|
HC DIFFUSION
|
Facility
|
OP
|
$404.49
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000009
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$71.31 |
| Max. Negotiated Rate |
$364.04 |
| Rate for Payer: Aetna Commercial |
$343.82
|
| Rate for Payer: Aetna Medicare |
$105.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.40
|
| Rate for Payer: BCBS Complete |
$74.87
|
| Rate for Payer: BCBS MAPPO |
$101.12
|
| Rate for Payer: BCBS Trust/PPO |
$332.53
|
| Rate for Payer: BCN Commercial |
$332.53
|
| Rate for Payer: BCN Medicare Advantage |
$101.12
|
| Rate for Payer: Cash Price |
$323.59
|
| Rate for Payer: Cofinity Commercial |
$347.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.12
|
| Rate for Payer: Healthscope Commercial |
$364.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.37
|
| Rate for Payer: Mclaren Medicaid |
$71.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.18
|
| Rate for Payer: Meridian Medicaid |
$74.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.82
|
| Rate for Payer: Nomi Health Commercial |
$331.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.37
|
| Rate for Payer: PACE Senior Care Partners |
$96.07
|
| Rate for Payer: PACE SWMI |
$101.12
|
| Rate for Payer: PHP Commercial |
$343.82
|
| Rate for Payer: PHP Medicare Advantage |
$101.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$351.91
|
| Rate for Payer: Priority Health Medicare |
$102.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.53
|
| Rate for Payer: Railroad Medicare Medicare |
$101.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.95
|
| Rate for Payer: UHC Core |
$337.75
|
| Rate for Payer: UHC Exchange |
$101.12
|
| Rate for Payer: UHC Medicaid |
$71.31
|
| Rate for Payer: UHC Medicare Advantage |
$101.12
|
| Rate for Payer: UHCCP Medicaid |
$71.31
|
| Rate for Payer: VA VA |
$101.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.37
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
IP
|
$172.71
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$155.44 |
| Rate for Payer: Aetna Commercial |
$146.80
|
| Rate for Payer: BCBS Trust/PPO |
$142.64
|
| Rate for Payer: BCN Commercial |
$142.64
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$148.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Healthscope Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.80
|
| Rate for Payer: Nomi Health Commercial |
$141.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.53
|
| Rate for Payer: PHP Commercial |
$146.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$150.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.98
|
| Rate for Payer: UHC Core |
$144.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.53
|
|
|
HC DI GEORGE SYNDROME
|
Facility
|
OP
|
$172.71
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
31000033
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$155.44 |
| Rate for Payer: Aetna Commercial |
$146.80
|
| Rate for Payer: Aetna Medicare |
$44.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.97
|
| Rate for Payer: BCBS Complete |
$31.97
|
| Rate for Payer: BCBS MAPPO |
$43.18
|
| Rate for Payer: BCBS Trust/PPO |
$141.98
|
| Rate for Payer: BCN Commercial |
$141.98
|
| Rate for Payer: BCN Medicare Advantage |
$43.18
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$148.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.18
|
| Rate for Payer: Healthscope Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.53
|
| Rate for Payer: Mclaren Medicaid |
$30.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.34
|
| Rate for Payer: Meridian Medicaid |
$31.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.80
|
| Rate for Payer: Nomi Health Commercial |
$141.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.53
|
| Rate for Payer: PACE Senior Care Partners |
$41.02
|
| Rate for Payer: PACE SWMI |
$43.18
|
| Rate for Payer: PHP Commercial |
$146.80
|
| Rate for Payer: PHP Medicare Advantage |
$43.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$150.26
|
| Rate for Payer: Priority Health Medicare |
$43.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.21
|
| Rate for Payer: Railroad Medicare Medicare |
$43.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.98
|
| Rate for Payer: UHC Core |
$144.21
|
| Rate for Payer: UHC Exchange |
$43.18
|
| Rate for Payer: UHC Medicaid |
$30.45
|
| Rate for Payer: UHC Medicare Advantage |
$43.18
|
| Rate for Payer: UHCCP Medicaid |
$30.45
|
| Rate for Payer: VA VA |
$43.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.53
|
|
|
HC DIGOXIN LVL
|
Facility
|
OP
|
$93.71
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$84.34 |
| Rate for Payer: Aetna Commercial |
$79.65
|
| Rate for Payer: Aetna Medicare |
$24.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.28
|
| Rate for Payer: BCBS Complete |
$17.35
|
| Rate for Payer: BCBS MAPPO |
$23.43
|
| Rate for Payer: BCBS Trust/PPO |
$77.04
|
| Rate for Payer: BCN Commercial |
$77.04
|
| Rate for Payer: BCN Medicare Advantage |
$23.43
