|
HC PSA FREE
|
Facility
|
OP
|
$68.31
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$61.48 |
| Rate for Payer: Aetna Commercial |
$58.06
|
| Rate for Payer: Aetna Medicare |
$17.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.35
|
| Rate for Payer: BCBS Complete |
$14.25
|
| Rate for Payer: BCBS MAPPO |
$17.08
|
| Rate for Payer: BCBS Trust/PPO |
$53.11
|
| Rate for Payer: BCN Commercial |
$53.11
|
| Rate for Payer: BCN Medicare Advantage |
$17.08
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$58.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.08
|
| Rate for Payer: Healthscope Commercial |
$61.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.23
|
| Rate for Payer: Mclaren Medicaid |
$13.57
|
| Rate for Payer: Meridian Medicaid |
$14.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: PACE Senior Care Partners |
$16.22
|
| Rate for Payer: PACE SWMI |
$17.08
|
| Rate for Payer: PHP Commercial |
$58.06
|
| Rate for Payer: PHP Medicare Advantage |
$17.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.43
|
| Rate for Payer: Priority Health Medicare |
$17.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.66
|
| Rate for Payer: Railroad Medicare Medicare |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.11
|
| Rate for Payer: UHC Core |
$57.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.08
|
| Rate for Payer: UHC Medicare Advantage |
$17.59
|
| Rate for Payer: VA VA |
$17.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.23
|
|
|
HC PSA FREE
|
Facility
|
IP
|
$68.31
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$61.48 |
| Rate for Payer: Aetna Commercial |
$58.06
|
| Rate for Payer: BCBS Trust/PPO |
$52.79
|
| Rate for Payer: BCN Commercial |
$52.79
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$58.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.65
|
| Rate for Payer: Healthscope Commercial |
$61.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: PHP Commercial |
$58.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.11
|
| Rate for Payer: UHC Core |
$57.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.23
|
|
|
HC PSA TOTAL
|
Facility
|
OP
|
$68.31
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$61.48 |
| Rate for Payer: Aetna Commercial |
$58.06
|
| Rate for Payer: Aetna Medicare |
$17.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.35
|
| Rate for Payer: BCBS Complete |
$14.25
|
| Rate for Payer: BCBS MAPPO |
$17.08
|
| Rate for Payer: BCBS Trust/PPO |
$53.11
|
| Rate for Payer: BCN Commercial |
$53.11
|
| Rate for Payer: BCN Medicare Advantage |
$17.08
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$58.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.08
|
| Rate for Payer: Healthscope Commercial |
$61.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.23
|
| Rate for Payer: Mclaren Medicaid |
$13.57
|
| Rate for Payer: Meridian Medicaid |
$14.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: PACE Senior Care Partners |
$16.22
|
| Rate for Payer: PACE SWMI |
$17.08
|
| Rate for Payer: PHP Commercial |
$58.06
|
| Rate for Payer: PHP Medicare Advantage |
$17.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.43
|
| Rate for Payer: Priority Health Medicare |
$17.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.66
|
| Rate for Payer: Railroad Medicare Medicare |
$17.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.11
|
| Rate for Payer: UHC Core |
$57.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.08
|
| Rate for Payer: UHC Medicare Advantage |
$17.59
|
| Rate for Payer: VA VA |
$17.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.23
|
|
|
HC PSA TOTAL
|
Facility
|
IP
|
$68.31
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$61.48 |
| Rate for Payer: Aetna Commercial |
$58.06
|
| Rate for Payer: BCBS Trust/PPO |
$52.79
|
| Rate for Payer: BCN Commercial |
$52.79
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$58.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.65
|
| Rate for Payer: Healthscope Commercial |
$61.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: PHP Commercial |
$58.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.11
|
| Rate for Payer: UHC Core |
$57.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.23
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
IP
|
$1,019.57
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$621.84 |
| Max. Negotiated Rate |
$917.61 |
| Rate for Payer: Aetna Commercial |
$866.63
|
| Rate for Payer: BCBS Trust/PPO |
$787.92
|
| Rate for Payer: BCN Commercial |
$787.92
|
| Rate for Payer: Cash Price |
$815.66
|
| Rate for Payer: Cofinity Commercial |
$876.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$815.66
|
| Rate for Payer: Healthscope Commercial |
$917.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$764.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$866.63
|
