|
HC DIALYSIS CATH LVL 9 LONG TERM
|
Facility
|
OP
|
$938.99
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27200320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.01 |
| Max. Negotiated Rate |
$845.09 |
| Rate for Payer: Aetna Commercial |
$798.14
|
| Rate for Payer: Aetna Medicare |
$244.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.43
|
| Rate for Payer: BCBS Complete |
$375.60
|
| Rate for Payer: BCBS MAPPO |
$234.75
|
| Rate for Payer: BCBS Trust/PPO |
$730.06
|
| Rate for Payer: BCN Commercial |
$730.06
|
| Rate for Payer: BCN Medicare Advantage |
$234.75
|
| Rate for Payer: Cash Price |
$751.19
|
| Rate for Payer: Cofinity Commercial |
$807.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$751.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.75
|
| Rate for Payer: Healthscope Commercial |
$845.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$704.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$246.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$798.14
|
| Rate for Payer: PACE Senior Care Partners |
$223.01
|
| Rate for Payer: PACE SWMI |
$234.75
|
| Rate for Payer: PHP Commercial |
$798.14
|
| Rate for Payer: PHP Medicare Advantage |
$234.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$816.92
|
| Rate for Payer: Priority Health Medicare |
$234.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$572.69
|
| Rate for Payer: Railroad Medicare Medicare |
$234.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$826.31
|
| Rate for Payer: UHC Core |
$784.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.75
|
| Rate for Payer: UHC Medicare Advantage |
$241.79
|
| Rate for Payer: VA VA |
$234.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$704.24
|
|
|
HC DIFFUSION
|
Facility
|
IP
|
$388.78
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$237.12 |
| Max. Negotiated Rate |
$349.90 |
| Rate for Payer: Aetna Commercial |
$330.46
|
| Rate for Payer: BCBS Trust/PPO |
$300.45
|
| Rate for Payer: BCN Commercial |
$300.45
|
| Rate for Payer: Cash Price |
$311.02
|
| Rate for Payer: Cofinity Commercial |
$334.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.02
|
| Rate for Payer: Healthscope Commercial |
$349.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.46
|
| Rate for Payer: PHP Commercial |
$330.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.13
|
| Rate for Payer: UHC Core |
$324.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.58
|
|
|
HC DIFFUSION
|
Facility
|
OP
|
$388.78
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$92.34 |
| Max. Negotiated Rate |
$349.90 |
| Rate for Payer: Aetna Commercial |
$330.46
|
| Rate for Payer: Aetna Medicare |
$101.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.49
|
| Rate for Payer: BCBS Complete |
$155.51
|
| Rate for Payer: BCBS MAPPO |
$97.20
|
| Rate for Payer: BCBS Trust/PPO |
$302.28
|
| Rate for Payer: BCN Commercial |
$302.28
|
| Rate for Payer: BCN Medicare Advantage |
$97.20
|
| Rate for Payer: Cash Price |
$311.02
|
| Rate for Payer: Cofinity Commercial |
$334.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.20
|
| Rate for Payer: Healthscope Commercial |
$349.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.46
|
| Rate for Payer: PACE Senior Care Partners |
$92.34
|
| Rate for Payer: PACE SWMI |
$97.20
|
| Rate for Payer: PHP Commercial |
$330.46
|
| Rate for Payer: PHP Medicare Advantage |
$97.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.24
|
| Rate for Payer: Priority Health Medicare |
$97.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.12
|
| Rate for Payer: Railroad Medicare Medicare |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.13
|
| Rate for Payer: UHC Core |
$324.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.20
|
| Rate for Payer: UHC Medicare Advantage |
$100.11
|
| Rate for Payer: VA VA |
$97.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.58
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.69 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna Commercial |
$141.10
|
| Rate for Payer: Aetna Medicare |
$43.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.88
|
| Rate for Payer: BCBS Complete |
$26.97
|
| Rate for Payer: BCBS MAPPO |
$41.50
|
| Rate for Payer: BCBS Trust/PPO |
$129.06
|
| Rate for Payer: BCN Commercial |
$129.06
|
| Rate for Payer: BCN Medicare Advantage |
$41.50
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$142.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.50
|
| Rate for Payer: Healthscope Commercial |
$149.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.50
|
| Rate for Payer: Mclaren Medicaid |
$25.69
|
| Rate for Payer: Meridian Medicaid |
$26.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.10
|
| Rate for Payer: PACE Senior Care Partners |
$39.42
|
| Rate for Payer: PACE SWMI |
$41.50
|
| Rate for Payer: PHP Commercial |
$141.10
|
| Rate for Payer: PHP Medicare Advantage |
$41.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.42
