|
HC HYDROCORTIZONE CREAM
|
Facility
|
IP
|
$9.73
|
|
| Hospital Charge Code |
27000116
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$8.76 |
| Rate for Payer: Aetna Commercial |
$8.27
|
| Rate for Payer: BCBS Trust/PPO |
$7.52
|
| Rate for Payer: BCN Commercial |
$7.52
|
| Rate for Payer: Cash Price |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$8.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$8.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.27
|
| Rate for Payer: PHP Commercial |
$8.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.56
|
| Rate for Payer: UHC Core |
$8.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.30
|
|
|
HC HYDROXYPREGNENOLONE 17
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
30100399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna Commercial |
$73.95
|
| Rate for Payer: BCBS Trust/PPO |
$67.23
|
| Rate for Payer: BCN Commercial |
$67.23
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.60
|
| Rate for Payer: Healthscope Commercial |
$78.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.95
|
| Rate for Payer: PHP Commercial |
$73.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.56
|
| Rate for Payer: UHC Core |
$72.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.25
|
|
|
HC HYDROXYPREGNENOLONE 17
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
30100399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna Commercial |
$73.95
|
| Rate for Payer: Aetna Medicare |
$22.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.19
|
| Rate for Payer: BCBS Complete |
$17.68
|
| Rate for Payer: BCBS MAPPO |
$21.75
|
| Rate for Payer: BCBS Trust/PPO |
$67.64
|
| Rate for Payer: BCN Commercial |
$67.64
|
| Rate for Payer: BCN Medicare Advantage |
$21.75
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.75
|
| Rate for Payer: Healthscope Commercial |
$78.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.25
|
| Rate for Payer: Mclaren Medicaid |
$16.83
|
| Rate for Payer: Meridian Medicaid |
$17.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.95
|
| Rate for Payer: PACE Senior Care Partners |
$20.66
|
| Rate for Payer: PACE SWMI |
$21.75
|
| Rate for Payer: PHP Commercial |
$73.95
|
| Rate for Payer: PHP Medicare Advantage |
$21.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.69
|
| Rate for Payer: Priority Health Medicare |
$21.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.06
|
| Rate for Payer: Railroad Medicare Medicare |
$21.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.56
|
| Rate for Payer: UHC Core |
$72.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.75
|
| Rate for Payer: UHC Medicare Advantage |
$22.40
|
| Rate for Payer: VA VA |
$21.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.25
|
|
|
HC HYDROXYPROGESTERONE 17
|
Facility
|
OP
|
$45.10
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
30100249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Aetna Commercial |
$38.34
|
| Rate for Payer: Aetna Medicare |
$11.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.09
|
| Rate for Payer: BCBS Complete |
$21.05
|
| Rate for Payer: BCBS MAPPO |
$11.28
|
| Rate for Payer: BCBS Trust/PPO |
$35.07
|
| Rate for Payer: BCN Commercial |
$35.07
|
| Rate for Payer: BCN Medicare Advantage |
$11.28
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cofinity Commercial |
$38.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.28
|
| Rate for Payer: Healthscope Commercial |
$40.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.82
|
| Rate for Payer: Mclaren Medicaid |
$20.05
|
| Rate for Payer: Meridian Medicaid |
$21.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.34
|
| Rate for Payer: PACE Senior Care Partners |
$10.71
|
| Rate for Payer: PACE SWMI |
$11.28
|
| Rate for Payer: PHP Commercial |
$38.34
|
| Rate for Payer: PHP Medicare Advantage |
$11.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.24
|
| Rate for Payer: Priority Health Medicare |
$11.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.51
|
| Rate for Payer: Railroad Medicare Medicare |
$11.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.69
|
| Rate for Payer: UHC Core |
$37.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.28
|
| Rate for Payer: UHC Medicare Advantage |
$11.61
|
| Rate for Payer: VA VA |
$11.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.82
|
|
|
HC HYDROXYPROGESTERONE 17
|
Facility
|
IP
|
$45.10
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
30100249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$40.59 |
| Rate for Payer: Aetna Commercial |
$38.34
|
| Rate for Payer: BCBS Trust/PPO |
$34.85
|
| Rate for Payer: BCN Commercial |
$34.85
|
| Rate for Payer: Cash Price |
$36.08
|
| Rate for Payer: Cofinity Commercial |
$38.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.08
|
| Rate for Payer: Healthscope Commercial |
$40.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.34
|
| Rate for Payer: PHP Commercial |
$38.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.69
|
| Rate for Payer: UHC Core |
$37.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.82
|
|
|
HC HYPERSENSITIVITY PNEUMO-CMPTS
|
Facility
|
IP
|
$27.54
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200270
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$21.28
|
| Rate for Payer: BCN Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.03
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.41
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.24
|
| Rate for Payer: UHC Core |
$23.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.66
|
|
|
HC HYPERSENSITIVITY PNEUMO-CMPTS
|
Facility
|
OP
|
$27.54
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200270
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Medicare |