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$80.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.43
|
| Rate for Payer: Healthscope Commercial |
$84.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.28
|
| Rate for Payer: Mclaren Medicaid |
$16.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.60
|
| Rate for Payer: Meridian Medicaid |
$17.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.65
|
| Rate for Payer: Nomi Health Commercial |
$76.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.28
|
| Rate for Payer: PACE Senior Care Partners |
$22.26
|
| Rate for Payer: PACE SWMI |
$23.43
|
| Rate for Payer: PHP Commercial |
$79.65
|
| Rate for Payer: PHP Medicare Advantage |
$23.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.53
|
| Rate for Payer: Priority Health Medicare |
$23.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.22
|
| Rate for Payer: Railroad Medicare Medicare |
$23.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.46
|
| Rate for Payer: UHC Core |
$78.25
|
| Rate for Payer: UHC Exchange |
$23.43
|
| Rate for Payer: UHC Medicaid |
$16.52
|
| Rate for Payer: UHC Medicare Advantage |
$23.43
|
| Rate for Payer: UHCCP Medicaid |
$16.52
|
| Rate for Payer: VA VA |
$23.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.28
|
|
|
HC DIGOXIN LVL
|
Facility
|
IP
|
$93.71
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
30100591
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.22 |
| Max. Negotiated Rate |
$84.34 |
| Rate for Payer: Aetna Commercial |
$79.65
|
| Rate for Payer: BCBS Trust/PPO |
$77.40
|
| Rate for Payer: BCN Commercial |
$77.40
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$80.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.97
|
| Rate for Payer: Healthscope Commercial |
$84.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.65
|
| Rate for Payer: Nomi Health Commercial |
$76.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.28
|
| Rate for Payer: PHP Commercial |
$79.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.46
|
| Rate for Payer: UHC Core |
$78.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.28
|
|
|
HC DILANTIN LEVEL
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: BCBS Trust/PPO |
$30.67
|
| Rate for Payer: BCN Commercial |
$30.67
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.68
|
| Rate for Payer: UHC Core |
$31.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC DILANTIN LEVEL
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.61
|
| Rate for Payer: BCBS Complete |
$6.87
|
| Rate for Payer: BCBS MAPPO |
$9.29
|
| Rate for Payer: BCBS Trust/PPO |
$30.53
|
| Rate for Payer: BCN Commercial |
$30.53
|
| Rate for Payer: BCN Medicare Advantage |
$9.29
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.75
|
| Rate for Payer: Meridian Medicaid |
$6.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.82
|
| Rate for Payer: PACE SWMI |
$9.29
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: PHP Medicare Advantage |
$9.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.31
|
| Rate for Payer: Priority Health Medicare |
$9.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.85
|
| Rate for Payer: Railroad Medicare Medicare |
$9.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.68
|
| Rate for Payer: UHC Core |
$31.01
|
| Rate for Payer: UHC Exchange |
$9.29
|
| Rate for Payer: UHC Medicaid |
$6.55
|
| Rate for Payer: UHC Medicare Advantage |
$9.29
|
| Rate for Payer: UHCCP Medicaid |
$6.55
|
| Rate for Payer: VA VA |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
OP
|
$107.78
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna Commercial |
$91.61
|
| Rate for Payer: Aetna Medicare |
$28.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.68
|
| Rate for Payer: BCBS Complete |
$19.95
|
| Rate for Payer: BCBS MAPPO |
$26.95
|
| Rate for Payer: BCBS Trust/PPO |
$88.61
|
| Rate for Payer: BCN Commercial |
$88.61
|
| Rate for Payer: BCN Medicare Advantage |
$26.95
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cofinity Commercial |
$92.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.95
|
| Rate for Payer: Healthscope Commercial |
$97.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.83
|
| Rate for Payer: Mclaren Medicaid |
$19.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.29
|
| Rate for Payer: Meridian Medicaid |
$19.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.61
|
| Rate for Payer: Nomi Health Commercial |
$88.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.83
|
| Rate for Payer: PACE Senior Care Partners |
$25.60
|
| Rate for Payer: PACE SWMI |
$26.95
|
| Rate for Payer: PHP Commercial |
$91.61
|
| Rate for Payer: PHP Medicare Advantage |
$26.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.77
|
| Rate for Payer: Priority Health Medicare |
$27.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.01
|
| Rate for Payer: Railroad Medicare Medicare |
$26.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.85
|
| Rate for Payer: UHC Core |
$90.00
|
| Rate for Payer: UHC Exchange |
$26.95
|
