|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
IP
|
$131.09
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
91400005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$117.98 |
| Rate for Payer: Aetna Commercial |
$111.43
|
| Rate for Payer: BCBS Trust/PPO |
$107.01
|
| Rate for Payer: BCN Commercial |
$101.31
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$112.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Healthscope Commercial |
$117.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$107.49
|
| Rate for Payer: PHP Commercial |
$111.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.21
|
| Rate for Payer: Priority Health HMO/PPO |
$114.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.36
|
| Rate for Payer: UHC Core |
$109.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.32
|
|
|
HC PSYCHOTHERAPY 60 MIN W PT
|
Facility
|
OP
|
$131.09
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
91400005
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$121.98 |
| Rate for Payer: Aetna Commercial |
$111.43
|
| Rate for Payer: Aetna Medicare |
$34.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.97
|
| Rate for Payer: BCBS Complete |
$121.98
|
| Rate for Payer: BCBS MAPPO |
$32.77
|
| Rate for Payer: BCBS Trust/PPO |
$107.77
|
| Rate for Payer: BCN Commercial |
$101.92
|
| Rate for Payer: BCN Medicare Advantage |
$32.77
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$112.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.77
|
| Rate for Payer: Healthscope Commercial |
$117.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.32
|
| Rate for Payer: Mclaren Medicaid |
$116.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.41
|
| Rate for Payer: Meridian Medicaid |
$121.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$107.49
|
| Rate for Payer: PACE Senior Care Partners |
$31.13
|
| Rate for Payer: PACE SWMI |
$32.77
|
| Rate for Payer: PHP Commercial |
$111.43
|
| Rate for Payer: PHP Medicare Advantage |
$32.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.21
|
| Rate for Payer: Priority Health HMO/PPO |
$114.05
|
| Rate for Payer: Priority Health Medicare |
$33.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.83
|
| Rate for Payer: Railroad Medicare Medicare |
$32.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.36
|
| Rate for Payer: UHC Core |
$109.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.77
|
| Rate for Payer: UHC Exchange |
$32.77
|
| Rate for Payer: UHC Medicare Advantage |
$32.77
|
| Rate for Payer: UHCCP Medicaid |
$116.16
|
| Rate for Payer: VA VA |
$32.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.32
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
91400012
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$37.47
|
| Rate for Payer: BCN Commercial |
$35.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health HMO/PPO |
$39.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 90785
|
| Hospital Charge Code |
91400012
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: BCBS MAPPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$37.73
|
| Rate for Payer: BCN Commercial |
$35.69
|
| Rate for Payer: BCN Medicare Advantage |
$11.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: PACE Senior Care Partners |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.47
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health HMO/PPO |
$39.93
|
| Rate for Payer: Priority Health Medicare |
$11.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.75
|
| Rate for Payer: Railroad Medicare Medicare |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.47
|
| Rate for Payer: UHC Exchange |
$11.47
|
| Rate for Payer: UHC Medicare Advantage |
$11.47
|
| Rate for Payer: VA VA |
$11.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC PSYCHOTHERAPY FOR CRISIS EA ADDL 15 MIN
|
Facility
|
OP
|
$118.32
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
91400014
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$106.49 |
| Rate for Payer: Aetna Commercial |
$100.57
|
| Rate for Payer: Aetna Medicare |
$30.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.98
|
| Rate for Payer: BCBS Complete |
$47.33
|
| Rate for Payer: BCBS MAPPO |
$29.58
|
| Rate for Payer: BCBS Trust/PPO |
$97.27
|
| Rate for Payer: BCN Commercial |
$91.99
|
| Rate for Payer: BCN Medicare Advantage |
$29.58
|
| Rate for Payer: Cash Price |
$94.66
|
| Rate for Payer: Cofinity Commercial |
$101.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.58
|
| Rate for Payer: Healthscope Commercial |
$106.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.57
|
| Rate for Payer: Nomi Health Commercial |
$97.02
|
| Rate for Payer: PACE Senior Care Partners |
$28.10
|
| Rate for Payer: PACE SWMI |
$29.58
|
| Rate for Payer: PHP Commercial |
$100.57
|
| Rate for Payer: PHP Medicare Advantage |