$7.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.61
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$6.88
|
| Rate for Payer: BCBS Trust/PPO |
$21.41
|
| Rate for Payer: BCN Commercial |
$21.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.88
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.88
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.66
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| Rate for Payer: Meridian Medicaid |
$9.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.41
|
| Rate for Payer: PACE Senior Care Partners |
$6.54
|
| Rate for Payer: PACE SWMI |
$6.88
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: PHP Medicare Advantage |
$6.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.96
|
| Rate for Payer: Priority Health Medicare |
$6.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.80
|
| Rate for Payer: Railroad Medicare Medicare |
$6.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.24
|
| Rate for Payer: UHC Core |
$23.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.88
|
| Rate for Payer: UHC Medicare Advantage |
$7.09
|
| Rate for Payer: VA VA |
$6.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.66
|
|
|
HC HYPERSENSITIVITY PNEUMONITIS P
|
Facility
|
IP
|
$28.56
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
30200223
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: BCBS Trust/PPO |
$22.07
|
| Rate for Payer: BCN Commercial |
$22.07
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.13
|
| Rate for Payer: UHC Core |
$23.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.42
|
|
|
HC HYPERSENSITIVITY PNEUMONITIS P
|
Facility
|
OP
|
$28.56
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
30200223
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Medicare |
$7.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.92
|
| Rate for Payer: BCBS Complete |
$11.66
|
| Rate for Payer: BCBS MAPPO |
$7.14
|
| Rate for Payer: BCBS Trust/PPO |
$22.21
|
| Rate for Payer: BCN Commercial |
$22.21
|
| Rate for Payer: BCN Medicare Advantage |
$7.14
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.14
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.42
|
| Rate for Payer: Mclaren Medicaid |
$11.11
|
| Rate for Payer: Meridian Medicaid |
$11.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PACE Senior Care Partners |
$6.78
|
| Rate for Payer: PACE SWMI |
$7.14
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Medicare Advantage |
$7.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.85
|
| Rate for Payer: Priority Health Medicare |
$7.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.42
|
| Rate for Payer: Railroad Medicare Medicare |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.13
|
| Rate for Payer: UHC Core |
$23.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.14
|
| Rate for Payer: UHC Medicare Advantage |
$7.35
|
| Rate for Payer: VA VA |
$7.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.42
|
|
|
HC HYPERSENSITIVITY PNEUMO PANEL
|
Facility
|
OP
|
$22.30
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna Medicare |
$5.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.97
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: BCBS MAPPO |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$17.34
|
| Rate for Payer: BCN Commercial |
$17.34
|
| Rate for Payer: BCN Medicare Advantage |
$5.58
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.58
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.72
|
| Rate for Payer: Mclaren Medicaid |
$5.77
|
| Rate for Payer: Meridian Medicaid |
$6.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.96
|
| Rate for Payer: PACE Senior Care Partners |
$5.30
|
| Rate for Payer: PACE SWMI |
$5.58
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: PHP Medicare Advantage |
$5.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.40
|
| Rate for Payer: Priority Health Medicare |
$5.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.60
|
| Rate for Payer: Railroad Medicare Medicare |
$5.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.62
|
| Rate for Payer: UHC Core |
$18.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.58
|
| Rate for Payer: UHC Medicare Advantage |
$5.74
|
| Rate for Payer: VA VA |
$5.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.72
|
|
|
HC HYPERSENSITIVITY PNEUMO PANEL
|
Facility
|
IP
|
$22.30
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: BCBS Trust/PPO |
$17.23
|
| Rate for Payer: BCN Commercial |
$17.23
|
| Rate for Payer: Cash Price |
$17.84
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.84
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.96
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.62
|
| Rate for Payer: UHC Core |
$18.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.72
|
|
|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$4,013.52
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$953.21 |
| Max. Negotiated Rate |
$3,612.17 |
| Rate for Payer: Aetna Commercial |
$3,411.49
|
| Rate for Payer: Aetna Medicare |
$1,043.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,254.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,254.22
|
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: BCBS MAPPO |
$1,003.38
|
| Rate for Payer: BCBS Trust/PPO |
$3,120.51
|
| Rate for Payer: BCN Commercial |
$3,120.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,003.38
|
| Rate for Payer: Cash Price |
$3,210.82
|
| Rate for Payer: Cash Price |
$3,210.82
|
| Rate for Payer: Cofinity Commercial |
$3,451.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,210.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,003.38
|
| Rate for Payer: Healthscope Commercial |
