|
HC US OB LTD
|
Facility
|
IP
|
$495.83
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.37 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Aetna Commercial |
$421.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.29
|
| Rate for Payer: Cash Price |
$396.66
|
| Rate for Payer: Cofinity Advantage |
$347.08
|
| Rate for Payer: Cofinity Commercial |
$426.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.66
|
| Rate for Payer: Healthscope Commercial |
$446.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.87
|
| Rate for Payer: PHP Commercial |
$421.46
|
| Rate for Payer: Priority Health SBD |
$312.37
|
|
|
HC US OB NT EACH ADDL FETUS
|
Facility
|
OP
|
$180.02
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$61.33 |
| Max. Negotiated Rate |
$162.02 |
| Rate for Payer: Aetna Commercial |
$153.02
|
| Rate for Payer: Aetna Medicare |
$90.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.01
|
| Rate for Payer: BCBS Complete |
$72.01
|
| Rate for Payer: BCBS Trust/PPO |
$61.33
|
| Rate for Payer: BCN Commercial |
$61.33
|
| Rate for Payer: Cash Price |
$144.02
|
| Rate for Payer: Cash Price |
$144.02
|
| Rate for Payer: Cofinity Advantage |
$126.01
|
| Rate for Payer: Cofinity Commercial |
$154.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.02
|
| Rate for Payer: Healthscope Commercial |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.01
|
| Rate for Payer: PHP Commercial |
$153.02
|
| Rate for Payer: Priority Health SBD |
$113.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.01
|
| Rate for Payer: UHC Core |
$93.79
|
| Rate for Payer: UHC Exchange |
$70.75
|
|
|
HC US OB NT EACH ADDL FETUS
|
Facility
|
IP
|
$180.02
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.41 |
| Max. Negotiated Rate |
$162.02 |
| Rate for Payer: Aetna Commercial |
$153.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.01
|
| Rate for Payer: Cash Price |
$144.02
|
| Rate for Payer: Cofinity Advantage |
$126.01
|
| Rate for Payer: Cofinity Commercial |
$154.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.02
|
| Rate for Payer: Healthscope Commercial |
$162.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.01
|
| Rate for Payer: PHP Commercial |
$153.02
|
| Rate for Payer: Priority Health SBD |
$113.41
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
OP
|
$467.56
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$420.80 |
| Rate for Payer: Aetna Commercial |
$397.43
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$131.74
|
| Rate for Payer: BCN Commercial |
$131.74
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$374.05
|
| Rate for Payer: Cash Price |
$374.05
|
| Rate for Payer: Cofinity Advantage |
$327.29
|
| Rate for Payer: Cofinity Commercial |
$402.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$420.80
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.43
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.67
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$397.43
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$294.56
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.91
|
| Rate for Payer: UHC Core |
$243.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$183.75
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
IP
|
$467.56
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$294.56 |
| Max. Negotiated Rate |
$420.80 |
| Rate for Payer: Aetna Commercial |
$397.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.91
|
| Rate for Payer: Cash Price |
$374.05
|
| Rate for Payer: Cofinity Advantage |
$327.29
|
| Rate for Payer: Cofinity Commercial |
$402.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.05
|
| Rate for Payer: Healthscope Commercial |
$420.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.67
|
| Rate for Payer: PHP Commercial |
$397.43
|
| Rate for Payer: Priority Health SBD |
$294.56
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
OP
|
$406.24
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$365.62 |
| Rate for Payer: Aetna Commercial |
$345.30
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$127.96
|
| Rate for Payer: BCN Commercial |
$127.96
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$324.99
|
| Rate for Payer: Cash Price |
$324.99
|
| Rate for Payer: Cofinity Advantage |
$284.37
|
| Rate for Payer: Cofinity Commercial |
$349.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$365.62
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.30
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.68
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$345.30
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$255.93
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.06
|
| Rate for Payer: UHC Core |
$211.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$159.65
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
IP
|
$406.24
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.93 |
| Max. Negotiated Rate |
$365.62 |
| Rate for Payer: Aetna Commercial |
$345.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.06
|
| Rate for Payer: Cash Price |
$324.99
|
| Rate for Payer: Cofinity Advantage |
$284.37
|
| Rate for Payer: Cofinity Commercial |
$349.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.99
|
| Rate for Payer: Healthscope Commercial |
$365.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.68
|
| Rate for Payer: PHP Commercial |
$345.30
|
| Rate for Payer: Priority Health SBD |
$255.93
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
IP
|
$1,110.78
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$699.79 |
| Max. Negotiated Rate |
$999.70 |
| Rate for Payer: Aetna Commercial |
$944.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.01
|
| Rate for Payer: Cash Price |
$888.62
|
| Rate for Payer: Cofinity Advantage |
$777.55
|
| Rate for Payer: Cofinity Commercial |
$955.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$888.62
|
| Rate for Payer: Healthscope Commercial |
$999.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$944.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.09
|
| Rate for Payer: PHP Commercial |
$944.16
|
| Rate for Payer: Priority Health SBD |
$699.79
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
OP
|
$1,110.78
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$999.70 |
| Rate for Payer: Aetna Commercial |
$944.16
|
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$722.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$104.50
|
| Rate for Payer: BCN Commercial |
$104.50
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$888.62
|
| Rate for Payer: Cash Price |
$888.62
|
| Rate for Payer: Cash Price |
$888.62
|
| Rate for Payer: Cofinity Advantage |
$777.55
|
| Rate for Payer: Cofinity Commercial |
$955.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$888.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$999.70
