|
HC CYGNUS MATRIX 4X6 PER SQ CM
|
Facility
|
IP
|
$159.89
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.28 |
| Max. Negotiated Rate |
$143.90 |
| Rate for Payer: Aetna Commercial |
$135.91
|
| Rate for Payer: BCBS Trust/PPO |
$132.05
|
| Rate for Payer: BCN Commercial |
$132.05
|
| Rate for Payer: Cash Price |
$127.91
|
| Rate for Payer: Cofinity Commercial |
$137.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.91
|
| Rate for Payer: Healthscope Commercial |
$143.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.91
|
| Rate for Payer: Nomi Health Commercial |
$131.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.92
|
| Rate for Payer: PHP Commercial |
$135.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.70
|
| Rate for Payer: UHC Core |
$133.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.92
|
|
|
HC CYGNUS MATRIX 4X6 PER SQ CM
|
Facility
|
OP
|
$159.89
|
|
|
Service Code
|
HCPCS Q4199
|
| Hospital Charge Code |
63600268
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$143.90 |
| Rate for Payer: Aetna Commercial |
$135.91
|
| Rate for Payer: Aetna Medicare |
$41.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.97
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS MAPPO |
$39.97
|
| Rate for Payer: BCBS Trust/PPO |
$131.45
|
| Rate for Payer: BCN Commercial |
$131.45
|
| Rate for Payer: BCN Medicare Advantage |
$39.97
|
| Rate for Payer: Cash Price |
$127.91
|
| Rate for Payer: Cofinity Commercial |
$137.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.97
|
| Rate for Payer: Healthscope Commercial |
$143.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.92
|
| Rate for Payer: Mclaren Medicaid |
$28.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.97
|
| Rate for Payer: Meridian Medicaid |
$29.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.91
|
| Rate for Payer: Nomi Health Commercial |
$131.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.92
|
| Rate for Payer: PACE Senior Care Partners |
$37.97
|
| Rate for Payer: PACE SWMI |
$39.97
|
| Rate for Payer: PHP Commercial |
$135.91
|
| Rate for Payer: PHP Medicare Advantage |
$39.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.10
|
| Rate for Payer: Priority Health Medicare |
$40.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.28
|
| Rate for Payer: Railroad Medicare Medicare |
$39.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.70
|
| Rate for Payer: UHC Core |
$133.51
|
| Rate for Payer: UHC Exchange |
$39.97
|
| Rate for Payer: UHC Medicaid |
$28.19
|
| Rate for Payer: UHC Medicare Advantage |
$39.97
|
| Rate for Payer: UHCCP Medicaid |
$28.19
|
| Rate for Payer: VA VA |
$39.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.92
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$17.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.13
|
| Rate for Payer: BCBS Complete |
$12.52
|
| Rate for Payer: BCBS MAPPO |
$16.91
|
| Rate for Payer: BCBS Trust/PPO |
$55.60
|
| Rate for Payer: BCN Commercial |
$55.60
|
| Rate for Payer: BCN Medicare Advantage |
$16.91
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Mclaren Medicaid |
$11.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.75
|
| Rate for Payer: Meridian Medicaid |
$12.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Senior Care Partners |
$16.06
|
| Rate for Payer: PACE SWMI |
$16.91
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$16.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.84
|
| Rate for Payer: Priority Health Medicare |
$17.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.07
|
| Rate for Payer: Railroad Medicare Medicare |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.51
|
| Rate for Payer: UHC Core |
$56.47
|
| Rate for Payer: UHC Exchange |
$16.91
|
| Rate for Payer: UHC Medicaid |
$11.92
|
| Rate for Payer: UHC Medicare Advantage |
$16.91
|
| Rate for Payer: UHCCP Medicaid |
$11.92
|
| Rate for Payer: VA VA |
$16.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: BCBS Trust/PPO |
$55.86
|
| Rate for Payer: BCN Commercial |
$55.86
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.51
|
| Rate for Payer: UHC Core |
$56.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR, SERUM
|
Facility
|
IP
|
$69.15
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.13 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Aetna Commercial |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$57.11
|
| Rate for Payer: BCN Commercial |
$57.11
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Commercial |
$59.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Healthscope Commercial |
$62.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Nomi Health Commercial |
$56.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: PHP Commercial |
$58.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.85
|
| Rate for Payer: UHC Core |
$57.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.86
|
|
|
HC CYSTATIN C WITH ESTIMATED GFR, SERUM
|
Facility
|
OP
|
$69.15
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
30100747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$62.23 |
| Rate for Payer: Aetna Commercial |
$58.78
|
| Rate for Payer: Aetna Medicare |
$17.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.61
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$17.29
|
| Rate for Payer: BCBS Trust/PPO |