$3,612.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,010.14
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,053.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,153.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,411.49
|
| Rate for Payer: PACE Senior Care Partners |
$953.21
|
| Rate for Payer: PACE SWMI |
$1,003.38
|
| Rate for Payer: PHP Commercial |
$3,411.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,003.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,809.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,491.76
|
| Rate for Payer: Priority Health Medicare |
$1,003.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,447.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,003.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,531.90
|
| Rate for Payer: UHC Core |
$3,351.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,003.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,033.48
|
| Rate for Payer: VA VA |
$1,003.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,010.14
|
|
|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$4,013.52
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,447.85 |
| Max. Negotiated Rate |
$3,612.17 |
| Rate for Payer: Aetna Commercial |
$3,411.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,101.65
|
| Rate for Payer: BCN Commercial |
$3,101.65
|
| Rate for Payer: Cash Price |
$3,210.82
|
| Rate for Payer: Cofinity Commercial |
$3,451.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,210.82
|
| Rate for Payer: Healthscope Commercial |
$3,612.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,010.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,411.49
|
| Rate for Payer: PHP Commercial |
$3,411.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,809.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,491.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,447.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,531.90
|
| Rate for Payer: UHC Core |
$3,351.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,010.14
|
|
|
HC HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
IP
|
$13,091.70
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,984.63 |
| Max. Negotiated Rate |
$11,782.53 |
| Rate for Payer: Aetna Commercial |
$11,127.94
|
| Rate for Payer: BCBS Trust/PPO |
$10,117.27
|
| Rate for Payer: BCN Commercial |
$10,117.27
|
| 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: Healthscope Commercial |
$11,782.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,818.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,127.94
|
| Rate for Payer: PHP Commercial |
$11,127.94
|
| 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 Narrow/Tiered Network |
$7,984.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,520.70
|
| Rate for Payer: UHC Core |
$10,931.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,818.78
|
|
|
HC HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
OP
|
$13,091.70
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
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
|
|
|
HC HYSTEROSCOPY REMOVE FB
|
Facility
|
OP
|
$7,789.74
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,850.06 |
| Max. Negotiated Rate |
$7,010.77 |
| Rate for Payer: Aetna Commercial |
$6,621.28
|
| Rate for Payer: Aetna Medicare |
$2,025.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,434.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,434.29
|
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: BCBS MAPPO |
$1,947.44
|
| Rate for Payer: BCBS Trust/PPO |
$6,056.52
|
| Rate for Payer: BCN Commercial |
$6,056.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,947.44
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$6,699.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,231.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,947.44
|
| Rate for Payer: Healthscope Commercial |
$7,010.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,842.30
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,044.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,239.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PACE Senior Care Partners |
$1,850.06
|
| Rate for Payer: PACE SWMI |
$1,947.44
|
| Rate for Payer: PHP Commercial |
$6,621.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,947.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,777.07
|
| Rate for Payer: Priority Health Medicare |
$1,947.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,750.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1,947.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,854.97
|
| Rate for Payer: UHC Core |
$6,504.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,947.44
|
| Rate for Payer: UHC Medicare Advantage |
$2,005.86
|
| Rate for Payer: VA VA |
$1,947.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,842.30
|
|
|
HC HYSTEROSCOPY REMOVE FB
|
Facility
|
IP
|
$7,789.74
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,750.96 |
| Max. Negotiated Rate |
$7,010.77 |
| Rate for Payer: Aetna Commercial |
$6,621.28
|
| Rate for Payer: BCBS Trust/PPO |
$6,019.91
|
| Rate for Payer: BCN Commercial |
$6,019.91
|
| Rate for Payer: Cash Price |
$6,231.79
|
| Rate for Payer: Cofinity Commercial |
$6,699.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,231.79
|
| Rate for Payer: Healthscope Commercial |
$7,010.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,842.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,621.28
|
| Rate for Payer: PHP Commercial |
$6,621.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,452.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,777.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,750.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,854.97
|