| Rate for Payer: UHC Medicaid |
$19.00
|
| Rate for Payer: UHC Medicare Advantage |
$26.95
|
| Rate for Payer: UHCCP Medicaid |
$19.00
|
| Rate for Payer: VA VA |
$26.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.83
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
IP
|
$107.78
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.01 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna Commercial |
$91.61
|
| Rate for Payer: BCBS Trust/PPO |
$89.02
|
| Rate for Payer: BCN Commercial |
$89.02
|
| Rate for Payer: Cash Price |
$86.22
|
| Rate for Payer: Cofinity Commercial |
$92.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.22
|
| Rate for Payer: Healthscope Commercial |
$97.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.61
|
| Rate for Payer: Nomi Health Commercial |
$88.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.83
|
| Rate for Payer: PHP Commercial |
$91.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.85
|
| Rate for Payer: UHC Core |
$90.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.83
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
OP
|
$173.51
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$156.16 |
| Rate for Payer: Aetna Commercial |
$147.48
|
| Rate for Payer: Aetna Medicare |
$45.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.22
|
| Rate for Payer: BCBS Complete |
$32.12
|
| Rate for Payer: BCBS MAPPO |
$43.38
|
| Rate for Payer: BCBS Trust/PPO |
$142.64
|
| Rate for Payer: BCN Commercial |
$142.64
|
| Rate for Payer: BCN Medicare Advantage |
$43.38
|
| Rate for Payer: Cash Price |
$138.81
|
| Rate for Payer: Cofinity Commercial |
$149.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.38
|
| Rate for Payer: Healthscope Commercial |
$156.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.13
|
| Rate for Payer: Mclaren Medicaid |
$30.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.55
|
| Rate for Payer: Meridian Medicaid |
$32.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.48
|
| Rate for Payer: Nomi Health Commercial |
$142.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.13
|
| Rate for Payer: PACE Senior Care Partners |
$41.21
|
| Rate for Payer: PACE SWMI |
$43.38
|
| Rate for Payer: PHP Commercial |
$147.48
|
| Rate for Payer: PHP Medicare Advantage |
$43.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$150.95
|
| Rate for Payer: Priority Health Medicare |
$43.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.76
|
| Rate for Payer: Railroad Medicare Medicare |
$43.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.69
|
| Rate for Payer: UHC Core |
$144.88
|
| Rate for Payer: UHC Exchange |
$43.38
|
| Rate for Payer: UHC Medicaid |
$30.59
|
| Rate for Payer: UHC Medicare Advantage |
$43.38
|
| Rate for Payer: UHCCP Medicaid |
$30.59
|
| Rate for Payer: VA VA |
$43.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.13
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
IP
|
$173.51
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.76 |
| Max. Negotiated Rate |
$156.16 |
| Rate for Payer: Aetna Commercial |
$147.48
|
| Rate for Payer: BCBS Trust/PPO |
$143.30
|
| Rate for Payer: BCN Commercial |
$143.30
|
| Rate for Payer: Cash Price |
$138.81
|
| Rate for Payer: Cofinity Commercial |
$149.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.81
|
| Rate for Payer: Healthscope Commercial |
$156.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.48
|
| Rate for Payer: Nomi Health Commercial |
$142.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.13
|
| Rate for Payer: PHP Commercial |
$147.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$150.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.69
|
| Rate for Payer: UHC Core |
$144.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.13
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
OP
|
$675.66
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.12 |
| Max. Negotiated Rate |
$608.09 |
| Rate for Payer: Aetna Commercial |
$574.31
|
| Rate for Payer: Aetna Medicare |
$175.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$211.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$211.14
|
| Rate for Payer: BCBS Complete |
$125.06
|
| Rate for Payer: BCBS MAPPO |
$168.91
|
| Rate for Payer: BCBS Trust/PPO |
$555.46
|
| Rate for Payer: BCN Commercial |
$555.46
|
| Rate for Payer: BCN Medicare Advantage |
$168.91
|
| Rate for Payer: Cash Price |
$540.53
|
| Rate for Payer: Cofinity Commercial |
$581.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.91
|
| Rate for Payer: Healthscope Commercial |
$608.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.75
|
| Rate for Payer: Mclaren Medicaid |
$119.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.36
|
| Rate for Payer: Meridian Medicaid |
$125.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$185.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.31
|
| Rate for Payer: Nomi Health Commercial |
$554.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$506.75
|
| Rate for Payer: PACE Senior Care Partners |
$160.47