|
| Rate for Payer: Mclaren Medicaid |
$105.35
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$944.16
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.09
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$944.16
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health SBD |
$699.79
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
HC US PARACENTESIS
|
Facility
|
OP
|
$1,437.47
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$472.65 |
| Max. Negotiated Rate |
$2,922.56 |
| Rate for Payer: Aetna Commercial |
$1,221.85
|
| Rate for Payer: Aetna Medicare |
$939.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,129.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,129.65
|
| Rate for Payer: BCBS Complete |
$496.32
|
| Rate for Payer: BCBS MAPPO |
$903.72
|
| Rate for Payer: BCBS Trust/PPO |
$480.39
|
| Rate for Payer: BCN Commercial |
$480.39
|
| Rate for Payer: BCN Medicare Advantage |
$903.72
|
| Rate for Payer: Cash Price |
$1,149.98
|
| Rate for Payer: Cash Price |
$1,149.98
|
| Rate for Payer: Cash Price |
$1,149.98
|
| Rate for Payer: Cofinity Advantage |
$1,006.23
|
| Rate for Payer: Cofinity Commercial |
$1,236.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,149.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$903.72
|
| Rate for Payer: Healthscope Commercial |
$1,293.72
|
| Rate for Payer: Mclaren Medicaid |
$472.65
|
| Rate for Payer: Mclaren Medicare |
$903.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$948.91
|
| Rate for Payer: Meridian Medicaid |
$948.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,039.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,221.85
|
| Rate for Payer: Nomi Health Commercial |
$2,711.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,078.10
|
| Rate for Payer: PACE Medicare |
$858.53
|
| Rate for Payer: PACE SWMI |
$903.72
|
| Rate for Payer: PHP Commercial |
$1,221.85
|
| Rate for Payer: PHP Medicare Advantage |
$903.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,922.56
|
| Rate for Payer: Priority Health Medicare |
$903.72
|
| Rate for Payer: Priority Health SBD |
$905.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,338.05
|
| Rate for Payer: Railroad Medicare Medicare |
$903.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$903.72
|
| Rate for Payer: UHC Medicaid |
$472.65
|
| Rate for Payer: UHCCP Medicaid |
$472.65
|
| Rate for Payer: VA VA |
$903.72
|
|
|
HC US PARACENTESIS
|
Facility
|
IP
|
$1,437.47
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$905.61 |
| Max. Negotiated Rate |
$1,293.72 |
| Rate for Payer: Aetna Commercial |
$1,221.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.36
|
| Rate for Payer: Cash Price |
$1,149.98
|
| Rate for Payer: Cofinity Advantage |
$1,006.23
|
| Rate for Payer: Cofinity Commercial |
$1,236.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,149.98
|
| Rate for Payer: Healthscope Commercial |
$1,293.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,221.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,078.10
|
| Rate for Payer: PHP Commercial |
$1,221.85
|
| Rate for Payer: Priority Health SBD |
$905.61
|
|
|
HC US PELVIS LTD
|
Facility
|
IP
|
$520.60
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$327.98 |
| Max. Negotiated Rate |
$468.54 |
| Rate for Payer: Aetna Commercial |
$442.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.39
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Advantage |
$364.42
|
| Rate for Payer: Cofinity Commercial |
$447.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Healthscope Commercial |
$468.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: PHP Commercial |
$442.51
|
| Rate for Payer: Priority Health SBD |
$327.98
|
|
|
HC US PELVIS LTD
|
Facility
|
OP
|
$520.60
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$468.54 |
| Rate for Payer: Aetna Commercial |
$442.51
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$60.57
|
| Rate for Payer: BCN Commercial |
$60.57
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Advantage |
$364.42
|
| Rate for Payer: Cofinity Commercial |
$447.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$468.54
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$442.51
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$327.98
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.39
|
| Rate for Payer: UHC Core |
$271.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$204.60
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
IP
|
$937.08
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$590.36 |
| Max. Negotiated Rate |
$843.37 |
| Rate for Payer: Aetna Commercial |
$796.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.10
|
| Rate for Payer: Cash Price |
$749.66
|
| Rate for Payer: Cofinity Advantage |
$655.96
|
| Rate for Payer: Cofinity Commercial |
$805.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.66
|
| Rate for Payer: Healthscope Commercial |
$843.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.81
|
| Rate for Payer: PHP Commercial |
$796.52
|
| Rate for Payer: Priority Health SBD |
$590.36
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
OP
|
$937.08
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$843.37 |
| Rate for Payer: Aetna Commercial |
$796.52
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$164.29
|
| Rate for Payer: BCN Commercial |
$164.29
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$749.66
|
| Rate for Payer: Cash Price |
$749.66
|
| Rate for Payer: Cofinity Advantage |
$655.96
|
| Rate for Payer: Cofinity Commercial |
$805.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$843.37
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.52
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.81
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$796.52
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$590.36
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.10
|
| Rate for Payer: UHC Core |
$488.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$368.27
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
OP
|
$385.45
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$346.90 |
| Rate for Payer: Aetna Commercial |
$327.63
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$193.07
|
| Rate for Payer: BCN Commercial |
$193.07
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$308.36
|
| Rate for Payer: Cash Price |
$308.36
|
| Rate for Payer: Cofinity Advantage |
$269.81
|
| Rate for Payer: Cofinity Commercial |
$331.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$346.90
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.63
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.09
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$327.63
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$242.83
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.54
|
