|
HC PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
91400003
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$137.23 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: BCBS Trust/PPO |
$173.88
|
| Rate for Payer: BCN Commercial |
$173.88
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.00
|
| Rate for Payer: UHC Core |
$187.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
|
HC PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
91400003
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$53.44 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna Commercial |
$191.25
|
| Rate for Payer: Aetna Medicare |
$58.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.31
|
| Rate for Payer: BCBS Complete |
$109.82
|
| Rate for Payer: BCBS MAPPO |
$56.25
|
| Rate for Payer: BCBS Trust/PPO |
$174.94
|
| Rate for Payer: BCN Commercial |
$174.94
|
| Rate for Payer: BCN Medicare Advantage |
$56.25
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$193.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.25
|
| Rate for Payer: Healthscope Commercial |
$202.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.75
|
| Rate for Payer: Mclaren Medicaid |
$104.59
|
| Rate for Payer: Meridian Medicaid |
$109.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.25
|
| Rate for Payer: PACE Senior Care Partners |
$53.44
|
| Rate for Payer: PACE SWMI |
$56.25
|
| Rate for Payer: PHP Commercial |
$191.25
|
| Rate for Payer: PHP Medicare Advantage |
$56.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.75
|
| Rate for Payer: Priority Health Medicare |
$56.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.23
|
| Rate for Payer: Railroad Medicare Medicare |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.00
|
| Rate for Payer: UHC Core |
$187.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.25
|
| Rate for Payer: UHC Medicare Advantage |
$57.94
|
| Rate for Payer: VA VA |
$56.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.75
|
|
|
HC PTCA ADD/BRANCH
|
Facility
|
OP
|
$7,147.66
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,697.57 |
| Max. Negotiated Rate |
$6,432.89 |
| Rate for Payer: Aetna Commercial |
$6,075.51
|
| Rate for Payer: Aetna Medicare |
$1,858.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,233.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,233.64
|
| Rate for Payer: BCBS Complete |
$2,859.06
|
| Rate for Payer: BCBS MAPPO |
$1,786.92
|
| Rate for Payer: BCBS Trust/PPO |
$5,557.31
|
| Rate for Payer: BCN Commercial |
$5,557.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,786.92
|
| Rate for Payer: Cash Price |
$5,718.13
|
| Rate for Payer: Cofinity Commercial |
$6,146.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,718.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,786.92
|
| Rate for Payer: Healthscope Commercial |
$6,432.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,360.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,876.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,054.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,075.51
|
| Rate for Payer: PACE Senior Care Partners |
$1,697.57
|
| Rate for Payer: PACE SWMI |
$1,786.92
|
| Rate for Payer: PHP Commercial |
$6,075.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,786.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,003.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,218.46
|
| Rate for Payer: Priority Health Medicare |
$1,786.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,359.36
|
| Rate for Payer: Railroad Medicare Medicare |
$1,786.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,289.94
|
| Rate for Payer: UHC Core |
$5,968.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,786.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,840.52
|
| Rate for Payer: VA VA |
$1,786.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,360.74
|
|
|
HC PTCA ADD/BRANCH
|
Facility
|
IP
|
$7,147.66
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,359.36 |
| Max. Negotiated Rate |
$6,432.89 |
| Rate for Payer: Aetna Commercial |
$6,075.51
|
| Rate for Payer: BCBS Trust/PPO |
$5,523.71
|
| Rate for Payer: BCN Commercial |
$5,523.71
|
| Rate for Payer: Cash Price |
$5,718.13
|
| Rate for Payer: Cofinity Commercial |
$6,146.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,718.13
|
| Rate for Payer: Healthscope Commercial |
$6,432.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,360.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,075.51
|
| Rate for Payer: PHP Commercial |
$6,075.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,003.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,218.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,359.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,289.94
|
| Rate for Payer: UHC Core |
$5,968.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,360.74
|
|
|
HC PTCA BALLOON
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.49 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Aetna Commercial |
$867.85
|
| Rate for Payer: Aetna Medicare |
$265.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$319.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$319.06
|
| Rate for Payer: BCBS Complete |
$408.40
|
| Rate for Payer: BCBS MAPPO |
$255.25
|
| Rate for Payer: BCBS Trust/PPO |
$793.83
|
| Rate for Payer: BCN Commercial |
$793.83
|
| Rate for Payer: BCN Medicare Advantage |
$255.25