$56.85
|
| Rate for Payer: BCN Commercial |
$56.85
|
| Rate for Payer: BCN Medicare Advantage |
$17.29
|
| Rate for Payer: Cash Price |
$55.32
|
| Rate for Payer: Cofinity Commercial |
$59.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$62.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.86
|
| Rate for Payer: Mclaren Medicaid |
$12.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.15
|
| Rate for Payer: Meridian Medicaid |
$12.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.78
|
| Rate for Payer: Nomi Health Commercial |
$56.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.86
|
| Rate for Payer: PACE Senior Care Partners |
$16.42
|
| Rate for Payer: PACE SWMI |
$17.29
|
| Rate for Payer: PHP Commercial |
$58.78
|
| Rate for Payer: PHP Medicare Advantage |
$17.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$60.16
|
| Rate for Payer: Priority Health Medicare |
$17.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.13
|
| Rate for Payer: Railroad Medicare Medicare |
$17.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.85
|
| Rate for Payer: UHC Core |
$57.74
|
| Rate for Payer: UHC Exchange |
$17.29
|
| Rate for Payer: UHC Medicaid |
$12.19
|
| Rate for Payer: UHC Medicare Advantage |
$17.29
|
| Rate for Payer: UHCCP Medicaid |
$12.19
|
| Rate for Payer: VA VA |
$17.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.86
|
|
|
HC CYSTIC FIBROSIS CARRIER DETECT
|
Facility
|
IP
|
$1,909.44
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
31000098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,328.97 |
| Max. Negotiated Rate |
$1,718.50 |
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,577.01
|
| Rate for Payer: BCN Commercial |
$1,577.01
|
| Rate for Payer: Cash Price |
$1,527.55
|
| Rate for Payer: Cofinity Commercial |
$1,642.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,527.55
|
| Rate for Payer: Healthscope Commercial |
$1,718.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,432.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,623.02
|
| Rate for Payer: Nomi Health Commercial |
$1,565.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,432.08
|
| Rate for Payer: PHP Commercial |
$1,623.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,661.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,328.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.31
|
| Rate for Payer: UHC Core |
$1,594.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,432.08
|
|
|
HC CYSTIC FIBROSIS CARRIER DETECT
|
Facility
|
OP
|
$1,909.44
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
31000098
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$336.63 |
| Max. Negotiated Rate |
$1,718.50 |
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: Aetna Medicare |
$496.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.70
|
| Rate for Payer: BCBS Complete |
$353.44
|
| Rate for Payer: BCBS MAPPO |
$477.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,569.75
|
| Rate for Payer: BCN Commercial |
$1,569.75
|
| Rate for Payer: BCN Medicare Advantage |
$477.36
|
| Rate for Payer: Cash Price |
$1,527.55
|
| Rate for Payer: Cofinity Commercial |
$1,642.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,527.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.36
|
| Rate for Payer: Healthscope Commercial |
$1,718.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,432.08
|
| Rate for Payer: Mclaren Medicaid |
$336.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.23
|
| Rate for Payer: Meridian Medicaid |
$353.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$525.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,623.02
|
| Rate for Payer: Nomi Health Commercial |
$1,565.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,432.08
|
| Rate for Payer: PACE Senior Care Partners |
$453.49
|
| Rate for Payer: PACE SWMI |
$477.36
|
| Rate for Payer: PHP Commercial |
$1,623.02
|
| Rate for Payer: PHP Medicare Advantage |
$477.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,661.21
|
| Rate for Payer: Priority Health Medicare |
$482.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,328.97
|
| Rate for Payer: Railroad Medicare Medicare |
$477.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.31
|
| Rate for Payer: UHC Core |
$1,594.38
|
| Rate for Payer: UHC Exchange |
$477.36
|
| Rate for Payer: UHC Medicaid |
$336.63
|
| Rate for Payer: UHC Medicare Advantage |
$477.36
|
| Rate for Payer: UHCCP Medicaid |
$336.63
|
| Rate for Payer: VA VA |
$477.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,432.08
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: BCBS Trust/PPO |
$77.34
|
| Rate for Payer: BCN Commercial |
$77.34
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC CYSTINE 24HR URINE
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 82136
|
| Hospital Charge Code |
30100090
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$24.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.26
|
| Rate for Payer: BCBS Complete |
$17.33
|
| Rate for Payer: BCBS MAPPO |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$76.98
|
| Rate for Payer: BCN Commercial |
$76.98
|
| Rate for Payer: BCN Medicare Advantage |
$23.41
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$16.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.58
|