|
| Rate for Payer: Priority Health Medicare |
$41.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.24
|
| Rate for Payer: Railroad Medicare Medicare |
$41.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.08
|
| Rate for Payer: UHC Core |
$138.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.50
|
| Rate for Payer: UHC Medicare Advantage |
$42.74
|
| Rate for Payer: VA VA |
$41.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.50
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.24 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna Commercial |
$141.10
|
| Rate for Payer: BCBS Trust/PPO |
$128.28
|
| Rate for Payer: BCN Commercial |
$128.28
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$142.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.80
|
| Rate for Payer: Healthscope Commercial |
$149.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.10
|
| Rate for Payer: PHP Commercial |
$141.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.08
|
| Rate for Payer: UHC Core |
$138.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.50
|
|
|
HC DIGOXIN LVL
|
Facility
|
IP
|
$90.07
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.93 |
| Max. Negotiated Rate |
$81.06 |
| Rate for Payer: Aetna Commercial |
$76.56
|
| Rate for Payer: BCBS Trust/PPO |
$69.61
|
| Rate for Payer: BCN Commercial |
$69.61
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cofinity Commercial |
$77.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.06
|
| Rate for Payer: Healthscope Commercial |
$81.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.56
|
| Rate for Payer: PHP Commercial |
$76.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.26
|
| Rate for Payer: UHC Core |
$75.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.55
|
|
|
HC DIGOXIN LVL
|
Facility
|
OP
|
$90.07
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$81.06 |
| Rate for Payer: Aetna Commercial |
$76.56
|
| Rate for Payer: Aetna Medicare |
$23.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.15
|
| Rate for Payer: BCBS Complete |
$10.29
|
| Rate for Payer: BCBS MAPPO |
$22.52
|
| Rate for Payer: BCBS Trust/PPO |
$70.03
|
| Rate for Payer: BCN Commercial |
$70.03
|
| Rate for Payer: BCN Medicare Advantage |
$22.52
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cofinity Commercial |
$77.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.52
|
| Rate for Payer: Healthscope Commercial |
$81.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.55
|
| Rate for Payer: Mclaren Medicaid |
$9.80
|
| Rate for Payer: Meridian Medicaid |
$10.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.56
|
| Rate for Payer: PACE Senior Care Partners |
$21.39
|
| Rate for Payer: PACE SWMI |
$22.52
|
| Rate for Payer: PHP Commercial |
$76.56
|
| Rate for Payer: PHP Medicare Advantage |
$22.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.36
|
| Rate for Payer: Priority Health Medicare |
$22.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.93
|
| Rate for Payer: Railroad Medicare Medicare |
$22.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.26
|
| Rate for Payer: UHC Core |
$75.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.52
|
| Rate for Payer: UHC Medicare Advantage |
$23.19
|
| Rate for Payer: VA VA |
$22.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.55
|
|
|
HC DILANTIN LEVEL
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: BCBS Trust/PPO |
$27.59
|
| Rate for Payer: BCN Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC DILANTIN LEVEL
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: BCBS MAPPO |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$27.76
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: BCN Medicare Advantage |
$8.92
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.92
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Mclaren Medicaid |
$9.78
|
| Rate for Payer: Meridian Medicaid |
$10.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Senior Care Partners |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.92
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.06
|
| Rate for Payer: Priority Health Medicare |
$8.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: Railroad Medicare Medicare |
$8.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.92
|
| Rate for Payer: UHC Medicare Advantage |
$9.19
|
| Rate for Payer: VA VA |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
IP
|
$103.60
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$93.24 |
| Rate for Payer: Aetna Commercial |
$88.06
|
| Rate for Payer: BCBS Trust/PPO |
$80.06
|
| Rate for Payer: BCN Commercial |
$80.06
|
| Rate for Payer: Cash Price |
$82.88
|
| Rate for Payer: Cofinity Commercial |
$89.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.88
|
| Rate for Payer: Healthscope Commercial |
$93.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.06
|
| Rate for Payer: PHP Commercial |