|
| Rate for Payer: PACE SWMI |
$168.91
|
| Rate for Payer: PHP Commercial |
$574.31
|
| Rate for Payer: PHP Medicare Advantage |
$168.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$587.82
|
| Rate for Payer: Priority Health Medicare |
$170.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$470.26
|
| Rate for Payer: Railroad Medicare Medicare |
$168.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.58
|
| Rate for Payer: UHC Core |
$564.18
|
| Rate for Payer: UHC Exchange |
$168.91
|
| Rate for Payer: UHC Medicaid |
$119.12
|
| Rate for Payer: UHC Medicare Advantage |
$168.91
|
| Rate for Payer: UHCCP Medicaid |
$119.12
|
| Rate for Payer: VA VA |
$168.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.75
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
IP
|
$675.66
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.26 |
| Max. Negotiated Rate |
$608.09 |
| Rate for Payer: Aetna Commercial |
$574.31
|
| Rate for Payer: BCBS Trust/PPO |
$558.03
|
| Rate for Payer: BCN Commercial |
$558.03
|
| Rate for Payer: Cash Price |
$540.53
|
| Rate for Payer: Cofinity Commercial |
$581.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$540.53
|
| Rate for Payer: Healthscope Commercial |
$608.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.31
|
| Rate for Payer: Nomi Health Commercial |
$554.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$506.75
|
| Rate for Payer: PHP Commercial |
$574.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$587.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$470.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.58
|
| Rate for Payer: UHC Core |
$564.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.75
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
OP
|
$3,736.26
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$658.70 |
| Max. Negotiated Rate |
$3,362.63 |
| Rate for Payer: Aetna Commercial |
$3,175.82
|
| Rate for Payer: Aetna Medicare |
$971.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,167.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,167.58
|
| Rate for Payer: BCBS Complete |
$691.58
|
| Rate for Payer: BCBS MAPPO |
$934.07
|
| Rate for Payer: BCBS Trust/PPO |
$3,071.58
|
| Rate for Payer: BCN Commercial |
$3,071.58
|
| Rate for Payer: BCN Medicare Advantage |
$934.07
|
| Rate for Payer: Cash Price |
$2,989.01
|
| Rate for Payer: Cofinity Commercial |
$3,213.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,989.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$934.07
|
| Rate for Payer: Healthscope Commercial |
$3,362.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,802.20
|
| Rate for Payer: Mclaren Medicaid |
$658.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.77
|
| Rate for Payer: Meridian Medicaid |
$691.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,074.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,027.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,175.82
|
| Rate for Payer: Nomi Health Commercial |
$3,063.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,802.20
|
| Rate for Payer: PACE Senior Care Partners |
$887.36
|
| Rate for Payer: PACE SWMI |
$934.07
|
| Rate for Payer: PHP Commercial |
$3,175.82
|
| Rate for Payer: PHP Medicare Advantage |
$934.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$658.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,250.55
|
| Rate for Payer: Priority Health Medicare |
$943.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,600.44
|
| Rate for Payer: Railroad Medicare Medicare |
$934.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,287.91
|
| Rate for Payer: UHC Core |
$3,119.78
|
| Rate for Payer: UHC Exchange |
$934.07
|
| Rate for Payer: UHC Medicaid |
$658.70
|
| Rate for Payer: UHC Medicare Advantage |
$934.07
|
| Rate for Payer: UHCCP Medicaid |
$658.70
|
| Rate for Payer: VA VA |
$934.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,802.20
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
IP
|
$3,736.26
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,600.44 |
| Max. Negotiated Rate |
$3,362.63 |
| Rate for Payer: Aetna Commercial |
$3,175.82
|
| Rate for Payer: BCBS Trust/PPO |
$3,085.78
|
| Rate for Payer: BCN Commercial |
$3,085.78
|
| Rate for Payer: Cash Price |
$2,989.01
|
| Rate for Payer: Cofinity Commercial |
$3,213.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,989.01
|
| Rate for Payer: Healthscope Commercial |
$3,362.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,802.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,175.82
|
| Rate for Payer: Nomi Health Commercial |
$3,063.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,802.20
|
| Rate for Payer: PHP Commercial |
$3,175.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,250.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,600.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,287.91
|
| Rate for Payer: UHC Core |
$3,119.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,802.20
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
