|
HC ENCEPH AUTOIMMUNE EVAL CMPT 2
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$27.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.81
|
| Rate for Payer: BCBS Complete |
$22.63
|
| Rate for Payer: BCBS MAPPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$81.64
|
| Rate for Payer: BCN Commercial |
$81.64
|
| Rate for Payer: BCN Medicare Advantage |
$26.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.25
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Mclaren Medicaid |
$21.56
|
| Rate for Payer: Meridian Medicaid |
$22.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Senior Care Partners |
$24.94
|
| Rate for Payer: PACE SWMI |
$26.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$26.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.35
|
| Rate for Payer: Priority Health Medicare |
$26.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.04
|
| Rate for Payer: Railroad Medicare Medicare |
$26.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.40
|
| Rate for Payer: UHC Core |
$87.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.25
|
| Rate for Payer: UHC Medicare Advantage |
$27.04
|
| Rate for Payer: VA VA |
$26.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC ENCEPH AUTOIMMUNE EVAL CMPT 2
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.04 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: BCBS Trust/PPO |
$81.14
|
| Rate for Payer: BCN Commercial |
$81.14
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.40
|
| Rate for Payer: UHC Core |
$87.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC ENDO BIOPSY
|
Facility
|
IP
|
$281.85
|
|
| Hospital Charge Code |
36000092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$171.90 |
| Max. Negotiated Rate |
$253.66 |
| Rate for Payer: Aetna Commercial |
$239.57
|
| Rate for Payer: BCBS Trust/PPO |
$217.81
|
| Rate for Payer: BCN Commercial |
$217.81
|
| Rate for Payer: Cash Price |
$225.48
|
| Rate for Payer: Cofinity Commercial |
$242.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.48
|
| Rate for Payer: Healthscope Commercial |
$253.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.57
|
| Rate for Payer: PHP Commercial |
$239.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.03
|
| Rate for Payer: UHC Core |
$235.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.39
|
|
|
HC ENDO BIOPSY
|
Facility
|
OP
|
$281.85
|
|
| Hospital Charge Code |
36000092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$66.94 |
| Max. Negotiated Rate |
$253.66 |
| Rate for Payer: Aetna Commercial |
$239.57
|
| Rate for Payer: Aetna Medicare |
$73.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.08
|
| Rate for Payer: BCBS Complete |
$112.74
|
| Rate for Payer: BCBS MAPPO |
$70.46
|
| Rate for Payer: BCBS Trust/PPO |
$219.14
|
| Rate for Payer: BCN Commercial |
$219.14
|
| Rate for Payer: BCN Medicare Advantage |
$70.46
|
| Rate for Payer: Cash Price |
$225.48
|
| Rate for Payer: Cofinity Commercial |
$242.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.46
|
| Rate for Payer: Healthscope Commercial |
$253.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.57
|
| Rate for Payer: PACE Senior Care Partners |
$66.94
|
| Rate for Payer: PACE SWMI |
$70.46
|
| Rate for Payer: PHP Commercial |
$239.57
|
| Rate for Payer: PHP Medicare Advantage |
$70.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.21
|
| Rate for Payer: Priority Health Medicare |
$70.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.90
|
| Rate for Payer: Railroad Medicare Medicare |
$70.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.03
|
| Rate for Payer: UHC Core |
$235.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.46
|
| Rate for Payer: UHC Medicare Advantage |
$72.58
|
| Rate for Payer: VA VA |
$70.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.39
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.36 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Commercial |
$563.55
|
| Rate for Payer: BCBS Trust/PPO |
$512.37
|
| Rate for Payer: BCN Commercial |
$512.37
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$570.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Healthscope Commercial |
$596.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.55
|
| Rate for Payer: PHP Commercial |
$563.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$576.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$404.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$583.44
|
| Rate for Payer: UHC Core |
$553.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.25
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.46 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Commercial |
$563.55
|
| Rate for Payer: Aetna Medicare |