| Rate for Payer: PHP Commercial |
$866.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$887.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$897.22
|
| Rate for Payer: UHC Core |
$851.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$764.68
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
OP
|
$1,019.57
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$242.15 |
| Max. Negotiated Rate |
$917.61 |
| Rate for Payer: Aetna Commercial |
$866.63
|
| Rate for Payer: Aetna Medicare |
$265.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$318.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$318.62
|
| Rate for Payer: BCBS Complete |
$432.70
|
| Rate for Payer: BCBS MAPPO |
$254.89
|
| Rate for Payer: BCBS Trust/PPO |
$792.72
|
| Rate for Payer: BCN Commercial |
$792.72
|
| Rate for Payer: BCN Medicare Advantage |
$254.89
|
| Rate for Payer: Cash Price |
$815.66
|
| Rate for Payer: Cash Price |
$815.66
|
| Rate for Payer: Cofinity Commercial |
$876.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$815.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$254.89
|
| Rate for Payer: Healthscope Commercial |
$917.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$764.68
|
| Rate for Payer: Mclaren Medicaid |
$412.10
|
| Rate for Payer: Meridian Medicaid |
$432.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$267.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$866.63
|
| Rate for Payer: PACE Senior Care Partners |
$242.15
|
| Rate for Payer: PACE SWMI |
$254.89
|
| Rate for Payer: PHP Commercial |
$866.63
|
| Rate for Payer: PHP Medicare Advantage |
$254.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$412.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$887.03
|
| Rate for Payer: Priority Health Medicare |
$254.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.84
|
| Rate for Payer: Railroad Medicare Medicare |
$254.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$897.22
|
| Rate for Payer: UHC Core |
$851.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$254.89
|
| Rate for Payer: UHC Medicare Advantage |
$262.54
|
| Rate for Payer: VA VA |
$254.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$764.68
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$6.10
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$5.81
|
| Rate for Payer: Meridian Medicaid |
$6.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,680.64
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$685.87 |
| Max. Negotiated Rate |
$5,112.58 |
| Rate for Payer: Aetna Commercial |
$4,828.54
|
| Rate for Payer: Aetna Medicare |
$1,476.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,775.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,775.20
|
| Rate for Payer: BCBS Complete |
$720.16
|
| Rate for Payer: BCBS MAPPO |
$1,420.16
|
| Rate for Payer: BCBS Trust/PPO |
$4,416.70
|
| Rate for Payer: BCN Commercial |
$4,416.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,420.16
|
| Rate for Payer: Cash Price |
$4,544.51
|
| Rate for Payer: Cash Price |
$4,544.51
|
| Rate for Payer: Cofinity Commercial |
$4,885.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,544.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,420.16
|
| Rate for Payer: Healthscope Commercial |
$5,112.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,260.48
|
| Rate for Payer: Mclaren Medicaid |
$685.87
|
| Rate for Payer: Meridian Medicaid |
$720.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,491.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,633.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,828.54
|
| Rate for Payer: PACE Senior Care Partners |
$1,349.15
|
| Rate for Payer: PACE SWMI |
$1,420.16
|
| Rate for Payer: PHP Commercial |
$4,828.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,420.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,976.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,942.16
|
| Rate for Payer: Priority Health Medicare |
$1,420.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,464.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,420.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,998.96
|
| Rate for Payer: UHC Core |
$4,743.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,420.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,462.76
|
| Rate for Payer: VA VA |
$1,420.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,260.48
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,680.64
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,464.62 |
| Max. Negotiated Rate |
$5,112.58 |
| Rate for Payer: Aetna Commercial |
$4,828.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,390.00
|
| Rate for Payer: BCN Commercial |
$4,390.00
|
| Rate for Payer: Cash Price |
$4,544.51
|
| Rate for Payer: Cofinity Commercial |
$4,885.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,544.51
|