IP
|
$1,983.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,380.17 |
| Max. Negotiated Rate |
$1,784.70 |
| Rate for Payer: Aetna Commercial |
$1,685.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,637.76
|
| Rate for Payer: BCN Commercial |
$1,637.76
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$1,705.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,586.40
|
| Rate for Payer: Healthscope Commercial |
$1,784.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,487.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,685.55
|
| Rate for Payer: Nomi Health Commercial |
$1,626.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,487.25
|
| Rate for Payer: PHP Commercial |
$1,685.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,725.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,380.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,745.04
|
| Rate for Payer: UHC Core |
$1,655.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,487.25
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
OP
|
$1,983.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$349.60 |
| Max. Negotiated Rate |
$1,784.70 |
| Rate for Payer: Aetna Commercial |
$1,685.55
|
| Rate for Payer: Aetna Medicare |
$515.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$619.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$619.69
|
| Rate for Payer: BCBS Complete |
$367.05
|
| Rate for Payer: BCBS MAPPO |
$495.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,630.22
|
| Rate for Payer: BCN Commercial |
$1,630.22
|
| Rate for Payer: BCN Medicare Advantage |
$495.75
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$1,705.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,586.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$495.75
|
| Rate for Payer: Healthscope Commercial |
$1,784.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,487.25
|
| Rate for Payer: Mclaren Medicaid |
$349.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$520.54
|
| Rate for Payer: Meridian Medicaid |
$367.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$570.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$545.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,685.55
|
| Rate for Payer: Nomi Health Commercial |
$1,626.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,487.25
|
| Rate for Payer: PACE Senior Care Partners |
$470.96
|
| Rate for Payer: PACE SWMI |
$495.75
|
| Rate for Payer: PHP Commercial |
$1,685.55
|
| Rate for Payer: PHP Medicare Advantage |
$495.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,725.21
|
| Rate for Payer: Priority Health Medicare |
$500.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,380.17
|
| Rate for Payer: Railroad Medicare Medicare |
$495.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,745.04
|
| Rate for Payer: UHC Core |
$1,655.81
|
| Rate for Payer: UHC Exchange |
$495.75
|
| Rate for Payer: UHC Medicaid |
$349.60
|
| Rate for Payer: UHC Medicare Advantage |
$495.75
|
| Rate for Payer: UHCCP Medicaid |
$349.60
|
| Rate for Payer: VA VA |
$495.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,487.25
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
IP
|
$8,102.32
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,639.21 |
| Max. Negotiated Rate |
$7,292.09 |
| Rate for Payer: Aetna Commercial |
$6,886.97
|
| Rate for Payer: BCBS Trust/PPO |
$6,691.71
|
| Rate for Payer: BCN Commercial |
$6,691.71
|
| Rate for Payer: Cash Price |
$6,481.86
|
| Rate for Payer: Cofinity Commercial |
$6,968.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,481.86
|
| Rate for Payer: Healthscope Commercial |
$7,292.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,076.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,886.97
|
| Rate for Payer: Nomi Health Commercial |
$6,643.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,076.74
|
| Rate for Payer: PHP Commercial |
$6,886.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,049.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,639.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,130.04
|
| Rate for Payer: UHC Core |
$6,765.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,076.74
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
OP
|
$8,102.32
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,428.44 |
| Max. Negotiated Rate |
$7,292.09 |
| Rate for Payer: Aetna Commercial |
$6,886.97
|
| Rate for Payer: Aetna Medicare |
$2,106.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,531.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,531.97
|
| Rate for Payer: BCBS Complete |
$1,499.74
|
| Rate for Payer: BCBS MAPPO |
$2,025.58
|
| Rate for Payer: BCBS Trust/PPO |
$6,660.92
|
| Rate for Payer: BCN Commercial |
$6,660.92
|
| Rate for Payer: BCN Medicare Advantage |
$2,025.58
|
| Rate for Payer: Cash Price |
$6,481.86
|
| Rate for Payer: Cofinity Commercial |
$6,968.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,481.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,025.58
|