| Rate for Payer: Meridian Medicaid |
$17.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PACE Senior Care Partners |
$22.24
|
| Rate for Payer: PACE SWMI |
$23.41
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Medicare Advantage |
$23.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.17
|
| Rate for Payer: Railroad Medicare Medicare |
$23.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: UHC Exchange |
$23.41
|
| Rate for Payer: UHC Medicaid |
$16.51
|
| Rate for Payer: UHC Medicare Advantage |
$23.41
|
| Rate for Payer: UHCCP Medicaid |
$16.51
|
| Rate for Payer: VA VA |
$23.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna Commercial |
$0.25
|
| Rate for Payer: Aetna Medicare |
$0.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.09
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS MAPPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.24
|
| Rate for Payer: BCN Commercial |
$0.24
|
| Rate for Payer: BCN Medicare Advantage |
$0.07
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cofinity Commercial |
$0.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.07
|
| Rate for Payer: Healthscope Commercial |
$0.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.22
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.08
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.25
|
| Rate for Payer: Nomi Health Commercial |
$0.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.22
|
| Rate for Payer: PACE Senior Care Partners |
$0.07
|
| Rate for Payer: PACE SWMI |
$0.07
|
| Rate for Payer: PHP Commercial |
$0.25
|
| Rate for Payer: PHP Medicare Advantage |
$0.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.25
|
| Rate for Payer: Priority Health Medicare |
$0.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.20
|
| Rate for Payer: Railroad Medicare Medicare |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.26
|
| Rate for Payer: UHC Core |
$0.24
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Medicaid |
$0.05
|
| Rate for Payer: UHC Medicare Advantage |
$0.07
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: VA VA |
$0.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.22
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
IP
|
$0.29
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Aetna Commercial |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.24
|
| Rate for Payer: BCN Commercial |
$0.24
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cofinity Commercial |
$0.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.23
|
| Rate for Payer: Healthscope Commercial |
$0.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.25
|
| Rate for Payer: Nomi Health Commercial |
$0.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.22
|
| Rate for Payer: PHP Commercial |
$0.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.26
|
| Rate for Payer: UHC Core |
$0.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.22
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
IP
|
$6,399.95
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,454.37 |
| Max. Negotiated Rate |
$5,759.95 |
| Rate for Payer: Aetna Commercial |
$5,439.96
|
| Rate for Payer: BCBS Trust/PPO |
$5,285.72
|
| Rate for Payer: BCN Commercial |
$5,285.72
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cofinity Commercial |
$5,503.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,119.96
|
| Rate for Payer: Healthscope Commercial |
$5,759.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,799.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,439.96
|
| Rate for Payer: Nomi Health Commercial |
$5,247.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,799.96
|
| Rate for Payer: PHP Commercial |
$5,439.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,567.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,454.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,631.96
|
| Rate for Payer: UHC Core |
$5,343.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,799.96
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
OP
|
$6,399.95
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,128.31 |
| Max. Negotiated Rate |
$5,759.95 |
| Rate for Payer: Aetna Commercial |
$5,439.96
|
| Rate for Payer: Aetna Medicare |
$1,663.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,999.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,999.98
|
| Rate for Payer: BCBS Complete |
$1,184.63
|
| Rate for Payer: BCBS MAPPO |
$1,599.99
|
| Rate for Payer: BCBS Trust/PPO |
$5,261.40
|
| Rate for Payer: BCN Commercial |
$5,261.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,599.99
|
| Rate for Payer: Cash Price |
$5,119.96
|
| Rate for Payer: Cofinity Commercial |
$5,503.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,119.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,599.99
|
| Rate for Payer: Healthscope Commercial |
$5,759.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,799.96
|
| Rate for Payer: Mclaren Medicaid |
$1,128.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,679.99
|
| Rate for Payer: Meridian Medicaid |
$1,184.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,839.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,759.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,439.96
|
| Rate for Payer: Nomi Health Commercial |
$5,247.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,799.96
