core |
$51.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.04
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV EA ADD 15 MIN
|
Facility
|
OP
|
$61.38
|
|
|
Service Code
|
CPT 96159
|
| Hospital Charge Code |
91400011
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$55.24 |
| Rate for Payer: Aetna Commercial |
$52.17
|
| Rate for Payer: Aetna Medicare |
$15.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.18
|
| Rate for Payer: BCBS Complete |
$24.55
|
| Rate for Payer: BCBS MAPPO |
$15.34
|
| Rate for Payer: BCBS Trust/PPO |
$50.46
|
| Rate for Payer: BCN Commercial |
$47.72
|
| Rate for Payer: BCN Medicare Advantage |
$15.34
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$52.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.34
|
| Rate for Payer: Healthscope Commercial |
$55.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Nomi Health Commercial |
$50.33
|
| Rate for Payer: PACE Senior Care Partners |
$14.58
|
| Rate for Payer: PACE SWMI |
$15.34
|
| Rate for Payer: PHP Commercial |
$52.17
|
| Rate for Payer: PHP Medicare Advantage |
$15.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO |
$53.40
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.12
|
| Rate for Payer: Railroad Medicare Medicare |
$15.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.01
|
| Rate for Payer: UHC Core |
$51.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.34
|
| Rate for Payer: UHC Exchange |
$15.34
|
| Rate for Payer: UHC Medicare Advantage |
$15.34
|
| Rate for Payer: VA VA |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.04
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
IP
|
$122.77
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$110.49 |
| Rate for Payer: Aetna Commercial |
$104.35
|
| Rate for Payer: BCBS Trust/PPO |
$100.22
|
| Rate for Payer: BCN Commercial |
$94.88
|
| Rate for Payer: Cash Price |
$98.22
|
| Rate for Payer: Cofinity Commercial |
$105.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.22
|
| Rate for Payer: Healthscope Commercial |
$110.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: Nomi Health Commercial |
$100.67
|
| Rate for Payer: PHP Commercial |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
| Rate for Payer: Priority Health HMO/PPO |
$106.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.04
|
| Rate for Payer: UHC Core |
$102.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.08
|
|
|
HC HEALTH & BEHAV INTERVENT INDIV INIT 30 MIN
|
Facility
|
OP
|
$122.77
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
91400010
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$29.16 |
| Max. Negotiated Rate |
$119.51 |
| Rate for Payer: Aetna Commercial |
$104.35
|
| Rate for Payer: Aetna Medicare |
$31.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.37
|
| Rate for Payer: BCBS Complete |
$119.51
|
| Rate for Payer: BCBS MAPPO |
$30.69
|
| Rate for Payer: BCBS Trust/PPO |
$100.93
|
| Rate for Payer: BCN Commercial |
$95.45
|
| Rate for Payer: BCN Medicare Advantage |
$30.69
|
| Rate for Payer: Cash Price |
$98.22
|
| Rate for Payer: Cash Price |
$98.22
|
| Rate for Payer: Cofinity Commercial |
$105.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.69
|
| Rate for Payer: Healthscope Commercial |
$110.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.08
|
| Rate for Payer: Mclaren Medicaid |
$113.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.23
|
| Rate for Payer: Meridian Medicaid |
$119.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: Nomi Health Commercial |
$100.67
|
| Rate for Payer: PACE Senior Care Partners |
$29.16
|
| Rate for Payer: PACE SWMI |
$30.69
|
| Rate for Payer: PHP Commercial |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$30.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
| Rate for Payer: Priority Health HMO/PPO |
$106.81
|
| Rate for Payer: Priority Health Medicare |
$31.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.26
|
| Rate for Payer: Railroad Medicare Medicare |
$30.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.04
|
| Rate for Payer: UHC Core |
$102.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.69
|
| Rate for Payer: UHC Exchange |
$30.69
|
| Rate for Payer: UHC Medicare Advantage |
$30.69
|
| Rate for Payer: UHCCP Medicaid |
$113.81
|
| Rate for Payer: VA VA |
$30.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.08
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$50.31
|
| Rate for Payer: BCN Commercial |
$47.58
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: PACE Senior Care Partners |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO |
$53.24
|
| Rate for Payer: Priority Health Medicare |
$15.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.00
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Exchange |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
| Rate for Payer: VA VA |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC HEARING AID CHECK BINAURAL
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
76100499
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$49.96
|
| Rate for Payer: BCN Commercial |
$47.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO |
$53.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC HEARING AID CHECK MONAURAL
|
Facility
|
IP
|
$54.06
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
47100402
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.14 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: BCBS Trust/PPO |
$44.13
|
| Rate for Payer: BCN Commercial |
$41.78
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.95
|
| Rate for Payer: Nomi Health Commercial |
$44.33
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.14
|
| Rate for Payer: Priority Health HMO/PPO |
$47.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.57
|
| Rate for Payer: UHC Core |
$45.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.54
|
|
|
HC HEARING AID CHECK MONAURAL
|
Facility
|
OP
|
$54.06
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
47100402
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$12.84 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna Medicare |