$29.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.91
|
| Rate for Payer: Priority Health HMO/PPO |
$102.94
|
| Rate for Payer: Priority Health Medicare |
$29.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.27
|
| Rate for Payer: Railroad Medicare Medicare |
$29.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.12
|
| Rate for Payer: UHC Core |
$98.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.58
|
| Rate for Payer: UHC Exchange |
$29.58
|
| Rate for Payer: UHC Medicare Advantage |
$29.58
|
| Rate for Payer: VA VA |
$29.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.74
|
|
|
HC PSYCHOTHERAPY FOR CRISIS EA ADDL 15 MIN
|
Facility
|
IP
|
$118.32
|
|
|
Service Code
|
CPT 90840
|
| Hospital Charge Code |
91400014
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$76.91 |
| Max. Negotiated Rate |
$106.49 |
| Rate for Payer: Aetna Commercial |
$100.57
|
| Rate for Payer: BCBS Trust/PPO |
$96.58
|
| Rate for Payer: BCN Commercial |
$91.44
|
| Rate for Payer: Cash Price |
$94.66
|
| Rate for Payer: Cofinity Commercial |
$101.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.66
|
| Rate for Payer: Healthscope Commercial |
$106.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.57
|
| Rate for Payer: Nomi Health Commercial |
$97.02
|
| Rate for Payer: PHP Commercial |
$100.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.91
|
| Rate for Payer: Priority Health HMO/PPO |
$102.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.12
|
| Rate for Payer: UHC Core |
$98.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.74
|
|
|
HC PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN
|
Facility
|
IP
|
$229.50
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
91400003
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$195.07
|
| Rate for Payer: BCBS Trust/PPO |
$187.34
|
| Rate for Payer: BCN Commercial |
$177.36
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.07
|
| Rate for Payer: Nomi Health Commercial |
$188.19
|
| Rate for Payer: PHP Commercial |
$195.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: Priority Health HMO/PPO |
$199.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.96
|
| Rate for Payer: UHC Core |
$191.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.12
|
|
|
HC PSYCHOTHERAPY FOR CRISIS FIRST 60 MIN
|
Facility
|
OP
|
$229.50
|
|
|
Service Code
|
CPT 90839
|
| Hospital Charge Code |
91400003
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$54.51 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$195.07
|
| Rate for Payer: Aetna Medicare |
$59.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.72
|
| Rate for Payer: BCBS Complete |
$121.98
|
| Rate for Payer: BCBS MAPPO |
$57.38
|
| Rate for Payer: BCBS Trust/PPO |
$188.67
|
| Rate for Payer: BCN Commercial |
$178.44
|
| Rate for Payer: BCN Medicare Advantage |
$57.38
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.38
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.12
|
| Rate for Payer: Mclaren Medicaid |
$116.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.24
|
| Rate for Payer: Meridian Medicaid |
$121.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.07
|
| Rate for Payer: Nomi Health Commercial |
$188.19
|
| Rate for Payer: PACE Senior Care Partners |
$54.51
|
| Rate for Payer: PACE SWMI |
$57.38
|
| Rate for Payer: PHP Commercial |
$195.07
|
| Rate for Payer: PHP Medicare Advantage |
$57.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: Priority Health HMO/PPO |
$199.66
|
| Rate for Payer: Priority Health Medicare |
$57.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.76
|
| Rate for Payer: Railroad Medicare Medicare |
$57.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.96
|
| Rate for Payer: UHC Core |
$191.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.38
|
| Rate for Payer: UHC Exchange |
$57.38
|
| Rate for Payer: UHC Medicare Advantage |
$57.38
|
| Rate for Payer: UHCCP Medicaid |
$116.16
|
| Rate for Payer: VA VA |
$57.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.12
|
|
|
HC PTCA ADD/BRANCH
|
Facility
|
IP
|
$7,290.61
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,738.90 |
| Max. Negotiated Rate |
$6,561.55 |
| Rate for Payer: Aetna Commercial |
$6,197.02
|
| Rate for Payer: BCBS Trust/PPO |
$5,951.32
|
| Rate for Payer: BCN Commercial |
$5,634.18
|
| Rate for Payer: Cash Price |
$5,832.49
|
| Rate for Payer: Cofinity Commercial |
$6,269.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,832.49
|
| Rate for Payer: Healthscope Commercial |
$6,561.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,467.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,197.02
|
| Rate for Payer: Nomi Health Commercial |
$5,978.30
|
| Rate for Payer: PHP Commercial |
$6,197.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,738.90
|
| Rate for Payer: Priority Health HMO/PPO |