$88.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.17
|
| Rate for Payer: UHC Core |
$86.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.70
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
OP
|
$103.60
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$93.24 |
| Rate for Payer: Aetna Commercial |
$88.06
|
| Rate for Payer: Aetna Medicare |
$26.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.38
|
| Rate for Payer: BCBS Complete |
$10.66
|
| Rate for Payer: BCBS MAPPO |
$25.90
|
| Rate for Payer: BCBS Trust/PPO |
$80.55
|
| Rate for Payer: BCN Commercial |
$80.55
|
| Rate for Payer: BCN Medicare Advantage |
$25.90
|
| Rate for Payer: Cash Price |
$82.88
|
| Rate for Payer: Cash Price |
$82.88
|
| Rate for Payer: Cofinity Commercial |
$89.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.90
|
| Rate for Payer: Healthscope Commercial |
$93.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.70
|
| Rate for Payer: Mclaren Medicaid |
$10.15
|
| Rate for Payer: Meridian Medicaid |
$10.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.06
|
| Rate for Payer: PACE Senior Care Partners |
$24.60
|
| Rate for Payer: PACE SWMI |
$25.90
|
| Rate for Payer: PHP Commercial |
$88.06
|
| Rate for Payer: PHP Medicare Advantage |
$25.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.13
|
| Rate for Payer: Priority Health Medicare |
$25.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.19
|
| Rate for Payer: Railroad Medicare Medicare |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.17
|
| Rate for Payer: UHC Core |
$86.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.90
|
| Rate for Payer: UHC Medicare Advantage |
$26.68
|
| Rate for Payer: VA VA |
$25.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.70
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
IP
|
$166.77
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.71 |
| Max. Negotiated Rate |
$150.09 |
| Rate for Payer: Aetna Commercial |
$141.75
|
| Rate for Payer: BCBS Trust/PPO |
$128.88
|
| Rate for Payer: BCN Commercial |
$128.88
|
| Rate for Payer: Cash Price |
$133.42
|
| Rate for Payer: Cofinity Commercial |
$143.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.42
|
| Rate for Payer: Healthscope Commercial |
$150.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.75
|
| Rate for Payer: PHP Commercial |
$141.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.76
|
| Rate for Payer: UHC Core |
$139.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.08
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
OP
|
$166.77
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.61 |
| Max. Negotiated Rate |
$150.09 |
| Rate for Payer: Aetna Commercial |
$141.75
|
| Rate for Payer: Aetna Medicare |
$43.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.12
|
| Rate for Payer: BCBS Complete |
$87.99
|
| Rate for Payer: BCBS MAPPO |
$41.69
|
| Rate for Payer: BCBS Trust/PPO |
$129.66
|
| Rate for Payer: BCN Commercial |
$129.66
|
| Rate for Payer: BCN Medicare Advantage |
$41.69
|
| Rate for Payer: Cash Price |
$133.42
|
| Rate for Payer: Cash Price |
$133.42
|
| Rate for Payer: Cofinity Commercial |
$143.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.69
|
| Rate for Payer: Healthscope Commercial |
$150.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.08
|
| Rate for Payer: Mclaren Medicaid |
$83.80
|
| Rate for Payer: Meridian Medicaid |
$87.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.75
|
| Rate for Payer: PACE Senior Care Partners |
$39.61
|
| Rate for Payer: PACE SWMI |
$41.69
|
| Rate for Payer: PHP Commercial |
$141.75
|
| Rate for Payer: PHP Medicare Advantage |
$41.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.09
|
| Rate for Payer: Priority Health Medicare |
$41.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.71
|
| Rate for Payer: Railroad Medicare Medicare |
$41.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.76
|
| Rate for Payer: UHC Core |
$139.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.69
|
| Rate for Payer: UHC Medicare Advantage |
$42.94
|
| Rate for Payer: VA VA |
$41.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.08
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
IP
|
$649.42
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.08 |
| Max. Negotiated Rate |
$584.48 |
| Rate for Payer: Aetna Commercial |
$552.01
|
| Rate for Payer: BCBS Trust/PPO |
$501.87
|
| Rate for Payer: BCN Commercial |
$501.87
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$558.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$519.54
|
| Rate for Payer: Healthscope Commercial |
$584.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: PHP Commercial |
$552.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$571.49
|
| Rate for Payer: UHC Core |
$542.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.06
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
OP
|
$649.42