| Rate for Payer: Healthscope Commercial |
$5,112.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,260.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,828.54
|
| Rate for Payer: PHP Commercial |
$4,828.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,976.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,942.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,464.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,998.96
|
| Rate for Payer: UHC Core |
$4,743.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,260.48
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,865.71
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$685.87 |
| Max. Negotiated Rate |
$5,279.14 |
| Rate for Payer: Aetna Commercial |
$4,985.85
|
| Rate for Payer: Aetna Medicare |
$1,525.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,833.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,833.03
|
| Rate for Payer: BCBS Complete |
$720.16
|
| Rate for Payer: BCBS MAPPO |
$1,466.43
|
| Rate for Payer: BCBS Trust/PPO |
$4,560.59
|
| Rate for Payer: BCN Commercial |
$4,560.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,466.43
|
| Rate for Payer: Cash Price |
$4,692.57
|
| Rate for Payer: Cash Price |
$4,692.57
|
| Rate for Payer: Cofinity Commercial |
$5,044.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,692.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,466.43
|
| Rate for Payer: Healthscope Commercial |
$5,279.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,399.28
|
| Rate for Payer: Mclaren Medicaid |
$685.87
|
| Rate for Payer: Meridian Medicaid |
$720.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,539.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,686.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,985.85
|
| Rate for Payer: PACE Senior Care Partners |
$1,393.11
|
| Rate for Payer: PACE SWMI |
$1,466.43
|
| Rate for Payer: PHP Commercial |
$4,985.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,466.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,106.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,103.17
|
| Rate for Payer: Priority Health Medicare |
$1,466.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,577.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,466.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,161.82
|
| Rate for Payer: UHC Core |
$4,897.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,466.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,510.42
|
| Rate for Payer: VA VA |
$1,466.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,399.28
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,865.71
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,577.50 |
| Max. Negotiated Rate |
$5,279.14 |
| Rate for Payer: Aetna Commercial |
$4,985.85
|
| Rate for Payer: BCBS Trust/PPO |
$4,533.02
|
| Rate for Payer: BCN Commercial |
$4,533.02
|
| Rate for Payer: Cash Price |
$4,692.57
|
| Rate for Payer: Cofinity Commercial |
$5,044.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,692.57
|
| Rate for Payer: Healthscope Commercial |
$5,279.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,399.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,985.85
|
| Rate for Payer: PHP Commercial |
$4,985.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,106.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,103.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,577.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,161.82
|
| Rate for Payer: UHC Core |
$4,897.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,399.28
|
|
|
HC PSORALEN
|
Facility
|
IP
|
$2,114.62
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,289.71 |
| Max. Negotiated Rate |
$1,903.16 |
| Rate for Payer: Aetna Commercial |
$1,797.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,634.18
|
| Rate for Payer: BCN Commercial |
$1,634.18
|
| Rate for Payer: Cash Price |
$1,691.70
|
| Rate for Payer: Cofinity Commercial |
$1,818.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.70
|
| Rate for Payer: Healthscope Commercial |
$1,903.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,585.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,797.43
|
| Rate for Payer: PHP Commercial |
$1,797.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,839.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,289.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,860.87
|
| Rate for Payer: UHC Core |
$1,765.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,585.96
|
|
|
HC PSORALEN
|
Facility
|
OP
|
$2,114.62
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$379.55 |
| Max. Negotiated Rate |
$1,903.16 |
| Rate for Payer: Aetna Commercial |
$1,797.43
|
| Rate for Payer: Aetna Medicare |
$549.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$660.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$660.82