$14.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.89
|
| Rate for Payer: BCBS Complete |
$21.62
|
| Rate for Payer: BCBS MAPPO |
$13.52
|
| Rate for Payer: BCBS Trust/PPO |
$44.44
|
| Rate for Payer: BCN Commercial |
$42.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.52
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.52
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.95
|
| Rate for Payer: Nomi Health Commercial |
$44.33
|
| Rate for Payer: PACE Senior Care Partners |
$12.84
|
| Rate for Payer: PACE SWMI |
$13.52
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicare Advantage |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.14
|
| Rate for Payer: Priority Health HMO/PPO |
$47.03
|
| Rate for Payer: Priority Health Medicare |
$13.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.22
|
| Rate for Payer: Railroad Medicare Medicare |
$13.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.57
|
| Rate for Payer: UHC Core |
$45.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.52
|
| Rate for Payer: UHC Exchange |
$13.52
|
| Rate for Payer: UHC Medicare Advantage |
$13.52
|
| Rate for Payer: VA VA |
$13.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.54
|
|
|
HC HEARING AID EXAM BOTH EARS
|
Facility
|
IP
|
$121.38
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$103.17
|
| Rate for Payer: BCBS Trust/PPO |
$99.08
|
| Rate for Payer: BCN Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$97.10
|
| Rate for Payer: Cofinity Commercial |
$104.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.10
|
| Rate for Payer: Healthscope Commercial |
$109.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.17
|
| Rate for Payer: Nomi Health Commercial |
$99.53
|
| Rate for Payer: PHP Commercial |
$103.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.90
|
| Rate for Payer: Priority Health HMO/PPO |
$105.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.81
|
| Rate for Payer: UHC Core |
$101.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.04
|
|
|
HC HEARING AID EXAM BOTH EARS
|
Facility
|
OP
|
$121.38
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
76100504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$103.17
|
| Rate for Payer: Aetna Medicare |
$31.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.93
|
| Rate for Payer: BCBS Complete |
$48.55
|
| Rate for Payer: BCBS MAPPO |
$30.34
|
| Rate for Payer: BCBS Trust/PPO |
$99.79
|
| Rate for Payer: BCN Commercial |
$94.37
|
| Rate for Payer: BCN Medicare Advantage |
$30.34
|
| Rate for Payer: Cash Price |
$97.10
|
| Rate for Payer: Cofinity Commercial |
$104.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.34
|
| Rate for Payer: Healthscope Commercial |
$109.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.17
|
| Rate for Payer: Nomi Health Commercial |
$99.53
|
| Rate for Payer: PACE Senior Care Partners |
$28.83
|
| Rate for Payer: PACE SWMI |
$30.34
|
| Rate for Payer: PHP Commercial |
$103.17
|
| Rate for Payer: PHP Medicare Advantage |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.90
|
| Rate for Payer: Priority Health HMO/PPO |
$105.60
|
| Rate for Payer: Priority Health Medicare |
$30.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.32
|
| Rate for Payer: Railroad Medicare Medicare |
$30.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.81
|
| Rate for Payer: UHC Core |
$101.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.34
|
| Rate for Payer: UHC Exchange |
$30.34
|
| Rate for Payer: UHC Medicare Advantage |
$30.34
|
| Rate for Payer: VA VA |
$30.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.04
|
|
|
HC HEARING AID EXAM ONE EAR
|
Facility
|
OP
|
$111.18
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$100.06 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Medicare |
$28.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.74
|
| Rate for Payer: BCBS Complete |
$44.47
|
| Rate for Payer: BCBS MAPPO |
$27.80
|
| Rate for Payer: BCBS Trust/PPO |
$91.40
|
| Rate for Payer: BCN Commercial |
$86.44
|
| Rate for Payer: BCN Medicare Advantage |
$27.80
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cofinity Commercial |
$95.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.80
|
| Rate for Payer: Healthscope Commercial |
$100.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.50
|
| Rate for Payer: Nomi Health Commercial |
$91.17
|
| Rate for Payer: PACE Senior Care Partners |
$26.41
|
| Rate for Payer: PACE SWMI |
$27.80
|
| Rate for Payer: PHP Commercial |
$94.50
|
| Rate for Payer: PHP Medicare Advantage |
$27.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.27
|
| Rate for Payer: Priority Health HMO/PPO |
$96.73
|
| Rate for Payer: Priority Health Medicare |
$28.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.49
|
| Rate for Payer: Railroad Medicare Medicare |
$27.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.84
|
| Rate for Payer: UHC Core |
$92.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.80
|
| Rate for Payer: UHC Exchange |
$27.80
|
| Rate for Payer: UHC Medicare Advantage |
$27.80
|
| Rate for Payer: VA VA |
$27.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.38
|
|
|
HC HEARING AID EXAM ONE EAR
|
Facility
|
IP
|
$111.18
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
76100505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$72.27 |
| Max. Negotiated Rate |
$100.06 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: BCBS Trust/PPO |
$90.76
|
| Rate for Payer: BCN Commercial |
$85.92
|
| Rate for Payer: Cash Price |
$88.94
|
| Rate for Payer: Cofinity Commercial |
$95.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.94
|
| Rate for Payer: Healthscope Commercial |
$100.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.50
|
| Rate for Payer: Nomi Health Commercial |
$91.17
|
| Rate for Payer: PHP Commercial |
$94.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.27
|
| Rate for Payer: Priority Health HMO/PPO |
$96.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.84
|
| Rate for Payer: UHC Core |
$92.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.38
|
|
