|
HC ATYPICAL PNEUMO EVAL C PNEUM IGM
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
30200243
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.78
|
| Rate for Payer: BCBS Complete |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$3.82
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Medicare Advantage |
$3.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.82
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Mclaren Medicaid |
$9.36
|
| Rate for Payer: Meridian Medicaid |
$9.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Senior Care Partners |
$3.63
|
| Rate for Payer: PACE SWMI |
$3.82
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicare Advantage |
$3.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.31
|
| Rate for Payer: Priority Health Medicare |
$3.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.33
|
| Rate for Payer: Railroad Medicare Medicare |
$3.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$12.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.82
|
| Rate for Payer: UHC Medicare Advantage |
$3.94
|
| Rate for Payer: VA VA |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
HC ATYPICAL PNEUMO EVAL C PNEUM IGM
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
30200243
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.82
|
| Rate for Payer: BCN Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$12.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
HC ATYPICAL PNEUMO EVAL L PNEUM
|
Facility
|
OP
|
$21.42
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna Commercial |
$18.21
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.69
|
| Rate for Payer: BCBS Complete |
$11.86
|
| Rate for Payer: BCBS MAPPO |
$5.36
|
| Rate for Payer: BCBS Trust/PPO |
$16.65
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: BCN Medicare Advantage |
$5.36
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.36
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.06
|
| Rate for Payer: Mclaren Medicaid |
$11.29
|
| Rate for Payer: Meridian Medicaid |
$11.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.21
|
| Rate for Payer: PACE Senior Care Partners |
$5.09
|
| Rate for Payer: PACE SWMI |
$5.36
|
| Rate for Payer: PHP Commercial |
$18.21
|
| Rate for Payer: PHP Medicare Advantage |
$5.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.64
|
| Rate for Payer: Priority Health Medicare |
$5.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.06
|
| Rate for Payer: Railroad Medicare Medicare |
$5.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.85
|
| Rate for Payer: UHC Core |
$17.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.36
|
| Rate for Payer: UHC Medicare Advantage |
$5.52
|
| Rate for Payer: VA VA |
$5.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.06
|
|
|
HC ATYPICAL PNEUMO EVAL L PNEUM
|
Facility
|
IP
|
$21.42
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
30200302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna Commercial |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$16.55
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.21
|
| Rate for Payer: PHP Commercial |
$18.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.85
|
| Rate for Payer: UHC Core |
$17.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.06
|
|
|
HC ATYPICAL PNEUMO EVAL M PNEUM
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC ATYPICAL PNEUMO EVAL M PNEUM
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200308
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Medicare |
$3.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.46
|
| Rate for Payer: BCBS Complete |
$10.26
|
| Rate for Payer: BCBS MAPPO |
$3.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.10
|
| Rate for Payer: BCN Commercial |
$11.10
|
| Rate for Payer: BCN Medicare Advantage |
$3.57
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Mclaren Medicaid |
$9.77
|
| Rate for Payer: Meridian Medicaid |
$10.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PACE Senior Care Partners |
$3.39
|
| Rate for Payer: PACE SWMI |
$3.57
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: PHP Medicare Advantage |
$3.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Medicare |
$3.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.57
|
| Rate for Payer: UHC Medicare Advantage |
$3.68
|
| Rate for Payer: VA VA |
$3.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC ATYPICAL PNEUMO EVALUATION
|
Facility
|
IP
|
$15.30
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200241
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.82
|
| Rate for Payer: BCN Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$12.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
HC ATYPICAL PNEUMO EVALUATION
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
30200241
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.78