|
| Rate for Payer: BCBS Complete |
$398.53
|
| Rate for Payer: BCBS MAPPO |
$528.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.12
|
| Rate for Payer: BCN Commercial |
$1,644.12
|
| Rate for Payer: BCN Medicare Advantage |
$528.66
|
| Rate for Payer: Cash Price |
$1,691.70
|
| Rate for Payer: Cash Price |
$1,691.70
|
| Rate for Payer: Cofinity Commercial |
$1,818.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.66
|
| Rate for Payer: Healthscope Commercial |
$1,903.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,585.96
|
| Rate for Payer: Mclaren Medicaid |
$379.55
|
| Rate for Payer: Meridian Medicaid |
$398.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$555.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$607.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,797.43
|
| Rate for Payer: PACE Senior Care Partners |
$502.22
|
| Rate for Payer: PACE SWMI |
$528.66
|
| Rate for Payer: PHP Commercial |
$1,797.43
|
| Rate for Payer: PHP Medicare Advantage |
$528.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$379.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,839.72
|
| Rate for Payer: Priority Health Medicare |
$528.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,289.71
|
| Rate for Payer: Railroad Medicare Medicare |
$528.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,860.87
|
| Rate for Payer: UHC Core |
$1,765.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$528.66
|
| Rate for Payer: UHC Medicare Advantage |
$544.51
|
| Rate for Payer: VA VA |
$528.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,585.96
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
IP
|
$2,194.62
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,338.50 |
| Max. Negotiated Rate |
$1,975.16 |
| Rate for Payer: Aetna Commercial |
$1,865.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,696.00
|
| Rate for Payer: BCN Commercial |
$1,696.00
|
| Rate for Payer: Cash Price |
$1,755.70
|
| Rate for Payer: Cofinity Commercial |
$1,887.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,755.70
|
| Rate for Payer: Healthscope Commercial |
$1,975.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,645.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,865.43
|
| Rate for Payer: PHP Commercial |
$1,865.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,536.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,909.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,338.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.27
|
| Rate for Payer: UHC Core |
$1,832.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,645.96
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
OP
|
$2,194.62
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$379.55 |
| Max. Negotiated Rate |
$1,975.16 |
| Rate for Payer: Aetna Commercial |
$1,865.43
|
| Rate for Payer: Aetna Medicare |
$570.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$685.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$685.82
|
| Rate for Payer: BCBS Complete |
$398.53
|
| Rate for Payer: BCBS MAPPO |
$548.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,706.32
|
| Rate for Payer: BCN Commercial |
$1,706.32
|
| Rate for Payer: BCN Medicare Advantage |
$548.66
|
| Rate for Payer: Cash Price |
$1,755.70
|
| Rate for Payer: Cash Price |
$1,755.70
|
| Rate for Payer: Cofinity Commercial |
$1,887.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,755.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$548.66
|
| Rate for Payer: Healthscope Commercial |
$1,975.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,645.96
|
| Rate for Payer: Mclaren Medicaid |
$379.55
|
| Rate for Payer: Meridian Medicaid |
$398.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$576.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$630.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,865.43
|
| Rate for Payer: PACE Senior Care Partners |
$521.22
|
| Rate for Payer: PACE SWMI |
$548.66
|
| Rate for Payer: PHP Commercial |
$1,865.43
|
| Rate for Payer: PHP Medicare Advantage |
$548.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$379.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,536.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,909.32
|
| Rate for Payer: Priority Health Medicare |
$548.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,338.50
|
| Rate for Payer: Railroad Medicare Medicare |
$548.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.27
|
| Rate for Payer: UHC Core |
$1,832.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$548.66
|
| Rate for Payer: UHC Medicare Advantage |
$565.11
|
| Rate for Payer: VA VA |
$548.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,645.96
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: BCBS Trust/PPO |
$67.79
|
| Rate for Payer: BCN Commercial |
$67.79
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.19