|
| Rate for Payer: PACE Senior Care Partners |
$1,519.99
|
| Rate for Payer: PACE SWMI |
$1,599.99
|
| Rate for Payer: PHP Commercial |
$5,439.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,599.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,128.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,567.96
|
| Rate for Payer: Priority Health Medicare |
$1,615.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,454.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,599.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,631.96
|
| Rate for Payer: UHC Core |
$5,343.96
|
| Rate for Payer: UHC Exchange |
$1,599.99
|
| Rate for Payer: UHC Medicaid |
$1,128.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,599.99
|
| Rate for Payer: UHCCP Medicaid |
$1,128.31
|
| Rate for Payer: VA VA |
$1,599.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,799.96
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
OP
|
$12,842.64
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,264.16 |
| Max. Negotiated Rate |
$11,558.38 |
| Rate for Payer: Aetna Commercial |
$10,916.24
|
| Rate for Payer: Aetna Medicare |
$3,339.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,013.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,013.32
|
| Rate for Payer: BCBS Complete |
$2,377.17
|
| Rate for Payer: BCBS MAPPO |
$3,210.66
|
| Rate for Payer: BCBS Trust/PPO |
$10,557.93
|
| Rate for Payer: BCN Commercial |
$10,557.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,210.66
|
| Rate for Payer: Cash Price |
$10,274.11
|
| Rate for Payer: Cofinity Commercial |
$11,044.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,274.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,210.66
|
| Rate for Payer: Healthscope Commercial |
$11,558.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,631.98
|
| Rate for Payer: Mclaren Medicaid |
$2,264.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,371.19
|
| Rate for Payer: Meridian Medicaid |
$2,377.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,692.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,531.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,916.24
|
| Rate for Payer: Nomi Health Commercial |
$10,530.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,631.98
|
| Rate for Payer: PACE Senior Care Partners |
$3,050.13
|
| Rate for Payer: PACE SWMI |
$3,210.66
|
| Rate for Payer: PHP Commercial |
$10,916.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,210.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,264.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11,173.10
|
| Rate for Payer: Priority Health Medicare |
$3,242.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,938.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,210.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,301.52
|
| Rate for Payer: UHC Core |
$10,723.60
|
| Rate for Payer: UHC Exchange |
$3,210.66
|
| Rate for Payer: UHC Medicaid |
$2,264.16
|
| Rate for Payer: UHC Medicare Advantage |
$3,210.66
|
| Rate for Payer: UHCCP Medicaid |
$2,264.16
|
| Rate for Payer: VA VA |
$3,210.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,631.98
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
IP
|
$12,842.64
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,938.48 |
| Max. Negotiated Rate |
$11,558.38 |
| Rate for Payer: Aetna Commercial |
$10,916.24
|
| Rate for Payer: BCBS Trust/PPO |
$10,606.74
|
| Rate for Payer: BCN Commercial |
$10,606.74
|
| Rate for Payer: Cash Price |
$10,274.11
|
| Rate for Payer: Cofinity Commercial |
$11,044.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,274.11
|
| Rate for Payer: Healthscope Commercial |
$11,558.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,631.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,916.24
|
| Rate for Payer: Nomi Health Commercial |
$10,530.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,631.98
|
| Rate for Payer: PHP Commercial |
$10,916.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11,173.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,938.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,301.52
|
| Rate for Payer: UHC Core |
$10,723.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,631.98
|
|
|
HC CYSTOMETROGRAM W/VP & UP
|
Facility
|
OP
|
$1,808.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Aetna Commercial |
$1,536.80
|
| Rate for Payer: Aetna Medicare |
$470.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$565.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$565.00
|
| Rate for Payer: BCBS Complete |
$334.66
|
| Rate for Payer: BCBS MAPPO |
$452.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,486.36
|
| Rate for Payer: BCN Commercial |
$1,486.36
|
| Rate for Payer: BCN Medicare Advantage |
$452.00
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cofinity Commercial |
$1,554.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.00
|
| Rate for Payer: Healthscope Commercial |
$1,627.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,356.00
|
| Rate for Payer: Mclaren Medicaid |
$318.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.60
|
| Rate for Payer: Meridian Medicaid |
$334.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$519.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$497.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,536.80