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.24 |
| Max. Negotiated Rate |
$584.48 |
| Rate for Payer: Aetna Commercial |
$552.01
|
| Rate for Payer: Aetna Medicare |
$168.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$202.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$202.94
|
| Rate for Payer: BCBS Complete |
$259.77
|
| Rate for Payer: BCBS MAPPO |
$162.36
|
| Rate for Payer: BCBS Trust/PPO |
$504.92
|
| Rate for Payer: BCN Commercial |
$504.92
|
| Rate for Payer: BCN Medicare Advantage |
$162.36
|
| Rate for Payer: Cash Price |
$519.54
|
| Rate for Payer: Cofinity Commercial |
$558.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$519.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.36
|
| Rate for Payer: Healthscope Commercial |
$584.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$170.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.01
|
| Rate for Payer: PACE Senior Care Partners |
$154.24
|
| Rate for Payer: PACE SWMI |
$162.36
|
| Rate for Payer: PHP Commercial |
$552.01
|
| Rate for Payer: PHP Medicare Advantage |
$162.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.00
|
| Rate for Payer: Priority Health Medicare |
$162.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.08
|
| Rate for Payer: Railroad Medicare Medicare |
$162.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$571.49
|
| Rate for Payer: UHC Core |
$542.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.36
|
| Rate for Payer: UHC Medicare Advantage |
$167.23
|
| Rate for Payer: VA VA |
$162.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.06
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
OP
|
$3,591.18
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$852.91 |
| Max. Negotiated Rate |
$7,090.23 |
| Rate for Payer: Aetna Commercial |
$3,052.50
|
| Rate for Payer: Aetna Medicare |
$933.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,122.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,122.24
|
| Rate for Payer: BCBS Complete |
$7,090.23
|
| Rate for Payer: BCBS MAPPO |
$897.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,792.14
|
| Rate for Payer: BCN Commercial |
$2,792.14
|
| Rate for Payer: BCN Medicare Advantage |
$897.80
|
| Rate for Payer: Cash Price |
$2,872.94
|
| Rate for Payer: Cash Price |
$2,872.94
|
| Rate for Payer: Cofinity Commercial |
$3,088.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,872.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$897.80
|
| Rate for Payer: Healthscope Commercial |
$3,232.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,693.38
|
| Rate for Payer: Mclaren Medicaid |
$6,752.60
|
| Rate for Payer: Meridian Medicaid |
$7,090.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$942.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,032.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,052.50
|
| Rate for Payer: PACE Senior Care Partners |
$852.91
|
| Rate for Payer: PACE SWMI |
$897.80
|
| Rate for Payer: PHP Commercial |
$3,052.50
|
| Rate for Payer: PHP Medicare Advantage |
$897.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,752.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,513.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,124.33
|
| Rate for Payer: Priority Health Medicare |
$897.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,190.26
|
| Rate for Payer: Railroad Medicare Medicare |
$897.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,160.24
|
| Rate for Payer: UHC Core |
$2,998.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$897.80
|
| Rate for Payer: UHC Medicare Advantage |
$924.73
|
| Rate for Payer: VA VA |
$897.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,693.38
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
IP
|
$3,591.18
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,190.26 |
| Max. Negotiated Rate |
$3,232.06 |
| Rate for Payer: Aetna Commercial |
$3,052.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,775.26
|
| Rate for Payer: BCN Commercial |
$2,775.26
|
| Rate for Payer: Cash Price |
$2,872.94
|
| Rate for Payer: Cofinity Commercial |
$3,088.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,872.94
|
| Rate for Payer: Healthscope Commercial |
$3,232.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,693.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,052.50
|
| Rate for Payer: PHP Commercial |
$3,052.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,513.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,124.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,190.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,160.24
|
| Rate for Payer: UHC Core |
$2,998.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,693.38
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,162.47 |
| Max. Negotiated Rate |
$1,715.40 |
| Rate for Payer: Aetna Commercial |
$1,620.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,472.96
|
| Rate for Payer: BCN Commercial |
$1,472.96