| Rate for Payer: Healthscope Commercial |
$7,292.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,076.74
|
| Rate for Payer: Mclaren Medicaid |
$1,428.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,126.86
|
| Rate for Payer: Meridian Medicaid |
$1,499.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,329.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,228.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,886.97
|
| Rate for Payer: Nomi Health Commercial |
$6,643.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,076.74
|
| Rate for Payer: PACE Senior Care Partners |
$1,924.30
|
| Rate for Payer: PACE SWMI |
$2,025.58
|
| Rate for Payer: PHP Commercial |
$6,886.97
|
| Rate for Payer: PHP Medicare Advantage |
$2,025.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,428.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7,049.02
|
| Rate for Payer: Priority Health Medicare |
$2,045.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,639.21
|
| Rate for Payer: Railroad Medicare Medicare |
$2,025.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,130.04
|
| Rate for Payer: UHC Core |
$6,765.44
|
| Rate for Payer: UHC Exchange |
$2,025.58
|
| Rate for Payer: UHC Medicaid |
$1,428.44
|
| Rate for Payer: UHC Medicare Advantage |
$2,025.58
|
| Rate for Payer: UHCCP Medicaid |
$1,428.44
|
| Rate for Payer: VA VA |
$2,025.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,076.74
|
|
|
HC DILATION & CURETTAGE DX/THER NONOBSTETRIC
|
Facility
|
IP
|
$9,990.90
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
36000136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,953.67 |
| Max. Negotiated Rate |
$8,991.81 |
| Rate for Payer: Aetna Commercial |
$8,492.26
|
| Rate for Payer: BCBS Trust/PPO |
$8,251.48
|
| Rate for Payer: BCN Commercial |
$8,251.48
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cofinity Commercial |
$8,592.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,992.72
|
| Rate for Payer: Healthscope Commercial |
$8,991.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,493.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,492.26
|
| Rate for Payer: Nomi Health Commercial |
$8,192.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,493.18
|
| Rate for Payer: PHP Commercial |
$8,492.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,692.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,953.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,791.99
|
| Rate for Payer: UHC Core |
$8,342.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,493.18
|
|
|
HC DILATION & CURETTAGE DX/THER NONOBSTETRIC
|
Facility
|
OP
|
$9,990.90
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
36000136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,761.40 |
| Max. Negotiated Rate |
$8,991.81 |
| Rate for Payer: Aetna Commercial |
$8,492.26
|
| Rate for Payer: Aetna Medicare |
$2,597.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,122.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,122.16
|
| Rate for Payer: BCBS Complete |
$1,849.32
|
| Rate for Payer: BCBS MAPPO |
$2,497.72
|
| Rate for Payer: BCBS Trust/PPO |
$8,213.52
|
| Rate for Payer: BCN Commercial |
$8,213.52
|
| Rate for Payer: BCN Medicare Advantage |
$2,497.72
|
| Rate for Payer: Cash Price |
$7,992.72
|
| Rate for Payer: Cofinity Commercial |
$8,592.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,992.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,497.72
|
| Rate for Payer: Healthscope Commercial |
$8,991.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,493.18
|
| Rate for Payer: Mclaren Medicaid |
$1,761.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,622.61
|
| Rate for Payer: Meridian Medicaid |
$1,849.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,872.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,747.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,492.26
|
| Rate for Payer: Nomi Health Commercial |
$8,192.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,493.18
|
| Rate for Payer: PACE Senior Care Partners |
$2,372.84
|
| Rate for Payer: PACE SWMI |
$2,497.72
|
| Rate for Payer: PHP Commercial |
$8,492.26
|
| Rate for Payer: PHP Medicare Advantage |
$2,497.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,761.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,692.08
|
| Rate for Payer: Priority Health Medicare |
$2,522.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,953.67
|
| Rate for Payer: Railroad Medicare Medicare |
$2,497.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,791.99
|
| Rate for Payer: UHC Core |
$8,342.40
|
| Rate for Payer: UHC Exchange |
$2,497.72
|
| Rate for Payer: UHC Medicaid |
$1,761.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,497.72
|
| Rate for Payer: UHCCP Medicaid |
$1,761.40
|
| Rate for Payer: VA VA |
$2,497.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,493.18
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
IP
|
$220.23
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.28 |
| Max. Negotiated Rate |