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: BCBS MAPPO |
$3.82
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Medicare Advantage |
$3.82
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.82
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Mclaren Medicaid |
$8.72
|
| Rate for Payer: Meridian Medicaid |
$9.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PACE Senior Care Partners |
$3.63
|
| Rate for Payer: PACE SWMI |
$3.82
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: PHP Medicare Advantage |
$3.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.31
|
| Rate for Payer: Priority Health Medicare |
$3.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.33
|
| Rate for Payer: Railroad Medicare Medicare |
$3.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$12.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.82
|
| Rate for Payer: UHC Medicare Advantage |
$3.94
|
| Rate for Payer: VA VA |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
IP
|
$208.01
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$126.87 |
| Max. Negotiated Rate |
$187.21 |
| Rate for Payer: Aetna Commercial |
$176.81
|
| Rate for Payer: BCBS Trust/PPO |
$160.75
|
| Rate for Payer: BCN Commercial |
$160.75
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$178.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.41
|
| Rate for Payer: Healthscope Commercial |
$187.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: PHP Commercial |
$176.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.05
|
| Rate for Payer: UHC Core |
$173.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.01
|
|
|
HC AUDIOMETRY AIR AND BONE
|
Facility
|
OP
|
$208.01
|
|
|
Service Code
|
CPT 92553
|
| Hospital Charge Code |
47100010
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$187.21 |
| Rate for Payer: Aetna Commercial |
$176.81
|
| Rate for Payer: Aetna Medicare |
$54.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.00
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.73
|
| Rate for Payer: BCN Commercial |
$161.73
|
| Rate for Payer: BCN Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$178.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$187.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.01
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: PACE Senior Care Partners |
$49.40
|
| Rate for Payer: PACE SWMI |
$52.00
|
| Rate for Payer: PHP Commercial |
$176.81
|
| Rate for Payer: PHP Medicare Advantage |
$52.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.97
|
| Rate for Payer: Priority Health Medicare |
$52.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.87
|
| Rate for Payer: Railroad Medicare Medicare |
$52.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.05
|
| Rate for Payer: UHC Core |
$173.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.00
|
| Rate for Payer: UHC Medicare Advantage |
$53.56
|
| Rate for Payer: VA VA |
$52.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.01
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
OP
|
$251.11
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: Aetna Commercial |
$213.44
|
| Rate for Payer: Aetna Medicare |
$65.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.47
|
| Rate for Payer: BCBS Complete |
$100.44
|
| Rate for Payer: BCBS MAPPO |
$62.78
|
| Rate for Payer: BCBS Trust/PPO |
$195.24
|
| Rate for Payer: BCN Commercial |
$195.24
|
| Rate for Payer: BCN Medicare Advantage |
$62.78
|
| Rate for Payer: Cash Price |
$200.89
|
| Rate for Payer: Cofinity Commercial |
$215.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.78
|
| Rate for Payer: Healthscope Commercial |
$226.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.44
|
| Rate for Payer: PACE Senior Care Partners |
$59.64
|
| Rate for Payer: PACE SWMI |
$62.78
|
| Rate for Payer: PHP Commercial |
$213.44
|
| Rate for Payer: PHP Medicare Advantage |
$62.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.47
|
| Rate for Payer: Priority Health Medicare |
$62.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.15
|
| Rate for Payer: Railroad Medicare Medicare |
$62.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.98
|
| Rate for Payer: UHC Core |
$209.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.78
|
| Rate for Payer: UHC Medicare Advantage |
$64.66
|
| Rate for Payer: VA VA |
$62.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.33
|
|
|
HC AUDITORY EVOKED POTENTIAL SCREENING
|
Facility
|
IP
|
$251.11
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
47100015
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$153.15 |
| Max. Negotiated Rate |
$226.00 |
| Rate for Payer: Aetna Commercial |
$213.44
|
| Rate for Payer: BCBS Trust/PPO |
$194.06
|
| Rate for Payer: BCN Commercial |
$194.06
|
| Rate for Payer: Cash Price |
$200.89
|