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$1,639.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,524.80
|
| Rate for Payer: Healthscope Commercial |
$1,715.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,429.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,620.10
|
| Rate for Payer: PHP Commercial |
$1,620.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,658.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,162.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,677.28
|
| Rate for Payer: UHC Core |
$1,591.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,429.50
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.68 |
| Max. Negotiated Rate |
$2,382.99 |
| Rate for Payer: Aetna Commercial |
$1,620.10
|
| Rate for Payer: Aetna Medicare |
$495.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.62
|
| Rate for Payer: BCBS Complete |
$2,382.99
|
| Rate for Payer: BCBS MAPPO |
$476.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,481.92
|
| Rate for Payer: BCN Commercial |
$1,481.92
|
| Rate for Payer: BCN Medicare Advantage |
$476.50
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$1,639.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,524.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.50
|
| Rate for Payer: Healthscope Commercial |
$1,715.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,429.50
|
| Rate for Payer: Mclaren Medicaid |
$2,269.51
|
| Rate for Payer: Meridian Medicaid |
$2,382.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,620.10
|
| Rate for Payer: PACE Senior Care Partners |
$452.68
|
| Rate for Payer: PACE SWMI |
$476.50
|
| Rate for Payer: PHP Commercial |
$1,620.10
|
| Rate for Payer: PHP Medicare Advantage |
$476.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,269.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,658.22
|
| Rate for Payer: Priority Health Medicare |
$476.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,162.47
|
| Rate for Payer: Railroad Medicare Medicare |
$476.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,677.28
|
| Rate for Payer: UHC Core |
$1,591.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.50
|
| Rate for Payer: UHC Medicare Advantage |
$490.80
|
| Rate for Payer: VA VA |
$476.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,429.50
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
IP
|
$7,787.70
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,749.72 |
| Max. Negotiated Rate |
$7,008.93 |
| Rate for Payer: Aetna Commercial |
$6,619.54
|
| Rate for Payer: BCBS Trust/PPO |
$6,018.33
|
| Rate for Payer: BCN Commercial |
$6,018.33
|
| Rate for Payer: Cash Price |
$6,230.16
|
| Rate for Payer: Cofinity Commercial |
$6,697.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,230.16
|
| Rate for Payer: Healthscope Commercial |
$7,008.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,840.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,619.54
|
| Rate for Payer: PHP Commercial |
$6,619.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,451.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,775.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,749.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,853.18
|
| Rate for Payer: UHC Core |
$6,502.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,840.78
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
OP
|
$7,787.70
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,849.58 |
| Max. Negotiated Rate |
$7,008.93 |
| Rate for Payer: Aetna Commercial |
$6,619.54
|
| Rate for Payer: Aetna Medicare |
$2,024.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,433.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,433.66
|
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: BCBS MAPPO |
$1,946.92
|
| Rate for Payer: BCBS Trust/PPO |
$6,054.94
|
| Rate for Payer: BCN Commercial |
$6,054.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,946.92
|
| Rate for Payer: Cash Price |
$6,230.16
|
| Rate for Payer: Cash Price |
$6,230.16
|
| Rate for Payer: Cofinity Commercial |
$6,697.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,230.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,946.92
|
| Rate for Payer: Healthscope Commercial |
$7,008.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,840.78
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,044.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,238.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,619.54
|
| Rate for Payer: PACE Senior Care Partners |
$1,849.58
|
| Rate for Payer: PACE SWMI |
$1,946.92
|
| Rate for Payer: PHP Commercial |
$6,619.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,946.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,451.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,775.30
|
| Rate for Payer: Priority Health Medicare |
$1,946.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,749.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,946.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,853.18