|
| Rate for Payer: Nomi Health Commercial |
$1,482.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,356.00
|
| Rate for Payer: PACE Senior Care Partners |
$429.40
|
| Rate for Payer: PACE SWMI |
$452.00
|
| Rate for Payer: PHP Commercial |
$1,536.80
|
| Rate for Payer: PHP Medicare Advantage |
$452.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,572.96
|
| Rate for Payer: Priority Health Medicare |
$456.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,258.37
|
| Rate for Payer: Railroad Medicare Medicare |
$452.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,591.04
|
| Rate for Payer: UHC Core |
$1,509.68
|
| Rate for Payer: UHC Exchange |
$452.00
|
| Rate for Payer: UHC Medicaid |
$318.75
|
| Rate for Payer: UHC Medicare Advantage |
$452.00
|
| Rate for Payer: UHCCP Medicaid |
$318.75
|
| Rate for Payer: VA VA |
$452.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,356.00
|
|
|
HC CYSTOMETROGRAM W/VP & UP
|
Facility
|
IP
|
$1,808.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,258.37 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Aetna Commercial |
$1,536.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,493.23
|
| Rate for Payer: BCN Commercial |
$1,493.23
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cofinity Commercial |
$1,554.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.40
|
| Rate for Payer: Healthscope Commercial |
$1,627.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,356.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,536.80
|
| Rate for Payer: Nomi Health Commercial |
$1,482.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,356.00
|
| Rate for Payer: PHP Commercial |
$1,536.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,572.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,258.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,591.04
|
| Rate for Payer: UHC Core |
$1,509.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,356.00
|
|
|
HC CYSTOSCOPY DIL URETHRAL STRICTURE
|
Facility
|
IP
|
$2,769.36
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
76100194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,927.47 |
| Max. Negotiated Rate |
$2,492.42 |
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,287.21
|
| Rate for Payer: BCN Commercial |
$2,287.21
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,077.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$2,270.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,409.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,927.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,437.04
|
| Rate for Payer: UHC Core |
$2,312.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,077.02
|
|
|
HC CYSTOSCOPY DIL URETHRAL STRICTURE
|
Facility
|
OP
|
$2,769.36
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
76100194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$488.24 |
| Max. Negotiated Rate |
$2,492.42 |
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna Medicare |
$720.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$865.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$865.42
|
| Rate for Payer: BCBS Complete |
$512.61
|
| Rate for Payer: BCBS MAPPO |
$692.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,276.69
|
| Rate for Payer: BCN Commercial |
$2,276.69
|
| Rate for Payer: BCN Medicare Advantage |
$692.34
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$692.34
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,077.02
|
| Rate for Payer: Mclaren Medicaid |
$488.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$726.96
|
| Rate for Payer: Meridian Medicaid |
$512.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$796.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$761.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$2,270.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PACE Senior Care Partners |
$657.72
|
| Rate for Payer: PACE SWMI |
$692.34
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: PHP Medicare Advantage |
$692.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,409.34
|
| Rate for Payer: Priority Health Medicare |
$699.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,927.47
|
| Rate for Payer: Railroad Medicare Medicare |
$692.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,437.04
|
| Rate for Payer: UHC Core |
$2,312.42
|
| Rate for Payer: UHC Exchange |
$692.34
|
| Rate for Payer: UHC Medicaid |
$488.24
|
| Rate for Payer: UHC Medicare Advantage |
$692.34
|
| Rate for Payer: UHCCP Medicaid |
$488.24
|
| Rate for Payer: VA VA |
$692.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,077.02
|
|
|
HC CYSTOSCOPY REMV CALCULUS, COMPLICATED
|
Facility
|
IP
|
$2,819.98
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,962.71 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,329.02
|
| Rate for Payer: BCN Commercial |
$2,329.02
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,114.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,453.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,962.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,481.58
|
| Rate for Payer: UHC Core |
$2,354.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,114.99
|
|
|
HC CYSTOSCOPY REMV CALCULUS, COMPLICATED
|
Facility
|
OP
|
$2,819.98