$172.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$207.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$207.19
|
| Rate for Payer: BCBS Complete |
$553.73
|
| Rate for Payer: BCBS MAPPO |
$165.75
|
| Rate for Payer: BCBS Trust/PPO |
$515.48
|
| Rate for Payer: BCCCP Commercial |
$162.36
|
| Rate for Payer: BCN Commercial |
$515.48
|
| Rate for Payer: BCN Medicare Advantage |
$165.75
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$570.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.75
|
| Rate for Payer: Healthscope Commercial |
$596.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.25
|
| Rate for Payer: Mclaren Medicaid |
$527.36
|
| Rate for Payer: Meridian Medicaid |
$553.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$174.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.55
|
| Rate for Payer: PACE Senior Care Partners |
$157.46
|
| Rate for Payer: PACE SWMI |
$165.75
|
| Rate for Payer: PHP Commercial |
$563.55
|
| Rate for Payer: PHP Medicare Advantage |
$165.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$527.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$576.81
|
| Rate for Payer: Priority Health Medicare |
$165.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$404.36
|
| Rate for Payer: Railroad Medicare Medicare |
$165.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$583.44
|
| Rate for Payer: UHC Core |
$553.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.75
|
| Rate for Payer: UHC Medicare Advantage |
$170.72
|
| Rate for Payer: VA VA |
$165.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.25
|
|
|
HC ENDO CLIPPING
|
Facility
|
IP
|
$317.00
|
|
| Hospital Charge Code |
36000117
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.34 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna Commercial |
$269.45
|
| Rate for Payer: BCBS Trust/PPO |
$244.98
|
| Rate for Payer: BCN Commercial |
$244.98
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$272.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.60
|
| Rate for Payer: Healthscope Commercial |
$285.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.45
|
| Rate for Payer: PHP Commercial |
$269.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.96
|
| Rate for Payer: UHC Core |
$264.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.75
|
|
|
HC ENDO CLIPPING
|
Facility
|
OP
|
$317.00
|
|
| Hospital Charge Code |
36000117
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.29 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna Commercial |
$269.45
|
| Rate for Payer: Aetna Medicare |
$82.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.06
|
| Rate for Payer: BCBS Complete |
$126.80
|
| Rate for Payer: BCBS MAPPO |
$79.25
|
| Rate for Payer: BCBS Trust/PPO |
$246.47
|
| Rate for Payer: BCN Commercial |
$246.47
|
| Rate for Payer: BCN Medicare Advantage |
$79.25
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$272.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.25
|
| Rate for Payer: Healthscope Commercial |
$285.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.45
|
| Rate for Payer: PACE Senior Care Partners |
$75.29
|
| Rate for Payer: PACE SWMI |
$79.25
|
| Rate for Payer: PHP Commercial |
$269.45
|
| Rate for Payer: PHP Medicare Advantage |
$79.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.79
|
| Rate for Payer: Priority Health Medicare |
$79.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.34
|
| Rate for Payer: Railroad Medicare Medicare |
$79.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.96
|
| Rate for Payer: UHC Core |
$264.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.25
|
| Rate for Payer: UHC Medicare Advantage |
$81.63
|
| Rate for Payer: VA VA |
$79.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.75
|
|
|
HC ENDO CYTOLOGY/BRUSHING
|
Facility
|
IP
|
$1,770.06
|
|
| Hospital Charge Code |
36000012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,079.56 |
| Max. Negotiated Rate |
$1,593.05 |
| Rate for Payer: Aetna Commercial |
$1,504.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,367.90
|
| Rate for Payer: BCN Commercial |
$1,367.90
|
| Rate for Payer: Cash Price |
$1,416.05
|
| Rate for Payer: Cofinity Commercial |
$1,522.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,416.05
|
| Rate for Payer: Healthscope Commercial |
$1,593.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,327.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,504.55
|
| Rate for Payer: PHP Commercial |
$1,504.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,539.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,079.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,557.65
|
| Rate for Payer: UHC Core |
$1,478.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,327.54
|
|
|
HC ENDO CYTOLOGY/BRUSHING
|
Facility
|
OP
|
$1,770.06
|
|