| Rate for Payer: Cofinity Commercial |
$215.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.89
|
| Rate for Payer: Healthscope Commercial |
$226.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.44
|
| Rate for Payer: PHP Commercial |
$213.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.98
|
| Rate for Payer: UHC Core |
$209.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.33
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
IP
|
$674.35
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$411.29 |
| Max. Negotiated Rate |
$606.92 |
| Rate for Payer: Aetna Commercial |
$573.20
|
| Rate for Payer: BCBS Trust/PPO |
$521.14
|
| Rate for Payer: BCN Commercial |
$521.14
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cofinity Commercial |
$579.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.48
|
| Rate for Payer: Healthscope Commercial |
$606.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$505.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.20
|
| Rate for Payer: PHP Commercial |
$573.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.43
|
| Rate for Payer: UHC Core |
$563.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$505.76
|
|
|
HC AUDITORY EVOK POT NEURODIAGNOSTIC W I&R
|
Facility
|
OP
|
$674.35
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
47000001
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$606.92 |
| Rate for Payer: Aetna Commercial |
$573.20
|
| Rate for Payer: Aetna Medicare |
$175.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.73
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$168.59
|
| Rate for Payer: BCBS Trust/PPO |
$524.31
|
| Rate for Payer: BCN Commercial |
$524.31
|
| Rate for Payer: BCN Medicare Advantage |
$168.59
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cofinity Commercial |
$579.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.59
|
| Rate for Payer: Healthscope Commercial |
$606.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$505.76
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.20
|
| Rate for Payer: PACE Senior Care Partners |
$160.16
|
| Rate for Payer: PACE SWMI |
$168.59
|
| Rate for Payer: PHP Commercial |
$573.20
|
| Rate for Payer: PHP Medicare Advantage |
$168.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.68
|
| Rate for Payer: Priority Health Medicare |
$168.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.29
|
| Rate for Payer: Railroad Medicare Medicare |
$168.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.43
|
| Rate for Payer: UHC Core |
$563.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.59
|
| Rate for Payer: UHC Medicare Advantage |
$173.65
|
| Rate for Payer: VA VA |
$168.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$505.76
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
OP
|
$674.35
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$606.92 |
| Rate for Payer: Aetna Commercial |
$573.20
|
| Rate for Payer: Aetna Medicare |
$175.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.73
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$168.59
|
| Rate for Payer: BCBS Trust/PPO |
$524.31
|
| Rate for Payer: BCN Commercial |
$524.31
|
| Rate for Payer: BCN Medicare Advantage |
$168.59
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cofinity Commercial |
$579.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.59
|
| Rate for Payer: Healthscope Commercial |
$606.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$505.76
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.20
|
| Rate for Payer: PACE Senior Care Partners |
$160.16
|
| Rate for Payer: PACE SWMI |
$168.59
|
| Rate for Payer: PHP Commercial |
$573.20
|
| Rate for Payer: PHP Medicare Advantage |
$168.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.68
|
| Rate for Payer: Priority Health Medicare |
$168.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.29
|
| Rate for Payer: Railroad Medicare Medicare |
$168.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.43
|
| Rate for Payer: UHC Core |
$563.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.59
|
| Rate for Payer: UHC Medicare Advantage |
$173.65
|
| Rate for Payer: VA VA |
$168.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$505.76
|
|
|
HC AUDITORY EVOK POT THRESHOLD MULTI FREQ
|
Facility
|
IP
|
$674.35
|
|
|
Service Code
|
CPT 92652
|
| Hospital Charge Code |
47000002
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$411.29 |
| Max. Negotiated Rate |
$606.92 |
| Rate for Payer: Aetna Commercial |
$573.20
|
| Rate for Payer: BCBS Trust/PPO |
$521.14
|
| Rate for Payer: BCN Commercial |
$521.14
|
| Rate for Payer: Cash Price |
$539.48
|
| Rate for Payer: Cofinity Commercial |
$579.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.48
|
| Rate for Payer: Healthscope Commercial |