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cofinity Commercial |
$878.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.25
|
| Rate for Payer: Healthscope Commercial |
$918.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$268.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$867.85
|
| Rate for Payer: PACE Senior Care Partners |
$242.49
|
| Rate for Payer: PACE SWMI |
$255.25
|
| Rate for Payer: PHP Commercial |
$867.85
|
| Rate for Payer: PHP Medicare Advantage |
$255.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$888.27
|
| Rate for Payer: Priority Health Medicare |
$255.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$622.71
|
| Rate for Payer: Railroad Medicare Medicare |
$255.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.48
|
| Rate for Payer: UHC Core |
$852.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.25
|
| Rate for Payer: UHC Medicare Advantage |
$262.91
|
| Rate for Payer: VA VA |
$255.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.75
|
|
|
HC PTCA BALLOON
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$622.71 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Aetna Commercial |
$867.85
|
| Rate for Payer: BCBS Trust/PPO |
$789.03
|
| Rate for Payer: BCN Commercial |
$789.03
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cofinity Commercial |
$878.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.80
|
| Rate for Payer: Healthscope Commercial |
$918.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$867.85
|
| Rate for Payer: PHP Commercial |
$867.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$888.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$622.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.48
|
| Rate for Payer: UHC Core |
$852.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.75
|
|
|
HC PTCA VESSEL/BRANCH
|
Facility
|
OP
|
$10,980.15
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,607.79 |
| Max. Negotiated Rate |
$9,882.14 |
| Rate for Payer: Aetna Commercial |
$9,333.13
|
| Rate for Payer: Aetna Medicare |
$2,854.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,431.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,431.30
|
| Rate for Payer: BCBS Complete |
$3,936.90
|
| Rate for Payer: BCBS MAPPO |
$2,745.04
|
| Rate for Payer: BCBS Trust/PPO |
$8,537.07
|
| Rate for Payer: BCN Commercial |
$8,537.07
|
| Rate for Payer: BCN Medicare Advantage |
$2,745.04
|
| Rate for Payer: Cash Price |
$8,784.12
|
| Rate for Payer: Cash Price |
$8,784.12
|
| Rate for Payer: Cofinity Commercial |
$9,442.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,784.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,745.04
|
| Rate for Payer: Healthscope Commercial |
$9,882.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,235.11
|
| Rate for Payer: Mclaren Medicaid |
$3,749.43
|
| Rate for Payer: Meridian Medicaid |
$3,936.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,882.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,156.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,333.13
|
| Rate for Payer: PACE Senior Care Partners |
$2,607.79
|
| Rate for Payer: PACE SWMI |
$2,745.04
|
| Rate for Payer: PHP Commercial |
$9,333.13
|
| Rate for Payer: PHP Medicare Advantage |
$2,745.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,749.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,686.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,552.73
|
| Rate for Payer: Priority Health Medicare |
$2,745.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,696.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,745.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,662.53
|
| Rate for Payer: UHC Core |
$9,168.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,745.04
|
| Rate for Payer: UHC Medicare Advantage |
$2,827.39
|
| Rate for Payer: VA VA |
$2,745.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,235.11
|
|
|
HC PTCA VESSEL/BRANCH
|
Facility
|
IP
|
$10,980.15
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,696.79 |
| Max. Negotiated Rate |
$9,882.14 |
| Rate for Payer: Aetna Commercial |
$9,333.13
|
| Rate for Payer: BCBS Trust/PPO |
$8,485.46
|
| Rate for Payer: BCN Commercial |
$8,485.46
|
| Rate for Payer: Cash Price |
$8,784.12
|
| Rate for Payer: Cofinity Commercial |
$9,442.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,784.12
|
| Rate for Payer: Healthscope Commercial |
$9,882.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,235.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,333.13
|
| Rate for Payer: PHP Commercial |
$9,333.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,686.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,552.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,696.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,662.53
|
| Rate for Payer: UHC Core |
$9,168.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,235.11
|
|
|
HC PTCRAWDES ADD.BRANCH
|
Facility
|
IP
|
$18,727.35
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,421.81 |
| Max. Negotiated Rate |
$16,854.62 |
| Rate for Payer: Aetna Commercial |
$15,918.25
|
| Rate for Payer: BCBS Trust/PPO |
$14,472.50
|
| Rate for Payer: BCN Commercial |
$14,472.50
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$16,105.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,981.88
|
| Rate for Payer: Healthscope Commercial |