$6,342.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,884.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,415.74
|
| Rate for Payer: UHC Core |
$6,087.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,467.96
|
|
|
HC PTCA ADD/BRANCH
|
Facility
|
OP
|
$7,290.61
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
48100099
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,731.52 |
| Max. Negotiated Rate |
$6,561.55 |
| Rate for Payer: Aetna Commercial |
$6,197.02
|
| Rate for Payer: Aetna Medicare |
$1,895.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,278.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,278.32
|
| Rate for Payer: BCBS Complete |
$2,916.24
|
| Rate for Payer: BCBS MAPPO |
$1,822.65
|
| Rate for Payer: BCBS Trust/PPO |
$5,993.61
|
| Rate for Payer: BCN Commercial |
$5,668.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,822.65
|
| Rate for Payer: Cash Price |
$5,832.49
|
| Rate for Payer: Cofinity Commercial |
$6,269.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,832.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,822.65
|
| Rate for Payer: Healthscope Commercial |
$6,561.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,467.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,913.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,096.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,197.02
|
| Rate for Payer: Nomi Health Commercial |
$5,978.30
|
| Rate for Payer: PACE Senior Care Partners |
$1,731.52
|
| Rate for Payer: PACE SWMI |
$1,822.65
|
| Rate for Payer: PHP Commercial |
$6,197.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,822.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,738.90
|
| Rate for Payer: Priority Health HMO/PPO |
$6,342.83
|
| Rate for Payer: Priority Health Medicare |
$1,840.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,884.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,822.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,415.74
|
| Rate for Payer: UHC Core |
$6,087.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,822.65
|
| Rate for Payer: UHC Exchange |
$1,822.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,822.65
|
| Rate for Payer: VA VA |
$1,822.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,467.96
|
|
|
HC PTCA VESSEL/BRANCH
|
Facility
|
OP
|
$11,199.75
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,659.94 |
| Max. Negotiated Rate |
$10,079.77 |
| Rate for Payer: Aetna Commercial |
$9,519.79
|
| Rate for Payer: Aetna Medicare |
$2,911.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,499.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,499.92
|
| Rate for Payer: BCBS Complete |
$4,328.59
|
| Rate for Payer: BCBS MAPPO |
$2,799.94
|
| Rate for Payer: BCBS Trust/PPO |
$9,207.31
|
| Rate for Payer: BCN Commercial |
$8,707.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,799.94
|
| Rate for Payer: Cash Price |
$8,959.80
|
| Rate for Payer: Cash Price |
$8,959.80
|
| Rate for Payer: Cofinity Commercial |
$9,631.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,959.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,799.94
|
| Rate for Payer: Healthscope Commercial |
$10,079.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,399.81
|
| Rate for Payer: Mclaren Medicaid |
$4,122.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,939.93
|
| Rate for Payer: Meridian Medicaid |
$4,328.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,219.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,519.79
|
| Rate for Payer: Nomi Health Commercial |
$9,183.80
|
| Rate for Payer: PACE Senior Care Partners |
$2,659.94
|
| Rate for Payer: PACE SWMI |
$2,799.94
|
| Rate for Payer: PHP Commercial |
$9,519.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,799.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,122.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,279.84
|
| Rate for Payer: Priority Health HMO/PPO |
$9,743.78
|
| Rate for Payer: Priority Health Medicare |
$2,827.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,503.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2,799.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,855.78
|
| Rate for Payer: UHC Core |
$9,351.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,799.94
|
| Rate for Payer: UHC Exchange |
$2,799.94
|
| Rate for Payer: UHC Medicare Advantage |
$2,799.94
|
| Rate for Payer: UHCCP Medicaid |
$4,122.20
|
| Rate for Payer: VA VA |
$2,799.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,399.81
|
|
|
HC PTCA VESSEL/BRANCH
|
Facility
|
IP
|
$11,199.75
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,279.84 |
| Max. Negotiated Rate |
$10,079.77 |
| Rate for Payer: Aetna Commercial |
$9,519.79
|
| Rate for Payer: BCBS Trust/PPO |
$9,142.36
|
| Rate for Payer: BCN Commercial |
$8,655.17
|
| Rate for Payer: Cash Price |
$8,959.80
|
| Rate for Payer: Cofinity Commercial |