|
| Rate for Payer: UHC Core |
$6,502.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,946.92
|
| Rate for Payer: UHC Medicare Advantage |
$2,005.33
|
| Rate for Payer: VA VA |
$1,946.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,840.78
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
OP
|
$211.68
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.27 |
| Max. Negotiated Rate |
$190.51 |
| Rate for Payer: Aetna Commercial |
$179.93
|
| Rate for Payer: Aetna Medicare |
$55.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.15
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$52.92
|
| Rate for Payer: BCBS Trust/PPO |
$164.58
|
| Rate for Payer: BCN Commercial |
$164.58
|
| Rate for Payer: BCN Medicare Advantage |
$52.92
|
| Rate for Payer: Cash Price |
$169.34
|
| Rate for Payer: Cash Price |
$169.34
|
| Rate for Payer: Cofinity Commercial |
$182.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.92
|
| Rate for Payer: Healthscope Commercial |
$190.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.76
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.93
|
| Rate for Payer: PACE Senior Care Partners |
$50.27
|
| Rate for Payer: PACE SWMI |
$52.92
|
| Rate for Payer: PHP Commercial |
$179.93
|
| Rate for Payer: PHP Medicare Advantage |
$52.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.16
|
| Rate for Payer: Priority Health Medicare |
$52.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.10
|
| Rate for Payer: Railroad Medicare Medicare |
$52.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.28
|
| Rate for Payer: UHC Core |
$176.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.92
|
| Rate for Payer: UHC Medicare Advantage |
$54.51
|
| Rate for Payer: VA VA |
$52.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.76
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
IP
|
$211.68
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.10 |
| Max. Negotiated Rate |
$190.51 |
| Rate for Payer: Aetna Commercial |
$179.93
|
| Rate for Payer: BCBS Trust/PPO |
$163.59
|
| Rate for Payer: BCN Commercial |
$163.59
|
| Rate for Payer: Cash Price |
$169.34
|
| Rate for Payer: Cofinity Commercial |
$182.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.34
|
| Rate for Payer: Healthscope Commercial |
$190.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.93
|
| Rate for Payer: PHP Commercial |
$179.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.28
|
| Rate for Payer: UHC Core |
$176.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.76
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
IP
|
$359.40
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$323.46 |
| Rate for Payer: Aetna Commercial |
$305.49
|
| Rate for Payer: BCBS Trust/PPO |
$277.74
|
| Rate for Payer: BCN Commercial |
$277.74
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cofinity Commercial |
$309.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.52
|
| Rate for Payer: Healthscope Commercial |
$323.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.49
|
| Rate for Payer: PHP Commercial |
$305.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.27
|
| Rate for Payer: UHC Core |
$300.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.55
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
OP
|
$359.40
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$323.46 |
| Rate for Payer: Aetna Commercial |
$305.49
|
| Rate for Payer: Aetna Medicare |
$93.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.31
|
| Rate for Payer: BCBS Complete |
$170.23
|
| Rate for Payer: BCBS MAPPO |
$89.85
|
| Rate for Payer: BCBS Trust/PPO |
$279.43
|
| Rate for Payer: BCN Commercial |
$279.43
|
| Rate for Payer: BCN Medicare Advantage |
$89.85
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cofinity Commercial |
$309.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.85
|
| Rate for Payer: Healthscope Commercial |
$323.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.55
|
| Rate for Payer: Mclaren Medicaid |
$162.12
|
| Rate for Payer: Meridian Medicaid |
$170.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$94.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.49
|
| Rate for Payer: PACE Senior Care Partners |
$85.36
|
| Rate for Payer: PACE SWMI |
$89.85
|
| Rate for Payer: PHP Commercial |
$305.49
|
| Rate for Payer: PHP Medicare Advantage |
$89.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.68
|
| Rate for Payer: Priority Health Medicare |
$89.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.20
|
| Rate for Payer: Railroad Medicare Medicare |
$89.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.27
|
| Rate for Payer: UHC Core |
$300.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.85
|
| Rate for Payer: UHC Medicare Advantage |
$92.55
|
| Rate for Payer: VA VA |
$89.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.55
|
|