$16,854.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,045.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: PHP Commercial |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,292.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,421.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,480.07
|
| Rate for Payer: UHC Core |
$15,637.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,045.51
|
|
|
HC PTCRAWDES ADD.BRANCH
|
Facility
|
OP
|
$18,727.35
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,447.75 |
| Max. Negotiated Rate |
$16,854.62 |
| Rate for Payer: Aetna Commercial |
$15,918.25
|
| Rate for Payer: Aetna Medicare |
$4,869.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,852.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,852.30
|
| Rate for Payer: BCBS Complete |
$7,490.94
|
| Rate for Payer: BCBS MAPPO |
$4,681.84
|
| Rate for Payer: BCBS Trust/PPO |
$14,560.51
|
| Rate for Payer: BCN Commercial |
$14,560.51
|
| Rate for Payer: BCN Medicare Advantage |
$4,681.84
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$16,105.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,981.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,681.84
|
| Rate for Payer: Healthscope Commercial |
$16,854.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,045.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,915.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,384.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: PACE Senior Care Partners |
$4,447.75
|
| Rate for Payer: PACE SWMI |
$4,681.84
|
| Rate for Payer: PHP Commercial |
$15,918.25
|
| Rate for Payer: PHP Medicare Advantage |
$4,681.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,292.79
|
| Rate for Payer: Priority Health Medicare |
$4,681.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,421.81
|
| Rate for Payer: Railroad Medicare Medicare |
$4,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,480.07
|
| Rate for Payer: UHC Core |
$15,637.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,681.84
|
| Rate for Payer: UHC Medicare Advantage |
$4,822.29
|
| Rate for Payer: VA VA |
$4,681.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,045.51
|
|
|
HC PTCRAWDES VES/BRANCH
|
Facility
|
IP
|
$28,586.86
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,435.13 |
| Max. Negotiated Rate |
$25,728.17 |
| Rate for Payer: Aetna Commercial |
$24,298.83
|
| Rate for Payer: BCBS Trust/PPO |
$22,091.93
|
| Rate for Payer: BCN Commercial |
$22,091.93
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$24,584.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,869.49
|
| Rate for Payer: Healthscope Commercial |
$25,728.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,440.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PHP Commercial |
$24,298.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,870.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17,435.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,156.44
|
| Rate for Payer: UHC Core |
$23,870.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,440.14
|
|
|
HC PTCRAWDES VES/BRANCH
|
Facility
|
OP
|
$28,586.86
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,789.38 |
| Max. Negotiated Rate |
$25,728.17 |
| Rate for Payer: Aetna Commercial |
$24,298.83
|
| Rate for Payer: Aetna Medicare |
$7,432.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,933.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,933.39
|
| Rate for Payer: BCBS Complete |
$12,078.04
|
| Rate for Payer: BCBS MAPPO |
$7,146.72
|
| Rate for Payer: BCBS Trust/PPO |
$22,226.28
|
| Rate for Payer: BCN Commercial |
$22,226.28
|
| Rate for Payer: BCN Medicare Advantage |
$7,146.72
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$24,584.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,869.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,146.72
|
| Rate for Payer: Healthscope Commercial |
$25,728.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,440.14
|
| Rate for Payer: Mclaren Medicaid |
$11,502.90
|
| Rate for Payer: Meridian Medicaid |
$12,078.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,504.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,218.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PACE Senior Care Partners |
$6,789.38
|
| Rate for Payer: PACE SWMI |
$7,146.72
|
| Rate for Payer: PHP Commercial |
$24,298.83
|
| Rate for Payer: PHP Medicare Advantage |
$7,146.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,502.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,870.57
|
| Rate for Payer: Priority Health Medicare |
$7,146.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17,435.13
|
| Rate for Payer: Railroad Medicare Medicare |
$7,146.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,156.44
|
| Rate for Payer: UHC Core |
$23,870.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,146.72
|
| Rate for Payer: UHC Medicare Advantage |
$7,361.12
|
| Rate for Payer: VA VA |
$7,146.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,440.14
|
|
|
HC PTCRAWPTCA ADD.BRANCH
|
Facility
|
IP
|
$11,706.18
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,139.60 |
| Max. Negotiated Rate |
$10,535.56 |
| Rate for Payer: Aetna Commercial |
$9,950.25
|
| Rate for Payer: BCBS Trust/PPO |
$9,046.54
|
| Rate for Payer: BCN Commercial |
$9,046.54
|
| Rate for Payer: Cash Price |
$9,364.94
|
| Rate for Payer: Cofinity Commercial |
$10,067.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,364.94
|