$606.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$505.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.20
|
| Rate for Payer: PHP Commercial |
$573.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.43
|
| Rate for Payer: UHC Core |
$563.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$505.76
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna Commercial |
$140.25
|
| Rate for Payer: Aetna Medicare |
$42.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.56
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$41.25
|
| Rate for Payer: BCBS Trust/PPO |
$128.29
|
| Rate for Payer: BCN Commercial |
$128.29
|
| Rate for Payer: BCN Medicare Advantage |
$41.25
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.25
|
| Rate for Payer: Healthscope Commercial |
$148.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.75
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.25
|
| Rate for Payer: PACE Senior Care Partners |
$39.19
|
| Rate for Payer: PACE SWMI |
$41.25
|
| Rate for Payer: PHP Commercial |
$140.25
|
| Rate for Payer: PHP Medicare Advantage |
$41.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.55
|
| Rate for Payer: Priority Health Medicare |
$41.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.63
|
| Rate for Payer: Railroad Medicare Medicare |
$41.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.20
|
| Rate for Payer: UHC Core |
$137.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.25
|
| Rate for Payer: UHC Medicare Advantage |
$42.49
|
| Rate for Payer: VA VA |
$41.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.75
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$100.63 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna Commercial |
$140.25
|
| Rate for Payer: BCBS Trust/PPO |
$127.51
|
| Rate for Payer: BCN Commercial |
$127.51
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$141.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.00
|
| Rate for Payer: Healthscope Commercial |
$148.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.25
|
| Rate for Payer: PHP Commercial |
$140.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.20
|
| Rate for Payer: UHC Core |
$137.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.75
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
IP
|
$58.79
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.86 |
| Max. Negotiated Rate |
$52.91 |
| Rate for Payer: Aetna Commercial |
$49.97
|
| Rate for Payer: BCBS Trust/PPO |
$45.43
|
| Rate for Payer: BCN Commercial |
$45.43
|
| Rate for Payer: Cash Price |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$50.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.03
|
| Rate for Payer: Healthscope Commercial |
$52.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.97
|
| Rate for Payer: PHP Commercial |
$49.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.74
|
| Rate for Payer: UHC Core |
$49.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.09
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
OP
|
$58.79
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$52.91 |
| Rate for Payer: Aetna Commercial |
$49.97
|
| Rate for Payer: Aetna Medicare |
$15.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.37
|
| Rate for Payer: BCBS Complete |
$23.52
|
| Rate for Payer: BCBS MAPPO |
$14.70
|
| Rate for Payer: BCBS Trust/PPO |
$45.71
|
| Rate for Payer: BCN Commercial |
$45.71
|
| Rate for Payer: BCN Medicare Advantage |
$14.70
|
| Rate for Payer: Cash Price |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$50.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.70
|
| Rate for Payer: Healthscope Commercial |
$52.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.97
|
| Rate for Payer: PACE Senior Care Partners |
$13.96
|
| Rate for Payer: PACE SWMI |
$14.70
|
| Rate for Payer: PHP Commercial |
$49.97
|
| Rate for Payer: PHP Medicare Advantage |
$14.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.15
|
| Rate for Payer: Priority Health Medicare |
$14.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.86
|
| Rate for Payer: Railroad Medicare Medicare |
$14.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.74
|
| Rate for Payer: UHC Core |
$49.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.70
|
| Rate for Payer: UHC Medicare Advantage |
$15.14
|
| Rate for Payer: VA VA |
$14.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.09
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
IP
|
$54.03
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$32.95 |
| Max. Negotiated Rate |
$48.63 |
| Rate for Payer: Aetna Commercial |
$45.93
|
| Rate for Payer: BCBS Trust/PPO |
$41.75
|
| Rate for Payer: BCN Commercial |
$41.75
|
| Rate for Payer: Cash Price |
$43.22
|
| Rate for Payer: Cofinity Commercial |
$46.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.22
|
| Rate for Payer: Healthscope Commercial |