| Rate for Payer: UHC Core |
$200.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$151.48
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
IP
|
$385.45
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$242.83 |
| Max. Negotiated Rate |
$346.90 |
| Rate for Payer: Aetna Commercial |
$327.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.54
|
| Rate for Payer: Cash Price |
$308.36
|
| Rate for Payer: Cofinity Advantage |
$269.81
|
| Rate for Payer: Cofinity Commercial |
$331.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.36
|
| Rate for Payer: Healthscope Commercial |
$346.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.09
|
| Rate for Payer: PHP Commercial |
$327.63
|
| Rate for Payer: Priority Health SBD |
$242.83
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$1,107.77
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$697.90 |
| Max. Negotiated Rate |
$996.99 |
| Rate for Payer: Aetna Commercial |
$941.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$720.05
|
| Rate for Payer: Cash Price |
$886.22
|
| Rate for Payer: Cofinity Advantage |
$775.44
|
| Rate for Payer: Cofinity Commercial |
$952.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$886.22
|
| Rate for Payer: Healthscope Commercial |
$996.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$941.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$830.83
|
| Rate for Payer: PHP Commercial |
$941.60
|
| Rate for Payer: Priority Health SBD |
$697.90
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$1,107.77
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$996.99 |
| Rate for Payer: Aetna Commercial |
$941.60
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$720.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$373.27
|
| Rate for Payer: BCN Commercial |
$373.27
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$886.22
|
| Rate for Payer: Cash Price |
$886.22
|
| Rate for Payer: Cofinity Advantage |
$775.44
|
| Rate for Payer: Cofinity Commercial |
$952.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$886.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$996.99
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$941.60
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$830.83
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$941.60
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$697.90
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$720.05
|
| Rate for Payer: UHC Core |
$577.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$435.35
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
OP
|
$297.14
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$252.57
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$224.87
|
| Rate for Payer: BCN Commercial |
$224.87
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cofinity Advantage |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$267.43
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.57
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.85
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$252.57
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$187.20
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.14
|
| Rate for Payer: UHC Core |
$154.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$116.78
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
IP
|
$297.14
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$267.43 |
| Rate for Payer: Aetna Commercial |
$252.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.14
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cofinity Advantage |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.71
|
| Rate for Payer: Healthscope Commercial |
$267.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.85
|
| Rate for Payer: PHP Commercial |
$252.57
|
| Rate for Payer: Priority Health SBD |
$187.20
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$781.02
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$702.92 |
| Rate for Payer: Aetna Commercial |
$663.87
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$165.82
|
| Rate for Payer: BCN Commercial |
$165.82
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cofinity Advantage |
$546.71
|
| Rate for Payer: Cofinity Commercial |
$671.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$702.92
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.87
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.76
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$663.87
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$492.04
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.66
|
| Rate for Payer: UHC Core |
$406.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$306.94
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$781.02
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$492.04 |
| Max. Negotiated Rate |
$702.92 |
| Rate for Payer: Aetna Commercial |
$663.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.66
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cofinity Advantage |
$546.71
|
| Rate for Payer: Cofinity Commercial |
$671.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.82
|
| Rate for Payer: Healthscope Commercial |
$702.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.76
|
| Rate for Payer: PHP Commercial |
$663.87
|
| Rate for Payer: Priority Health SBD |
$492.04
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
OP
|
$781.02
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$702.92 |
| Rate for Payer: Aetna Commercial |
$663.87
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$75.71
|
| Rate for Payer: BCN Commercial |
$75.71
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cofinity Advantage |
$546.71
|
| Rate for Payer: Cofinity Commercial |
$671.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$702.92
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.87
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.76
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$663.87
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$492.04
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.66
|
| Rate for Payer: UHC Core |
$406.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$306.94
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
IP
|
$781.02
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$492.04 |
| Max. Negotiated Rate |
$702.92 |
| Rate for Payer: Aetna Commercial |
$663.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.66
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cofinity Advantage |
$546.71
|
| Rate for Payer: Cofinity Commercial |
$671.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.82
|
| Rate for Payer: Healthscope Commercial |
$702.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.76
|
| Rate for Payer: PHP Commercial |
$663.87
|
| Rate for Payer: Priority Health SBD |
$492.04
|
|