| Rate for Payer: Healthscope Commercial |
$10,535.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,779.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,950.25
|
| Rate for Payer: PHP Commercial |
$9,950.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,194.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,184.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,139.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,301.44
|
| Rate for Payer: UHC Core |
$9,774.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,779.64
|
|
|
HC PTCRAWPTCA ADD.BRANCH
|
Facility
|
OP
|
$11,706.18
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,780.22 |
| Max. Negotiated Rate |
$10,535.56 |
| Rate for Payer: Aetna Commercial |
$9,950.25
|
| Rate for Payer: Aetna Medicare |
$3,043.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,658.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,658.18
|
| Rate for Payer: BCBS Complete |
$4,682.47
|
| Rate for Payer: BCBS MAPPO |
$2,926.54
|
| Rate for Payer: BCBS Trust/PPO |
$9,101.55
|
| Rate for Payer: BCN Commercial |
$9,101.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,926.54
|
| Rate for Payer: Cash Price |
$9,364.94
|
| Rate for Payer: Cofinity Commercial |
$10,067.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,364.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,926.54
|
| Rate for Payer: Healthscope Commercial |
$10,535.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,779.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,072.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,365.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,950.25
|
| Rate for Payer: PACE Senior Care Partners |
$2,780.22
|
| Rate for Payer: PACE SWMI |
$2,926.54
|
| Rate for Payer: PHP Commercial |
$9,950.25
|
| Rate for Payer: PHP Medicare Advantage |
$2,926.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,194.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,184.38
|
| Rate for Payer: Priority Health Medicare |
$2,926.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,139.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,926.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,301.44
|
| Rate for Payer: UHC Core |
$9,774.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,926.54
|
| Rate for Payer: UHC Medicare Advantage |
$3,014.34
|
| Rate for Payer: VA VA |
$2,926.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,779.64
|
|
|
HC PTCRAWPTCA VES/BRANCH
|
Facility
|
OP
|
$15,389.41
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,654.98 |
| Max. Negotiated Rate |
$13,850.47 |
| Rate for Payer: Aetna Commercial |
$13,081.00
|
| Rate for Payer: Aetna Medicare |
$4,001.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,809.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,809.19
|
| Rate for Payer: BCBS Complete |
$7,577.51
|
| Rate for Payer: BCBS MAPPO |
$3,847.35
|
| Rate for Payer: BCBS Trust/PPO |
$11,965.27
|
| Rate for Payer: BCN Commercial |
$11,965.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,847.35
|
| Rate for Payer: Cash Price |
$12,311.53
|
| Rate for Payer: Cash Price |
$12,311.53
|
| Rate for Payer: Cofinity Commercial |
$13,234.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,311.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,847.35
|
| Rate for Payer: Healthscope Commercial |
$13,850.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,542.06
|
| Rate for Payer: Mclaren Medicaid |
$7,216.67
|
| Rate for Payer: Meridian Medicaid |
$7,577.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,039.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,424.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,081.00
|
| Rate for Payer: PACE Senior Care Partners |
$3,654.98
|
| Rate for Payer: PACE SWMI |
$3,847.35
|
| Rate for Payer: PHP Commercial |
$13,081.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,847.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,216.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,772.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,388.79
|
| Rate for Payer: Priority Health Medicare |
$3,847.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,386.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,847.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,542.68
|
| Rate for Payer: UHC Core |
$12,850.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,847.35
|
| Rate for Payer: UHC Medicare Advantage |
$3,962.77
|
| Rate for Payer: VA VA |
$3,847.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,542.06
|
|
|
HC PTCRAWPTCA VES/BRANCH
|
Facility
|
IP
|
$15,389.41
|
|
|
Service Code
|
CPT 92924
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,386.00 |
| Max. Negotiated Rate |
$13,850.47 |
| Rate for Payer: Aetna Commercial |
$13,081.00
|
| Rate for Payer: BCBS Trust/PPO |
$11,892.94
|
| Rate for Payer: BCN Commercial |
$11,892.94
|
| Rate for Payer: Cash Price |
$12,311.53
|
| Rate for Payer: Cofinity Commercial |
$13,234.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,311.53
|
| Rate for Payer: Healthscope Commercial |
$13,850.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,542.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13,081.00
|
| Rate for Payer: PHP Commercial |
$13,081.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,772.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,388.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,386.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,542.68