| Hospital Charge Code |
36000012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$420.39 |
| Max. Negotiated Rate |
$1,593.05 |
| Rate for Payer: Aetna Commercial |
$1,504.55
|
| Rate for Payer: Aetna Medicare |
$460.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$553.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$553.14
|
| Rate for Payer: BCBS Complete |
$708.02
|
| Rate for Payer: BCBS MAPPO |
$442.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,376.22
|
| Rate for Payer: BCN Commercial |
$1,376.22
|
| Rate for Payer: BCN Medicare Advantage |
$442.52
|
| Rate for Payer: Cash Price |
$1,416.05
|
| Rate for Payer: Cofinity Commercial |
$1,522.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,416.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.52
|
| Rate for Payer: Healthscope Commercial |
$1,593.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,327.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$464.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$508.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,504.55
|
| Rate for Payer: PACE Senior Care Partners |
$420.39
|
| Rate for Payer: PACE SWMI |
$442.52
|
| Rate for Payer: PHP Commercial |
$1,504.55
|
| Rate for Payer: PHP Medicare Advantage |
$442.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,539.95
|
| Rate for Payer: Priority Health Medicare |
$442.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,079.56
|
| Rate for Payer: Railroad Medicare Medicare |
$442.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,557.65
|
| Rate for Payer: UHC Core |
$1,478.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$442.52
|
| Rate for Payer: UHC Medicare Advantage |
$455.79
|
| Rate for Payer: VA VA |
$442.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,327.54
|
|
|
HC ENDO DILATATION
|
Facility
|
OP
|
$1,304.30
|
|
| Hospital Charge Code |
36000115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$309.77 |
| Max. Negotiated Rate |
$1,173.87 |
| Rate for Payer: Aetna Commercial |
$1,108.66
|
| Rate for Payer: Aetna Medicare |
$339.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$407.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$407.59
|
| Rate for Payer: BCBS Complete |
$521.72
|
| Rate for Payer: BCBS MAPPO |
$326.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.09
|
| Rate for Payer: BCN Commercial |
$1,014.09
|
| Rate for Payer: BCN Medicare Advantage |
$326.08
|
| Rate for Payer: Cash Price |
$1,043.44
|
| Rate for Payer: Cofinity Commercial |
$1,121.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,043.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.08
|
| Rate for Payer: Healthscope Commercial |
$1,173.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$978.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$342.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,108.66
|
| Rate for Payer: PACE Senior Care Partners |
$309.77
|
| Rate for Payer: PACE SWMI |
$326.08
|
| Rate for Payer: PHP Commercial |
$1,108.66
|
| Rate for Payer: PHP Medicare Advantage |
$326.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,134.74
|
| Rate for Payer: Priority Health Medicare |
$326.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$795.49
|
| Rate for Payer: Railroad Medicare Medicare |
$326.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,147.78
|
| Rate for Payer: UHC Core |
$1,089.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.08
|
| Rate for Payer: UHC Medicare Advantage |
$335.86
|
| Rate for Payer: VA VA |
$326.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$978.22
|
|
|
HC ENDO DILATATION
|
Facility
|
IP
|
$1,304.30
|
|
| Hospital Charge Code |
36000115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$795.49 |
| Max. Negotiated Rate |
$1,173.87 |
| Rate for Payer: Aetna Commercial |
$1,108.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.96
|
| Rate for Payer: BCN Commercial |
$1,007.96
|
| Rate for Payer: Cash Price |
$1,043.44
|
| Rate for Payer: Cofinity Commercial |
$1,121.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,043.44
|
| Rate for Payer: Healthscope Commercial |
$1,173.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$978.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,108.66
|
| Rate for Payer: PHP Commercial |
$1,108.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,134.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$795.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,147.78
|
| Rate for Payer: UHC Core |
$1,089.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$978.22
|
|
|
HC ENDO FINE NEEDLE ASP/BIOPSY
|
Facility
|
OP
|
$1,053.46
|
|
| Hospital Charge Code |
36000103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$250.20 |
| Max. Negotiated Rate |
$948.11 |
| Rate for Payer: Aetna Commercial |