$198.21 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: BCBS Trust/PPO |
$181.89
|
| Rate for Payer: BCN Commercial |
$181.89
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cofinity Commercial |
$189.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.18
|
| Rate for Payer: Healthscope Commercial |
$198.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.20
|
| Rate for Payer: Nomi Health Commercial |
$180.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.17
|
| Rate for Payer: PHP Commercial |
$187.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$191.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.80
|
| Rate for Payer: UHC Core |
$183.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.17
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
OP
|
$220.23
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$198.21 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Medicare |
$57.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.82
|
| Rate for Payer: BCBS Complete |
$40.76
|
| Rate for Payer: BCBS MAPPO |
$55.06
|
| Rate for Payer: BCBS Trust/PPO |
$181.05
|
| Rate for Payer: BCN Commercial |
$181.05
|
| Rate for Payer: BCN Medicare Advantage |
$55.06
|
| Rate for Payer: Cash Price |
$176.18
|
| Rate for Payer: Cofinity Commercial |
$189.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.06
|
| Rate for Payer: Healthscope Commercial |
$198.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.17
|
| Rate for Payer: Mclaren Medicaid |
$38.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.81
|
| Rate for Payer: Meridian Medicaid |
$40.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.20
|
| Rate for Payer: Nomi Health Commercial |
$180.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.17
|
| Rate for Payer: PACE Senior Care Partners |
$52.30
|
| Rate for Payer: PACE SWMI |
$55.06
|
| Rate for Payer: PHP Commercial |
$187.20
|
| Rate for Payer: PHP Medicare Advantage |
$55.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$191.60
|
| Rate for Payer: Priority Health Medicare |
$55.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.28
|
| Rate for Payer: Railroad Medicare Medicare |
$55.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.80
|
| Rate for Payer: UHC Core |
$183.89
|
| Rate for Payer: UHC Exchange |
$55.06
|
| Rate for Payer: UHC Medicaid |
$38.83
|
| Rate for Payer: UHC Medicare Advantage |
$55.06
|
| Rate for Payer: UHCCP Medicaid |
$38.83
|
| Rate for Payer: VA VA |
$55.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.17
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
IP
|
$373.92
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.25 |
| Max. Negotiated Rate |
$336.53 |
| Rate for Payer: Aetna Commercial |
$317.83
|
| Rate for Payer: BCBS Trust/PPO |
$308.82
|
| Rate for Payer: BCN Commercial |
$308.82
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Commercial |
$321.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.83
|
| Rate for Payer: Nomi Health Commercial |
$306.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.44
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$325.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.05
|
| Rate for Payer: UHC Core |
$312.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.44
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
OP
|
$373.92
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.92 |
| Max. Negotiated Rate |
$336.53 |
| Rate for Payer: Aetna Commercial |
$317.83
|
| Rate for Payer: Aetna Medicare |
$97.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.85
|
| Rate for Payer: BCBS Complete |
$69.21
|
| Rate for Payer: BCBS MAPPO |
$93.48
|
| Rate for Payer: BCBS Trust/PPO |
$307.40
|
| Rate for Payer: BCN Commercial |
$307.40
|
| Rate for Payer: BCN Medicare Advantage |
$93.48
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Commercial |
$321.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.48
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.44
|
| Rate for Payer: Mclaren Medicaid |
$65.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.15
|
| Rate for Payer: Meridian Medicaid |
$69.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.83
|
| Rate for Payer: Nomi Health Commercial |
$306.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.44
|
| Rate for Payer: PACE Senior Care Partners |
$88.81
|
| Rate for Payer: PACE SWMI |
$93.48
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: PHP Medicare Advantage |
$93.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$325.31
|
| Rate for Payer: Priority Health Medicare |
$94.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.25
|
| Rate for Payer: Railroad Medicare Medicare |
$93.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.05
|
| Rate for Payer: UHC Core |
$312.22
|
| Rate for Payer: UHC Exchange |
$93.48
|
| Rate for Payer: UHC Medicaid |
$65.92
|
| Rate for Payer: UHC Medicare Advantage |
$93.48
|
| Rate for Payer: UHCCP Medicaid |
$65.92
|
| Rate for Payer: VA VA |
$93.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.44
|
|