|
| Rate for Payer: UHC Core |
$12,850.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,542.06
|
|
|
HC PTCRAWSTENT ADD.BRANCH
|
Facility
|
IP
|
$18,727.35
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$11,421.81 |
| Max. Negotiated Rate |
$16,854.62 |
| Rate for Payer: Aetna Commercial |
$15,918.25
|
| Rate for Payer: BCBS Trust/PPO |
$14,472.50
|
| Rate for Payer: BCN Commercial |
$14,472.50
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$16,105.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,981.88
|
| Rate for Payer: Healthscope Commercial |
$16,854.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,045.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: PHP Commercial |
$15,918.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,292.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,421.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,480.07
|
| Rate for Payer: UHC Core |
$15,637.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,045.51
|
|
|
HC PTCRAWSTENT ADD.BRANCH
|
Facility
|
OP
|
$18,727.35
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,447.75 |
| Max. Negotiated Rate |
$16,854.62 |
| Rate for Payer: Aetna Commercial |
$15,918.25
|
| Rate for Payer: Aetna Medicare |
$4,869.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,852.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,852.30
|
| Rate for Payer: BCBS Complete |
$7,490.94
|
| Rate for Payer: BCBS MAPPO |
$4,681.84
|
| Rate for Payer: BCBS Trust/PPO |
$14,560.51
|
| Rate for Payer: BCN Commercial |
$14,560.51
|
| Rate for Payer: BCN Medicare Advantage |
$4,681.84
|
| Rate for Payer: Cash Price |
$14,981.88
|
| Rate for Payer: Cofinity Commercial |
$16,105.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14,981.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,681.84
|
| Rate for Payer: Healthscope Commercial |
$16,854.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,045.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,915.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,384.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,918.25
|
| Rate for Payer: PACE Senior Care Partners |
$4,447.75
|
| Rate for Payer: PACE SWMI |
$4,681.84
|
| Rate for Payer: PHP Commercial |
$15,918.25
|
| Rate for Payer: PHP Medicare Advantage |
$4,681.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,109.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,292.79
|
| Rate for Payer: Priority Health Medicare |
$4,681.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11,421.81
|
| Rate for Payer: Railroad Medicare Medicare |
$4,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,480.07
|
| Rate for Payer: UHC Core |
$15,637.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,681.84
|
| Rate for Payer: UHC Medicare Advantage |
$4,822.29
|
| Rate for Payer: VA VA |
$4,681.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,045.51
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
IP
|
$28,586.86
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,435.13 |
| Max. Negotiated Rate |
$25,728.17 |
| Rate for Payer: Aetna Commercial |
$24,298.83
|
| Rate for Payer: BCBS Trust/PPO |
$22,091.93
|
| Rate for Payer: BCN Commercial |
$22,091.93
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$24,584.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,869.49
|
| Rate for Payer: Healthscope Commercial |
$25,728.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,440.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PHP Commercial |
$24,298.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,870.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17,435.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,156.44
|
| Rate for Payer: UHC Core |
$23,870.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,440.14
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
OP
|
$28,586.86
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,789.38 |
| Max. Negotiated Rate |
$25,728.17 |
| Rate for Payer: Aetna Commercial |
$24,298.83
|
| Rate for Payer: Aetna Medicare |
$7,432.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,933.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,933.39
|
| Rate for Payer: BCBS Complete |
$12,078.04
|
| Rate for Payer: BCBS MAPPO |
$7,146.72
|
| Rate for Payer: BCBS Trust/PPO |
$22,226.28
|
| Rate for Payer: BCN Commercial |
$22,226.28
|
| Rate for Payer: BCN Medicare Advantage |
$7,146.72
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cash Price |
$22,869.49
|
| Rate for Payer: Cofinity Commercial |
$24,584.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,869.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,146.72
|
| Rate for Payer: Healthscope Commercial |
$25,728.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,440.14
|
| Rate for Payer: Mclaren Medicaid |
$11,502.90
|
| Rate for Payer: Meridian Medicaid |
$12,078.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,504.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,218.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,298.83
|
| Rate for Payer: PACE Senior Care Partners |
$6,789.38
|
| Rate for Payer: PACE SWMI |
$7,146.72
|
| Rate for Payer: PHP Commercial |
$24,298.83
|
| Rate for Payer: PHP Medicare Advantage |
$7,146.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,502.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20,010.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,870.57