$895.44
|
| Rate for Payer: Aetna Medicare |
$273.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.21
|
| Rate for Payer: BCBS Complete |
$421.38
|
| Rate for Payer: BCBS MAPPO |
$263.36
|
| Rate for Payer: BCBS Trust/PPO |
$819.07
|
| Rate for Payer: BCN Commercial |
$819.07
|
| Rate for Payer: BCN Medicare Advantage |
$263.36
|
| Rate for Payer: Cash Price |
$842.77
|
| Rate for Payer: Cofinity Commercial |
$905.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.36
|
| Rate for Payer: Healthscope Commercial |
$948.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$790.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$895.44
|
| Rate for Payer: PACE Senior Care Partners |
$250.20
|
| Rate for Payer: PACE SWMI |
$263.36
|
| Rate for Payer: PHP Commercial |
$895.44
|
| Rate for Payer: PHP Medicare Advantage |
$263.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$916.51
|
| Rate for Payer: Priority Health Medicare |
$263.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$642.51
|
| Rate for Payer: Railroad Medicare Medicare |
$263.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$927.04
|
| Rate for Payer: UHC Core |
$879.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.36
|
| Rate for Payer: UHC Medicare Advantage |
$271.27
|
| Rate for Payer: VA VA |
$263.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$790.10
|
|
|
HC ENDO FINE NEEDLE ASP/BIOPSY
|
Facility
|
IP
|
$1,053.46
|
|
| Hospital Charge Code |
36000103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$642.51 |
| Max. Negotiated Rate |
$948.11 |
| Rate for Payer: Aetna Commercial |
$895.44
|
| Rate for Payer: BCBS Trust/PPO |
$814.11
|
| Rate for Payer: BCN Commercial |
$814.11
|
| Rate for Payer: Cash Price |
$842.77
|
| Rate for Payer: Cofinity Commercial |
$905.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$842.77
|
| Rate for Payer: Healthscope Commercial |
$948.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$790.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$895.44
|
| Rate for Payer: PHP Commercial |
$895.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$916.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$642.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$927.04
|
| Rate for Payer: UHC Core |
$879.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$790.10
|
|
|
HC ENDOFORM 2X2
|
Facility
|
IP
|
$38.25
|
|
| Hospital Charge Code |
27000459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$34.42 |
| Rate for Payer: Aetna Commercial |
$32.51
|
| Rate for Payer: BCBS Trust/PPO |
$29.56
|
| Rate for Payer: BCN Commercial |
$29.56
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.60
|
| Rate for Payer: Healthscope Commercial |
$34.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.51
|
| Rate for Payer: PHP Commercial |
$32.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.66
|
| Rate for Payer: UHC Core |
$31.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.69
|
|
|
HC ENDOFORM 2X2
|
Facility
|
OP
|
$38.25
|
|
| Hospital Charge Code |
27000459
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.08 |
| Max. Negotiated Rate |
$34.42 |
| Rate for Payer: Aetna Commercial |
$32.51
|
| Rate for Payer: Aetna Medicare |
$9.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.95
|
| Rate for Payer: BCBS Complete |
$15.30
|
| Rate for Payer: BCBS MAPPO |
$9.56
|
| Rate for Payer: BCBS Trust/PPO |
$29.74
|
| Rate for Payer: BCN Commercial |
$29.74
|
| Rate for Payer: BCN Medicare Advantage |
$9.56
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cofinity Commercial |
$32.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.56
|
| Rate for Payer: Healthscope Commercial |
$34.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.51
|
| Rate for Payer: PACE Senior Care Partners |
$9.08
|
| Rate for Payer: PACE SWMI |
$9.56
|
| Rate for Payer: PHP Commercial |
$32.51
|
| Rate for Payer: PHP Medicare Advantage |
$9.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.28
|
| Rate for Payer: Priority Health Medicare |
$9.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.33
|
| Rate for Payer: Railroad Medicare Medicare |
$9.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.66
|
| Rate for Payer: UHC Core |
$31.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.56
|
| Rate for Payer: UHC Medicare Advantage |
$9.85
|
| Rate for Payer: VA VA |
$9.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.69
|
|
|
HC ENDOFORM 4X4
|
Facility
|
IP
|
$133.06
|
|
| Hospital Charge Code |
27000460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$119.75 |
| Rate for Payer: Aetna Commercial |
$113.10
|
| Rate for Payer: BCBS Trust/PPO |
$102.83
|
| Rate for Payer: BCN Commercial |
$102.83
|
| Rate for Payer: Cash Price |
$106.45
|
| Rate for Payer: Cofinity Commercial |