$9,631.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,959.80
|
| Rate for Payer: Healthscope Commercial |
$10,079.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,399.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,519.79
|
| Rate for Payer: Nomi Health Commercial |
$9,183.80
|
| Rate for Payer: PHP Commercial |
$9,519.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,279.84
|
| Rate for Payer: Priority Health HMO/PPO |
$9,743.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,503.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,855.78
|
| Rate for Payer: UHC Core |
$9,351.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,399.81
|
|
|
HC PTCRAWDES ADD.BRANCH
|
Facility
|
OP
|
$19,101.90
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,536.70 |
| Max. Negotiated Rate |
$17,191.71 |
| Rate for Payer: Aetna Commercial |
$16,236.61
|
| Rate for Payer: Aetna Medicare |
$4,966.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,969.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,969.34
|
| Rate for Payer: BCBS Complete |
$7,640.76
|
| Rate for Payer: BCBS MAPPO |
$4,775.48
|
| Rate for Payer: BCBS Trust/PPO |
$15,703.67
|
| Rate for Payer: BCN Commercial |
$14,851.73
|
| Rate for Payer: BCN Medicare Advantage |
$4,775.48
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$16,427.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,775.48
|
| Rate for Payer: Healthscope Commercial |
$17,191.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,326.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,014.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,491.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.61
|
| Rate for Payer: Nomi Health Commercial |
$15,663.56
|
| Rate for Payer: PACE Senior Care Partners |
$4,536.70
|
| Rate for Payer: PACE SWMI |
$4,775.48
|
| Rate for Payer: PHP Commercial |
$16,236.61
|
| Rate for Payer: PHP Medicare Advantage |
$4,775.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health HMO/PPO |
$16,618.65
|
| Rate for Payer: Priority Health Medicare |
$4,823.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,798.27
|
| Rate for Payer: Railroad Medicare Medicare |
$4,775.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,809.67
|
| Rate for Payer: UHC Core |
$15,950.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,775.48
|
| Rate for Payer: UHC Exchange |
$4,775.48
|
| Rate for Payer: UHC Medicare Advantage |
$4,775.48
|
| Rate for Payer: VA VA |
$4,775.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,326.42
|
|
|
HC PTCRAWDES ADD.BRANCH
|
Facility
|
IP
|
$19,101.90
|
|
|
Service Code
|
CPT C9603
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,416.24 |
| Max. Negotiated Rate |
$17,191.71 |
| Rate for Payer: Aetna Commercial |
$16,236.61
|
| Rate for Payer: BCBS Trust/PPO |
$15,592.88
|
| Rate for Payer: BCN Commercial |
$14,761.95
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$16,427.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$17,191.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,326.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.61
|
| Rate for Payer: Nomi Health Commercial |
$15,663.56
|
| Rate for Payer: PHP Commercial |
$16,236.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health HMO/PPO |
$16,618.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,798.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,809.67
|
| Rate for Payer: UHC Core |
$15,950.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,326.42
|
|
|
HC PTCRAWDES VES/BRANCH
|
Facility
|
OP
|
$29,158.60
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,925.17 |
| Max. Negotiated Rate |
$26,242.74 |
| Rate for Payer: Aetna Commercial |
$24,784.81
|
| Rate for Payer: Aetna Medicare |
$7,581.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,112.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,112.06
|
| Rate for Payer: BCBS Complete |
$13,632.74
|
| Rate for Payer: BCBS MAPPO |
$7,289.65
|
| Rate for Payer: BCBS Trust/PPO |
$23,971.29
|
| Rate for Payer: BCN Commercial |
$22,670.81
|
| Rate for Payer: BCN Medicare Advantage |
$7,289.65
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$25,076.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,289.65
|
| Rate for Payer: Healthscope Commercial |
$26,242.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,868.95
|
| Rate for Payer: Mclaren Medicaid |
$12,982.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,654.13
|
| Rate for Payer: Meridian Medicaid |
$13,632.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,383.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: Nomi Health Commercial |
$23,910.05
|
| Rate for Payer: PACE Senior Care Partners |
$6,925.17
|
| Rate for Payer: PACE SWMI |
$7,289.65
|
| Rate for Payer: PHP Commercial |
$24,784.81
|
| Rate for Payer: PHP Medicare Advantage |