| Rate for Payer: UHC Core |
$6,504.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,842.30
|
|
|
HC HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
IP
|
$13,091.70
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
76100338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,984.63 |
| Max. Negotiated Rate |
$11,782.53 |
| Rate for Payer: Aetna Commercial |
$11,127.94
|
| Rate for Payer: BCBS Trust/PPO |
$10,117.27
|
| Rate for Payer: BCN Commercial |
$10,117.27
|
| 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: Healthscope Commercial |
$11,782.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,818.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,127.94
|
| Rate for Payer: PHP Commercial |
$11,127.94
|
| 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 Narrow/Tiered Network |
$7,984.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,520.70
|
| Rate for Payer: UHC Core |
$10,931.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,818.78
|
|
|
HC HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
OP
|
$13,091.70
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
76100338
|
|
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
|
|
|
HC HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
OP
|
$13,091.70
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
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
|
|
|
HC HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
IP
|
$13,091.70
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,984.63 |
| Max. Negotiated Rate |
$11,782.53 |
| Rate for Payer: Aetna Commercial |
$11,127.94
|
| Rate for Payer: BCBS Trust/PPO |
$10,117.27
|
| Rate for Payer: BCN Commercial |
$10,117.27
|
| 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: Healthscope Commercial |
$11,782.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,818.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,127.94
|
| Rate for Payer: PHP Commercial |
$11,127.94
|
| 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 Narrow/Tiered Network |
$7,984.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,520.70
|
| Rate for Payer: UHC Core |
$10,931.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,818.78
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
IP
|
$4,013.52
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,447.85 |
| Max. Negotiated Rate |
$3,612.17 |
| Rate for Payer: Aetna Commercial |
$3,411.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,101.65
|
| Rate for Payer: BCN Commercial |
$3,101.65
|
| Rate for Payer: Cash Price |
$3,210.82
|
| Rate for Payer: Cofinity Commercial |
$3,451.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,210.82
|
| Rate for Payer: Healthscope Commercial |
$3,612.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,010.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,411.49
|
| Rate for Payer: PHP Commercial |
$3,411.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,809.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,491.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,447.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,531.90
|
| Rate for Payer: UHC Core |
$3,351.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,010.14
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
OP
|
$4,013.52
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$953.21 |
| Max. Negotiated Rate |
$3,612.17 |
| Rate for Payer: Aetna Commercial |
$3,411.49
|
| Rate for Payer: Aetna Medicare |
$1,043.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,254.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,254.22
|
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: BCBS MAPPO |
$1,003.38
|
| Rate for Payer: BCBS Trust/PPO |
$3,120.51
|
| Rate for Payer: BCN Commercial |
$3,120.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,003.38
|
| Rate for Payer: Cash Price |
$3,210.82
|
| Rate for Payer: Cash Price |
$3,210.82
|
| Rate for Payer: Cofinity Commercial |
$3,451.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,210.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,003.38
|
| Rate for Payer: Healthscope Commercial |
$3,612.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,010.14
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,053.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,153.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,411.49
|
| Rate for Payer: PACE Senior Care Partners |
$953.21
|
| Rate for Payer: PACE SWMI |
$1,003.38
|
| Rate for Payer: PHP Commercial |
$3,411.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,003.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,809.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,491.76
|
| Rate for Payer: Priority Health Medicare |
$1,003.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,447.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,003.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,531.90
|
| Rate for Payer: UHC Core |
$3,351.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,003.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,033.48
|
| Rate for Payer: VA VA |
$1,003.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,010.14
|
|
|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
OP
|
$103.60
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$24.60 |
| 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 |
$41.44
|
| 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: 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: 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 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 I-123 CAPSULE PER 100 UCI
|
Facility
|
IP
|
$103.60
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| 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
|
|