$114.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.45
|
| Rate for Payer: Healthscope Commercial |
$119.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.10
|
| Rate for Payer: PHP Commercial |
$113.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.09
|
| Rate for Payer: UHC Core |
$111.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.80
|
|
|
HC ENDOFORM 4X4
|
Facility
|
OP
|
$133.06
|
|
| Hospital Charge Code |
27000460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$119.75 |
| Rate for Payer: Aetna Commercial |
$113.10
|
| Rate for Payer: Aetna Medicare |
$34.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.58
|
| Rate for Payer: BCBS Complete |
$53.22
|
| Rate for Payer: BCBS MAPPO |
$33.26
|
| Rate for Payer: BCBS Trust/PPO |
$103.45
|
| Rate for Payer: BCN Commercial |
$103.45
|
| Rate for Payer: BCN Medicare Advantage |
$33.26
|
| Rate for Payer: Cash Price |
$106.45
|
| Rate for Payer: Cofinity Commercial |
$114.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.26
|
| Rate for Payer: Healthscope Commercial |
$119.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.10
|
| Rate for Payer: PACE Senior Care Partners |
$31.60
|
| Rate for Payer: PACE SWMI |
$33.26
|
| Rate for Payer: PHP Commercial |
$113.10
|
| Rate for Payer: PHP Medicare Advantage |
$33.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.76
|
| Rate for Payer: Priority Health Medicare |
$33.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.15
|
| Rate for Payer: Railroad Medicare Medicare |
$33.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.09
|
| Rate for Payer: UHC Core |
$111.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.26
|
| Rate for Payer: UHC Medicare Advantage |
$34.26
|
| Rate for Payer: VA VA |
$33.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.80
|
|
|
HC ENDO HEMOSTASIS
|
Facility
|
IP
|
$123.00
|
|
| Hospital Charge Code |
36000116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.02 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna Commercial |
$104.55
|
| Rate for Payer: BCBS Trust/PPO |
$95.05
|
| Rate for Payer: BCN Commercial |
$95.05
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$105.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.40
|
| Rate for Payer: Healthscope Commercial |
$110.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.55
|
| Rate for Payer: PHP Commercial |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.24
|
| Rate for Payer: UHC Core |
$102.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.25
|
|
|
HC ENDO HEMOSTASIS
|
Facility
|
OP
|
$123.00
|
|
| Hospital Charge Code |
36000116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$29.21 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna Commercial |
$104.55
|
| Rate for Payer: Aetna Medicare |
$31.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.44
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$30.75
|
| Rate for Payer: BCBS Trust/PPO |
$95.63
|
| Rate for Payer: BCN Commercial |
$95.63
|
| Rate for Payer: BCN Medicare Advantage |
$30.75
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$105.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.75
|
| Rate for Payer: Healthscope Commercial |
$110.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.55
|
| Rate for Payer: PACE Senior Care Partners |
$29.21
|
| Rate for Payer: PACE SWMI |
$30.75
|
| Rate for Payer: PHP Commercial |
$104.55
|
| Rate for Payer: PHP Medicare Advantage |
$30.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.01
|
| Rate for Payer: Priority Health Medicare |
$30.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.02
|
| Rate for Payer: Railroad Medicare Medicare |
$30.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.24
|
| Rate for Payer: UHC Core |
$102.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.75
|
| Rate for Payer: UHC Medicare Advantage |
$31.67
|
| Rate for Payer: VA VA |
$30.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.25
|
|
|
HC ENDOLUMINAL BIOPSY OF BILIARY TREE
|
Facility
|
IP
|
$649.42
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
36100500
|
|
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 ENDOLUMINAL BIOPSY OF BILIARY TREE
|
Facility
|
OP
|
$649.42
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
36100500
|
|
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 ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC
|
Facility
|
IP
|
$4,998.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
36100615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,048.28 |
| Max. Negotiated Rate |
$4,498.20 |
| Rate for Payer: Aetna Commercial |
$4,248.30
|
| Rate for Payer: BCBS Trust/PPO |
$3,862.45
|
| Rate for Payer: BCN Commercial |
$3,862.45
|
| Rate for Payer: Cash Price |
$3,998.40
|