$7,289.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,982.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health HMO/PPO |
$25,367.98
|
| Rate for Payer: Priority Health Medicare |
$7,362.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,536.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,289.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,659.57
|
| Rate for Payer: UHC Core |
$24,347.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,289.65
|
| Rate for Payer: UHC Exchange |
$7,289.65
|
| Rate for Payer: UHC Medicare Advantage |
$7,289.65
|
| Rate for Payer: UHCCP Medicaid |
$12,982.71
|
| Rate for Payer: VA VA |
$7,289.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,868.95
|
|
|
HC PTCRAWDES VES/BRANCH
|
Facility
|
IP
|
$29,158.60
|
|
|
Service Code
|
CPT C9602
|
| Hospital Charge Code |
48100079
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,953.09 |
| Max. Negotiated Rate |
$26,242.74 |
| Rate for Payer: Aetna Commercial |
$24,784.81
|
| Rate for Payer: BCBS Trust/PPO |
$23,802.17
|
| Rate for Payer: BCN Commercial |
$22,533.77
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$25,076.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Healthscope Commercial |
$26,242.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,868.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: Nomi Health Commercial |
$23,910.05
|
| Rate for Payer: PHP Commercial |
$24,784.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health HMO/PPO |
$25,367.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,536.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,659.57
|
| Rate for Payer: UHC Core |
$24,347.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,868.95
|
|
|
HC PTCRAWPTCA ADD.BRANCH
|
Facility
|
IP
|
$11,940.30
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,761.19 |
| Max. Negotiated Rate |
$10,746.27 |
| Rate for Payer: Aetna Commercial |
$10,149.25
|
| Rate for Payer: BCBS Trust/PPO |
$9,746.87
|
| Rate for Payer: BCN Commercial |
$9,227.46
|
| Rate for Payer: Cash Price |
$9,552.24
|
| Rate for Payer: Cofinity Commercial |
$10,268.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,552.24
|
| Rate for Payer: Healthscope Commercial |
$10,746.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,955.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,149.25
|
| Rate for Payer: Nomi Health Commercial |
$9,791.05
|
| Rate for Payer: PHP Commercial |
$10,149.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,761.19
|
| Rate for Payer: Priority Health HMO/PPO |
$10,388.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,000.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,507.46
|
| Rate for Payer: UHC Core |
$9,970.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,955.23
|
|
|
HC PTCRAWPTCA ADD.BRANCH
|
Facility
|
OP
|
$11,940.30
|
|
|
Service Code
|
CPT 92925
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,835.82 |
| Max. Negotiated Rate |
$10,746.27 |
| Rate for Payer: Aetna Commercial |
$10,149.25
|
| Rate for Payer: Aetna Medicare |
$3,104.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,731.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,731.34
|
| Rate for Payer: BCBS Complete |
$4,776.12
|
| Rate for Payer: BCBS MAPPO |
$2,985.07
|
| Rate for Payer: BCBS Trust/PPO |
$9,816.12
|
| Rate for Payer: BCN Commercial |
$9,283.58
|
| Rate for Payer: BCN Medicare Advantage |
$2,985.07
|
| Rate for Payer: Cash Price |
$9,552.24
|
| Rate for Payer: Cofinity Commercial |
$10,268.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,552.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,985.07
|
| Rate for Payer: Healthscope Commercial |
$10,746.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,955.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,134.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,432.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,149.25
|
| Rate for Payer: Nomi Health Commercial |
$9,791.05
|
| Rate for Payer: PACE Senior Care Partners |
$2,835.82
|
| Rate for Payer: PACE SWMI |
$2,985.07
|
| Rate for Payer: PHP Commercial |
$10,149.25
|
| Rate for Payer: PHP Medicare Advantage |
$2,985.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,761.19
|
| Rate for Payer: Priority Health HMO/PPO |
$10,388.06
|
| Rate for Payer: Priority Health Medicare |
$3,014.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,000.00
|
| Rate for Payer: Railroad Medicare Medicare |
$2,985.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,507.46
|
| Rate for Payer: UHC Core |
$9,970.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,985.07
|
| Rate for Payer: UHC Exchange |
$2,985.07
|
| Rate for Payer: UHC Medicare Advantage |
$2,985.07
|
| Rate for Payer: VA VA |
$2,985.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,955.23
|
|
|
HC PTCRAWSTENT ADD.BRANCH
|
Facility
|
OP
|