$48.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.93
|
| Rate for Payer: PHP Commercial |
$45.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.55
|
| Rate for Payer: UHC Core |
$45.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.52
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
OP
|
$54.03
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$48.63 |
| Rate for Payer: Aetna Commercial |
$45.93
|
| Rate for Payer: Aetna Medicare |
$14.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.88
|
| Rate for Payer: BCBS Complete |
$21.61
|
| Rate for Payer: BCBS MAPPO |
$13.51
|
| Rate for Payer: BCBS Trust/PPO |
$42.01
|
| Rate for Payer: BCN Commercial |
$42.01
|
| Rate for Payer: BCN Medicare Advantage |
$13.51
|
| Rate for Payer: Cash Price |
$43.22
|
| Rate for Payer: Cofinity Commercial |
$46.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.51
|
| Rate for Payer: Healthscope Commercial |
$48.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.93
|
| Rate for Payer: PACE Senior Care Partners |
$12.83
|
| Rate for Payer: PACE SWMI |
$13.51
|
| Rate for Payer: PHP Commercial |
$45.93
|
| Rate for Payer: PHP Medicare Advantage |
$13.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.01
|
| Rate for Payer: Priority Health Medicare |
$13.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.95
|
| Rate for Payer: Railroad Medicare Medicare |
$13.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.55
|
| Rate for Payer: UHC Core |
$45.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.51
|
| Rate for Payer: UHC Medicare Advantage |
$13.91
|
| Rate for Payer: VA VA |
$13.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.52
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
OP
|
$454.36
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$102.47 |
| Max. Negotiated Rate |
$408.92 |
| Rate for Payer: Aetna Commercial |
$386.21
|
| Rate for Payer: Aetna Medicare |
$118.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.99
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$113.59
|
| Rate for Payer: BCBS Trust/PPO |
$353.26
|
| Rate for Payer: BCN Commercial |
$353.26
|
| Rate for Payer: BCN Medicare Advantage |
$113.59
|
| Rate for Payer: Cash Price |
$363.49
|
| Rate for Payer: Cash Price |
$363.49
|
| Rate for Payer: Cofinity Commercial |
$390.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.59
|
| Rate for Payer: Healthscope Commercial |
$408.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.77
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.21
|
| Rate for Payer: PACE Senior Care Partners |
$107.91
|
| Rate for Payer: PACE SWMI |
$113.59
|
| Rate for Payer: PHP Commercial |
$386.21
|
| Rate for Payer: PHP Medicare Advantage |
$113.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$395.29
|
| Rate for Payer: Priority Health Medicare |
$113.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.11
|
| Rate for Payer: Railroad Medicare Medicare |
$113.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$399.84
|
| Rate for Payer: UHC Core |
$379.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.59
|
| Rate for Payer: UHC Medicare Advantage |
$117.00
|
| Rate for Payer: VA VA |
$113.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.77
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
IP
|
$454.36
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$277.11 |
| Max. Negotiated Rate |
$408.92 |
| Rate for Payer: Aetna Commercial |
$386.21
|
| Rate for Payer: BCBS Trust/PPO |
$351.13
|
| Rate for Payer: BCN Commercial |
$351.13
|
| Rate for Payer: Cash Price |
$363.49
|
| Rate for Payer: Cofinity Commercial |
$390.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.49
|
| Rate for Payer: Healthscope Commercial |
$408.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.21
|
| Rate for Payer: PHP Commercial |
$386.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$395.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$399.84
|
| Rate for Payer: UHC Core |
$379.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.77
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
IP
|
$809.10
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$493.47 |
| Max. Negotiated Rate |
$728.19 |
| Rate for Payer: Aetna Commercial |
$687.74
|
| Rate for Payer: BCBS Trust/PPO |
$625.27
|
| Rate for Payer: BCN Commercial |
$625.27
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cofinity Commercial |
$695.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.28
|
| Rate for Payer: Healthscope Commercial |
$728.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.74
|
| Rate for Payer: PHP Commercial |
$687.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$703.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$712.01
|
| Rate for Payer: UHC Core |
$675.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.82
|
|