| Rate for Payer: Cofinity Commercial |
$4,298.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,998.40
|
| Rate for Payer: Healthscope Commercial |
$4,498.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,748.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,248.30
|
| Rate for Payer: PHP Commercial |
$4,248.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,498.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,348.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,048.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,398.24
|
| Rate for Payer: UHC Core |
$4,173.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,748.50
|
|
|
HC ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC
|
Facility
|
OP
|
$4,998.00
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
36100615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,187.02 |
| Max. Negotiated Rate |
$4,498.20 |
| Rate for Payer: Aetna Commercial |
$4,248.30
|
| Rate for Payer: Aetna Medicare |
$1,299.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,561.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,561.88
|
| Rate for Payer: BCBS Complete |
$1,999.20
|
| Rate for Payer: BCBS MAPPO |
$1,249.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,885.94
|
| Rate for Payer: BCN Commercial |
$3,885.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,249.50
|
| Rate for Payer: Cash Price |
$3,998.40
|
| Rate for Payer: Cofinity Commercial |
$4,298.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,998.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,249.50
|
| Rate for Payer: Healthscope Commercial |
$4,498.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,748.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,311.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,436.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,248.30
|
| Rate for Payer: PACE Senior Care Partners |
$1,187.02
|
| Rate for Payer: PACE SWMI |
$1,249.50
|
| Rate for Payer: PHP Commercial |
$4,248.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,249.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,498.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,348.26
|
| Rate for Payer: Priority Health Medicare |
$1,249.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,048.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,249.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,398.24
|
| Rate for Payer: UHC Core |
$4,173.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,249.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,286.98
|
| Rate for Payer: VA VA |
$1,249.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,748.50
|
|
|
HC ENDOMETR ABLATE THERMAL
|
Facility
|
OP
|
$13,091.70
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,109.28 |
| Max. Negotiated Rate |
$11,782.53 |
| Rate for Payer: Aetna Commercial |
$11,127.94
|
| Rate for Payer: Aetna Medicare |
$3,403.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,091.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,091.16
|
| Rate for Payer: BCBS Complete |
$3,425.99
|
| Rate for Payer: BCBS MAPPO |
$3,272.92
|
| Rate for Payer: BCBS Trust/PPO |
$10,178.80
|
| Rate for Payer: BCN Commercial |
$10,178.80
|
| Rate for Payer: BCN Medicare Advantage |
$3,272.92
|
| Rate for Payer: Cash Price |
$10,473.36
|
| Rate for Payer: Cash Price |
$10,473.36
|
| Rate for Payer: Cofinity Commercial |
$11,258.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,473.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,272.92
|
| Rate for Payer: Healthscope Commercial |
$11,782.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,818.78
|
| Rate for Payer: Mclaren Medicaid |
$3,262.85
|
| Rate for Payer: Meridian Medicaid |
$3,425.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,436.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,763.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,127.94
|
| Rate for Payer: PACE Senior Care Partners |
$3,109.28
|
| Rate for Payer: PACE SWMI |
$3,272.92
|
| Rate for Payer: PHP Commercial |
$11,127.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,272.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,262.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,164.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,389.78
|
| Rate for Payer: Priority Health Medicare |
$3,272.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,984.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,272.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,520.70
|
| Rate for Payer: UHC Core |
$10,931.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,272.92
|
| Rate for Payer: UHC Medicare Advantage |
$3,371.11
|
| Rate for Payer: VA VA |
$3,272.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,818.78
|
|