$19,101.90
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,536.70 |
| Max. Negotiated Rate |
$17,191.71 |
| Rate for Payer: Aetna Commercial |
$16,236.61
|
| Rate for Payer: Aetna Medicare |
$4,966.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,969.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,969.34
|
| Rate for Payer: BCBS Complete |
$7,640.76
|
| Rate for Payer: BCBS MAPPO |
$4,775.48
|
| Rate for Payer: BCBS Trust/PPO |
$15,703.67
|
| Rate for Payer: BCN Commercial |
$14,851.73
|
| Rate for Payer: BCN Medicare Advantage |
$4,775.48
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$16,427.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,775.48
|
| Rate for Payer: Healthscope Commercial |
$17,191.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,326.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,014.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,491.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.61
|
| Rate for Payer: Nomi Health Commercial |
$15,663.56
|
| Rate for Payer: PACE Senior Care Partners |
$4,536.70
|
| Rate for Payer: PACE SWMI |
$4,775.48
|
| Rate for Payer: PHP Commercial |
$16,236.61
|
| Rate for Payer: PHP Medicare Advantage |
$4,775.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health HMO/PPO |
$16,618.65
|
| Rate for Payer: Priority Health Medicare |
$4,823.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,798.27
|
| Rate for Payer: Railroad Medicare Medicare |
$4,775.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,809.67
|
| Rate for Payer: UHC Core |
$15,950.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,775.48
|
| Rate for Payer: UHC Exchange |
$4,775.48
|
| Rate for Payer: UHC Medicare Advantage |
$4,775.48
|
| Rate for Payer: VA VA |
$4,775.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,326.42
|
|
|
HC PTCRAWSTENT ADD.BRANCH
|
Facility
|
IP
|
$19,101.90
|
|
|
Service Code
|
CPT 92934
|
| Hospital Charge Code |
48100078
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$12,416.24 |
| Max. Negotiated Rate |
$17,191.71 |
| Rate for Payer: Aetna Commercial |
$16,236.61
|
| Rate for Payer: BCBS Trust/PPO |
$15,592.88
|
| Rate for Payer: BCN Commercial |
$14,761.95
|
| Rate for Payer: Cash Price |
$15,281.52
|
| Rate for Payer: Cofinity Commercial |
$16,427.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,281.52
|
| Rate for Payer: Healthscope Commercial |
$17,191.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,326.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,236.61
|
| Rate for Payer: Nomi Health Commercial |
$15,663.56
|
| Rate for Payer: PHP Commercial |
$16,236.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,416.24
|
| Rate for Payer: Priority Health HMO/PPO |
$16,618.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,798.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,809.67
|
| Rate for Payer: UHC Core |
$15,950.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,326.42
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
IP
|
$29,158.60
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$18,953.09 |
| Max. Negotiated Rate |
$26,242.74 |
| Rate for Payer: Aetna Commercial |
$24,784.81
|
| Rate for Payer: BCBS Trust/PPO |
$23,802.17
|
| Rate for Payer: BCN Commercial |
$22,533.77
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$25,076.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Healthscope Commercial |
$26,242.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,868.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: Nomi Health Commercial |
$23,910.05
|
| Rate for Payer: PHP Commercial |
$24,784.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health HMO/PPO |
$25,367.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,536.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,659.57
|
| Rate for Payer: UHC Core |
$24,347.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,868.95
|
|
|
HC PTCRAWSTENT VES/BRANCH
|
Facility
|
OP
|
$29,158.60
|
|
|
Service Code
|
CPT 92933
|
| Hospital Charge Code |
48100077
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,925.17 |
| Max. Negotiated Rate |
$26,242.74 |
| Rate for Payer: Aetna Commercial |
$24,784.81
|
| Rate for Payer: Aetna Medicare |
$7,581.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,112.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,112.06
|
| Rate for Payer: BCBS Complete |
$13,632.74
|
| Rate for Payer: BCBS MAPPO |
$7,289.65
|
| Rate for Payer: BCBS Trust/PPO |
$23,971.29
|
| Rate for Payer: BCN Commercial |
$22,670.81
|
| Rate for Payer: BCN Medicare Advantage |
$7,289.65
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cash Price |
$23,326.88
|
| Rate for Payer: Cofinity Commercial |
$25,076.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,326.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,289.65
|
| Rate for Payer: Healthscope Commercial |