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.16 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna Medicare |
$733.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.24
|
| Rate for Payer: BCBS Complete |
$521.98
|
| Rate for Payer: BCBS MAPPO |
$705.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,318.31
|
| Rate for Payer: BCN Commercial |
$2,318.31
|
| Rate for Payer: BCN Medicare Advantage |
$705.00
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.00
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,114.99
|
| Rate for Payer: Mclaren Medicaid |
$497.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.24
|
| Rate for Payer: Meridian Medicaid |
$521.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$810.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$775.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PACE Senior Care Partners |
$669.75
|
| Rate for Payer: PACE SWMI |
$705.00
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: PHP Medicare Advantage |
$705.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$497.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,453.38
|
| Rate for Payer: Priority Health Medicare |
$712.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,962.71
|
| Rate for Payer: Railroad Medicare Medicare |
$705.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,481.58
|
| Rate for Payer: UHC Core |
$2,354.68
|
| Rate for Payer: UHC Exchange |
$705.00
|
| Rate for Payer: UHC Medicaid |
$497.16
|
| Rate for Payer: UHC Medicare Advantage |
$705.00
|
| Rate for Payer: UHCCP Medicaid |
$497.16
|
| Rate for Payer: VA VA |
$705.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,114.99
|
|
|
HC CYSTOSCOPY REMV CALCULUS SIMPLE
|
Facility
|
IP
|
$2,769.36
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
76100195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,927.47 |
| Max. Negotiated Rate |
$2,492.42 |
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,287.21
|
| Rate for Payer: BCN Commercial |
$2,287.21
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,077.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$2,270.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,409.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,927.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,437.04
|
| Rate for Payer: UHC Core |
$2,312.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,077.02
|
|
|
HC CYSTOSCOPY REMV CALCULUS SIMPLE
|
Facility
|
OP
|
$2,769.36
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
76100195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$488.24 |
| Max. Negotiated Rate |
$2,492.42 |
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna Medicare |
$720.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$865.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$865.42
|
| Rate for Payer: BCBS Complete |
$512.61
|
| Rate for Payer: BCBS MAPPO |
$692.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,276.69
|
| Rate for Payer: BCN Commercial |
$2,276.69
|
| Rate for Payer: BCN Medicare Advantage |
$692.34
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$692.34
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,077.02
|
| Rate for Payer: Mclaren Medicaid |
$488.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$726.96
|
| Rate for Payer: Meridian Medicaid |
$512.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$796.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$761.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$2,270.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PACE Senior Care Partners |
$657.72
|
| Rate for Payer: PACE SWMI |
$692.34
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: PHP Medicare Advantage |
$692.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,409.34
|
| Rate for Payer: Priority Health Medicare |
$699.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,927.47
|
| Rate for Payer: Railroad Medicare Medicare |
$692.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,437.04
|
| Rate for Payer: UHC Core |
$2,312.42
|
| Rate for Payer: UHC Exchange |
$692.34
|
| Rate for Payer: UHC Medicaid |
$488.24
|
| Rate for Payer: UHC Medicare Advantage |
$692.34
|
| Rate for Payer: UHCCP Medicaid |
$488.24
|
| Rate for Payer: VA VA |
$692.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,077.02
|
|
|
HC CYSTO TX FEMALE URETHRAL SYNDROME
|
Facility
|
IP
|
$885.90
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.59 |
| Max. Negotiated Rate |
$797.31 |
| Rate for Payer: Aetna Commercial |
$753.01
|
| Rate for Payer: BCBS Trust/PPO |
$731.66
|
| Rate for Payer: BCN Commercial |
$731.66
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cofinity Commercial |
$761.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.72
|
| Rate for Payer: Healthscope Commercial |
$797.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$664.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.01
|
| Rate for Payer: Nomi Health Commercial |
$726.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$664.42
|
| Rate for Payer: PHP Commercial |
$753.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$770.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$616.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$779.59
|
| Rate for Payer: UHC Core |
$739.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$664.42
|
|