|
| Rate for Payer: UHC Core |
$73.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.79
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna Medicare |
$22.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.41
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: BCBS MAPPO |
$21.93
|
| Rate for Payer: BCBS Trust/PPO |
$68.20
|
| Rate for Payer: BCN Commercial |
$68.20
|
| Rate for Payer: BCN Medicare Advantage |
$21.93
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: PACE Senior Care Partners |
$20.83
|
| Rate for Payer: PACE SWMI |
$21.93
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: PHP Medicare Advantage |
$21.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.32
|
| Rate for Payer: Priority Health Medicare |
$21.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.50
|
| Rate for Payer: Railroad Medicare Medicare |
$21.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.19
|
| Rate for Payer: UHC Core |
$73.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.93
|
| Rate for Payer: UHC Medicare Advantage |
$22.59
|
| Rate for Payer: VA VA |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.79
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
OP
|
$93.84
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$84.46 |
| Rate for Payer: Aetna Commercial |
$79.76
|
| Rate for Payer: Aetna Medicare |
$24.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.32
|
| Rate for Payer: BCBS Complete |
$61.40
|
| Rate for Payer: BCBS MAPPO |
$23.46
|
| Rate for Payer: BCBS Trust/PPO |
$72.96
|
| Rate for Payer: BCN Commercial |
$72.96
|
| Rate for Payer: BCN Medicare Advantage |
$23.46
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$80.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$84.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.38
|
| Rate for Payer: Mclaren Medicaid |
$58.47
|
| Rate for Payer: Meridian Medicaid |
$61.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.76
|
| Rate for Payer: PACE Senior Care Partners |
$22.29
|
| Rate for Payer: PACE SWMI |
$23.46
|
| Rate for Payer: PHP Commercial |
$79.76
|
| Rate for Payer: PHP Medicare Advantage |
$23.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.64
|
| Rate for Payer: Priority Health Medicare |
$23.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.23
|
| Rate for Payer: Railroad Medicare Medicare |
$23.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.58
|
| Rate for Payer: UHC Core |
$78.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.46
|
| Rate for Payer: UHC Medicare Advantage |
$24.16
|
| Rate for Payer: VA VA |
$23.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.38
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
IP
|
$93.84
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.23 |
| Max. Negotiated Rate |
$84.46 |
| Rate for Payer: Aetna Commercial |
$79.76
|
| Rate for Payer: BCBS Trust/PPO |
$72.52
|
| Rate for Payer: BCN Commercial |
$72.52
|
| Rate for Payer: Cash Price |
$75.07
|
| Rate for Payer: Cofinity Commercial |
$80.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.07
|
| Rate for Payer: Healthscope Commercial |
$84.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.76
|
| Rate for Payer: PHP Commercial |
$79.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.58
|
| Rate for Payer: UHC Core |
$78.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.38
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
OP
|
$103.22
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$109.82 |
| Rate for Payer: Aetna Commercial |
$87.74
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: BCBS Complete |
$109.82
|
| Rate for Payer: BCBS MAPPO |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$80.25
|
| Rate for Payer: BCN Commercial |
$80.25
|
| Rate for Payer: BCN Medicare Advantage |
$25.80
|
| Rate for Payer: Cash Price |
$82.58
|
| Rate for Payer: Cash Price |
$82.58
|
| Rate for Payer: Cofinity Commercial |
$88.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$92.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.42
|
| Rate for Payer: Mclaren Medicaid |
$104.59
|
| Rate for Payer: Meridian Medicaid |
$109.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.74
|
| Rate for Payer: PACE Senior Care Partners |
$24.51
|
| Rate for Payer: PACE SWMI |
$25.80
|
| Rate for Payer: PHP Commercial |
$87.74
|
| Rate for Payer: PHP Medicare Advantage |
$25.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.80
|
| Rate for Payer: Priority Health Medicare |
$25.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.95
|
| Rate for Payer: Railroad Medicare Medicare |
$25.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.83
|
| Rate for Payer: UHC Core |
$86.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.80
|
| Rate for Payer: UHC Medicare Advantage |
$26.58
|
| Rate for Payer: VA VA |