|
| Rate for Payer: Priority Health Medicare |
$7,146.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17,435.13
|
| Rate for Payer: Railroad Medicare Medicare |
$7,146.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,156.44
|
| Rate for Payer: UHC Core |
$23,870.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,146.72
|
| Rate for Payer: UHC Medicare Advantage |
$7,361.12
|
| Rate for Payer: VA VA |
$7,146.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,440.14
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$308.55
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$188.18 |
| Max. Negotiated Rate |
$277.70 |
| Rate for Payer: Aetna Commercial |
$262.27
|
| Rate for Payer: BCBS Trust/PPO |
$238.45
|
| Rate for Payer: BCN Commercial |
$238.45
|
| Rate for Payer: Cash Price |
$246.84
|
| Rate for Payer: Cofinity Commercial |
$265.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.84
|
| Rate for Payer: Healthscope Commercial |
$277.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.27
|
| Rate for Payer: PHP Commercial |
$262.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.52
|
| Rate for Payer: UHC Core |
$257.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.41
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$308.55
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$73.28 |
| Max. Negotiated Rate |
$277.70 |
| Rate for Payer: Aetna Commercial |
$262.27
|
| Rate for Payer: Aetna Medicare |
$80.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.42
|
| Rate for Payer: BCBS Complete |
$123.42
|
| Rate for Payer: BCBS MAPPO |
$77.14
|
| Rate for Payer: BCBS Trust/PPO |
$239.90
|
| Rate for Payer: BCN Commercial |
$239.90
|
| Rate for Payer: BCN Medicare Advantage |
$77.14
|
| Rate for Payer: Cash Price |
$246.84
|
| Rate for Payer: Cofinity Commercial |
$265.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.14
|
| Rate for Payer: Healthscope Commercial |
$277.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$80.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$262.27
|
| Rate for Payer: PACE Senior Care Partners |
$73.28
|
| Rate for Payer: PACE SWMI |
$77.14
|
| Rate for Payer: PHP Commercial |
$262.27
|
| Rate for Payer: PHP Medicare Advantage |
$77.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.44
|
| Rate for Payer: Priority Health Medicare |
$77.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.18
|
| Rate for Payer: Railroad Medicare Medicare |
$77.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.52
|
| Rate for Payer: UHC Core |
$257.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.14
|
| Rate for Payer: UHC Medicare Advantage |
$79.45
|
| Rate for Payer: VA VA |
$77.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.41
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
OP
|
$252.45
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$59.96 |
| Max. Negotiated Rate |
$227.20 |
| Rate for Payer: Aetna Commercial |
$214.58
|
| Rate for Payer: Aetna Medicare |
$65.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.89
|
| Rate for Payer: BCBS Complete |
$100.98
|
| Rate for Payer: BCBS MAPPO |
$63.11
|
| Rate for Payer: BCBS Trust/PPO |
$196.28
|
| Rate for Payer: BCN Commercial |
$196.28
|
| Rate for Payer: BCN Medicare Advantage |
$63.11
|
| Rate for Payer: Cash Price |
$201.96
|
| Rate for Payer: Cofinity Commercial |
$217.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.11
|
| Rate for Payer: Healthscope Commercial |
$227.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.58
|
| Rate for Payer: PACE Senior Care Partners |
$59.96
|
| Rate for Payer: PACE SWMI |
$63.11
|
| Rate for Payer: PHP Commercial |
$214.58
|
| Rate for Payer: PHP Medicare Advantage |
$63.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.63
|
| Rate for Payer: Priority Health Medicare |
$63.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.97
|
| Rate for Payer: Railroad Medicare Medicare |
$63.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.16
|
| Rate for Payer: UHC Core |
$210.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.11
|
| Rate for Payer: UHC Medicare Advantage |
$65.01
|
| Rate for Payer: VA VA |
$63.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.34
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$252.45
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$153.97 |
| Max. Negotiated Rate |
$227.20 |
| Rate for Payer: Aetna Commercial |
$214.58
|
| Rate for Payer: BCBS Trust/PPO |
$195.09
|
| Rate for Payer: BCN Commercial |
$195.09
|
| Rate for Payer: Cash Price |
$201.96
|
| Rate for Payer: Cofinity Commercial |
$217.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.96
|
| Rate for Payer: Healthscope Commercial |
$227.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.58
|
| Rate for Payer: PHP Commercial |
$214.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.16
|
| Rate for Payer: UHC Core |
$210.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.34
|
|
|
HC PT EVAL MODERATE COMPLEXITY
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
42400007
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: BCBS Trust/PPO |
$216.77
|
| Rate for Payer: BCN Commercial |
$216.77
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.42
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.84
|
| Rate for Payer: UHC Core |
$234.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