$26,242.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,868.95
|
| Rate for Payer: Mclaren Medicaid |
$12,982.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,654.13
|
| Rate for Payer: Meridian Medicaid |
$13,632.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,383.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,784.81
|
| Rate for Payer: Nomi Health Commercial |
$23,910.05
|
| Rate for Payer: PACE Senior Care Partners |
$6,925.17
|
| Rate for Payer: PACE SWMI |
$7,289.65
|
| Rate for Payer: PHP Commercial |
$24,784.81
|
| Rate for Payer: PHP Medicare Advantage |
$7,289.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,982.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,953.09
|
| Rate for Payer: Priority Health HMO/PPO |
$25,367.98
|
| Rate for Payer: Priority Health Medicare |
$7,362.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,536.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,289.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,659.57
|
| Rate for Payer: UHC Core |
$24,347.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,289.65
|
| Rate for Payer: UHC Exchange |
$7,289.65
|
| Rate for Payer: UHC Medicare Advantage |
$7,289.65
|
| Rate for Payer: UHCCP Medicaid |
$12,982.71
|
| Rate for Payer: VA VA |
$7,289.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,868.95
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
OP
|
$314.72
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$283.25 |
| Rate for Payer: Aetna Commercial |
$267.51
|
| Rate for Payer: Aetna Medicare |
$81.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.35
|
| Rate for Payer: BCBS Complete |
$125.89
|
| Rate for Payer: BCBS MAPPO |
$78.68
|
| Rate for Payer: BCBS Trust/PPO |
$258.73
|
| Rate for Payer: BCN Commercial |
$244.69
|
| Rate for Payer: BCN Medicare Advantage |
$78.68
|
| Rate for Payer: Cash Price |
$251.78
|
| Rate for Payer: Cofinity Commercial |
$270.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.68
|
| Rate for Payer: Healthscope Commercial |
$283.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.51
|
| Rate for Payer: Nomi Health Commercial |
$258.07
|
| Rate for Payer: PACE Senior Care Partners |
$74.75
|
| Rate for Payer: PACE SWMI |
$78.68
|
| Rate for Payer: PHP Commercial |
$267.51
|
| Rate for Payer: PHP Medicare Advantage |
$78.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.57
|
| Rate for Payer: Priority Health HMO/PPO |
$273.81
|
| Rate for Payer: Priority Health Medicare |
$79.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.86
|
| Rate for Payer: Railroad Medicare Medicare |
$78.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.95
|
| Rate for Payer: UHC Core |
$262.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.68
|
| Rate for Payer: UHC Exchange |
$78.68
|
| Rate for Payer: UHC Medicare Advantage |
$78.68
|
| Rate for Payer: VA VA |
$78.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.04
|
|
|
HC PT EVAL HIGH COMPLEXITY
|
Facility
|
IP
|
$314.72
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
42400008
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$204.57 |
| Max. Negotiated Rate |
$283.25 |
| Rate for Payer: Aetna Commercial |
$267.51
|
| Rate for Payer: BCBS Trust/PPO |
$256.91
|
| Rate for Payer: BCN Commercial |
$243.22
|
| Rate for Payer: Cash Price |
$251.78
|
| Rate for Payer: Cofinity Commercial |
$270.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.78
|
| Rate for Payer: Healthscope Commercial |
$283.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.51
|
| Rate for Payer: Nomi Health Commercial |
$258.07
|
| Rate for Payer: PHP Commercial |
$267.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.57
|
| Rate for Payer: Priority Health HMO/PPO |
$273.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.95
|
| Rate for Payer: UHC Core |
$262.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.04
|
|
|
HC PT EVAL LOW COMPLEXITY
|
Facility
|
IP
|
$257.50
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
42400006
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$167.38 |
| Max. Negotiated Rate |
$231.75 |
| Rate for Payer: Aetna Commercial |
$218.88
|
| Rate for Payer: BCBS Trust/PPO |
$210.20
|
| Rate for Payer: BCN Commercial |
$199.00
|
| Rate for Payer: Cash Price |
$206.00
|
| Rate for Payer: Cofinity Commercial |
$221.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.00
|
| Rate for Payer: Healthscope Commercial |
$231.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.88
|
| Rate for Payer: Nomi Health Commercial |
$211.15
|
| Rate for Payer: PHP Commercial |
$218.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.38
|
| Rate for Payer: Priority Health HMO/PPO |
$224.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.60
|
| Rate for Payer: UHC Core |
$215.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.12
|
|