$25.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.42
|
|
|
HC PSYCH COLLAB CARE MGMT SUBSEQ 60 MIN
|
Facility
|
IP
|
$103.22
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
51000093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.95 |
| Max. Negotiated Rate |
$92.90 |
| Rate for Payer: Aetna Commercial |
$87.74
|
| Rate for Payer: BCBS Trust/PPO |
$79.77
|
| Rate for Payer: BCN Commercial |
$79.77
|
| Rate for Payer: Cash Price |
$82.58
|
| Rate for Payer: Cofinity Commercial |
$88.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.58
|
| Rate for Payer: Healthscope Commercial |
$92.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.74
|
| Rate for Payer: PHP Commercial |
$87.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.83
|
| Rate for Payer: UHC Core |
$86.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.42
|
|
|
HC PSYCH DIAGNOSTIC EVAL W/MED SVCS
|
Facility
|
OP
|
$194.82
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
91400008
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$175.34 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Medicare |
$50.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.88
|
| Rate for Payer: BCBS Complete |
$109.82
|
| Rate for Payer: BCBS MAPPO |
$48.70
|
| Rate for Payer: BCBS Trust/PPO |
$151.47
|
| Rate for Payer: BCN Commercial |
$151.47
|
| Rate for Payer: BCN Medicare Advantage |
$48.70
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cofinity Commercial |
$167.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.70
|
| Rate for Payer: Healthscope Commercial |
$175.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.12
|
| Rate for Payer: Mclaren Medicaid |
$104.59
|
| Rate for Payer: Meridian Medicaid |
$109.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.60
|
| Rate for Payer: PACE Senior Care Partners |
$46.27
|
| Rate for Payer: PACE SWMI |
$48.70
|
| Rate for Payer: PHP Commercial |
$165.60
|
| Rate for Payer: PHP Medicare Advantage |
$48.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Medicare |
$48.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.82
|
| Rate for Payer: Railroad Medicare Medicare |
$48.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.44
|
| Rate for Payer: UHC Core |
$162.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.70
|
| Rate for Payer: UHC Medicare Advantage |
$50.17
|
| Rate for Payer: VA VA |
$48.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.12
|
|
|
HC PSYCH DIAGNOSTIC EVAL W/MED SVCS
|
Facility
|
IP
|
$194.82
|
|
|
Service Code
|
CPT 90792
|
| Hospital Charge Code |
91400008
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$118.82 |
| Max. Negotiated Rate |
$175.34 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: BCBS Trust/PPO |
$150.56
|
| Rate for Payer: BCN Commercial |
$150.56
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cofinity Commercial |
$167.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.86
|
| Rate for Payer: Healthscope Commercial |
$175.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.60
|
| Rate for Payer: PHP Commercial |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.44
|
| Rate for Payer: UHC Core |
$162.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.12
|
|
|
HC PSYCHIATRIC DIAG EVAL
|
Facility
|
OP
|
$194.82
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
91400004
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$175.34 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Medicare |
$50.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.88
|
| Rate for Payer: BCBS Complete |
$109.82
|
| Rate for Payer: BCBS MAPPO |
$48.70
|
| Rate for Payer: BCBS Trust/PPO |
$151.47
|
| Rate for Payer: BCN Commercial |
$151.47
|
| Rate for Payer: BCN Medicare Advantage |
$48.70
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cash Price |
$155.86
|
| Rate for Payer: Cofinity Commercial |
$167.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.70
|
| Rate for Payer: Healthscope Commercial |
$175.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.12
|
| Rate for Payer: Mclaren Medicaid |
$104.59
|
| Rate for Payer: Meridian Medicaid |
$109.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.60
|
| Rate for Payer: PACE Senior Care Partners |
$46.27
|
| Rate for Payer: PACE SWMI |
$48.70
|
| Rate for Payer: PHP Commercial |
$165.60
|
| Rate for Payer: PHP Medicare Advantage |
$48.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.49
|
| Rate for Payer: Priority Health Medicare |
$48.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.82
|
| Rate for Payer: Railroad Medicare Medicare |
$48.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.44
|
| Rate for Payer: UHC Core |
$162.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.70
|
| Rate for Payer: UHC Medicare Advantage |
$50.17
|
| Rate for Payer: VA VA |
$48.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.12
|
|
