|
HC DILANTIN LEVEL
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$28.14
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
OP
|
$105.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$95.10 |
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna Medicare |
$27.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.02
|
| Rate for Payer: BCBS Complete |
$10.45
|
| Rate for Payer: BCBS MAPPO |
$26.42
|
| Rate for Payer: BCBS Trust/PPO |
$86.87
|
| Rate for Payer: BCN Commercial |
$82.16
|
| Rate for Payer: BCN Medicare Advantage |
$26.42
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$90.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.42
|
| Rate for Payer: Healthscope Commercial |
$95.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.25
|
| Rate for Payer: Mclaren Medicaid |
$9.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.74
|
| Rate for Payer: Meridian Medicaid |
$10.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: Nomi Health Commercial |
$86.65
|
| Rate for Payer: PACE Senior Care Partners |
$25.10
|
| Rate for Payer: PACE SWMI |
$26.42
|
| Rate for Payer: PHP Commercial |
$89.82
|
| Rate for Payer: PHP Medicare Advantage |
$26.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health HMO/PPO |
$91.93
|
| Rate for Payer: Priority Health Medicare |
$26.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.80
|
| Rate for Payer: Railroad Medicare Medicare |
$26.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.99
|
| Rate for Payer: UHC Core |
$88.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.42
|
| Rate for Payer: UHC Exchange |
$26.42
|
| Rate for Payer: UHC Medicare Advantage |
$26.42
|
| Rate for Payer: UHCCP Medicaid |
$9.95
|
| Rate for Payer: VA VA |
$26.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.25
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
IP
|
$105.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$95.10 |
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: BCBS Trust/PPO |
$86.26
|
| Rate for Payer: BCN Commercial |
$81.66
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$90.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Healthscope Commercial |
$95.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: Nomi Health Commercial |
$86.65
|
| Rate for Payer: PHP Commercial |
$89.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health HMO/PPO |
$91.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.99
|
| Rate for Payer: UHC Core |
$88.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.25
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
OP
|
$170.11
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$153.10 |
| Rate for Payer: Aetna Commercial |
$144.59
|
| Rate for Payer: Aetna Medicare |
$44.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.16
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: BCBS MAPPO |
$42.53
|
| Rate for Payer: BCBS Trust/PPO |
$139.85
|
| Rate for Payer: BCN Commercial |
$132.26
|
| Rate for Payer: BCN Medicare Advantage |
$42.53
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cofinity Commercial |
$146.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.53
|
| Rate for Payer: Healthscope Commercial |
$153.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.58
|
| Rate for Payer: Mclaren Medicaid |
$91.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.65
|
| Rate for Payer: Meridian Medicaid |
$95.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.59
|
| Rate for Payer: Nomi Health Commercial |
$139.49
|
| Rate for Payer: PACE Senior Care Partners |
$40.40
|
| Rate for Payer: PACE SWMI |
$42.53
|
| Rate for Payer: PHP Commercial |
$144.59
|
| Rate for Payer: PHP Medicare Advantage |
$42.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.57
|
| Rate for Payer: Priority Health HMO/PPO |
$148.00
|
| Rate for Payer: Priority Health Medicare |
$42.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.97
|
| Rate for Payer: Railroad Medicare Medicare |
$42.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.70
|
| Rate for Payer: UHC Core |
$142.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.53
|
| Rate for Payer: UHC Exchange |
$42.53
|
| Rate for Payer: UHC Medicare Advantage |
$42.53
|
| Rate for Payer: UHCCP Medicaid |
$91.31
|
| Rate for Payer: VA VA |
$42.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.58
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
IP
|
$170.11
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.57 |
| Max. Negotiated Rate |
$153.10 |
| Rate for Payer: Aetna Commercial |
$144.59
|
| Rate for Payer: BCBS Trust/PPO |
$138.86
|
| Rate for Payer: BCN Commercial |
$131.46
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cofinity Commercial |
$146.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.09
|
| Rate for Payer: Healthscope Commercial |
$153.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.59
|
| Rate for Payer: Nomi Health Commercial |
$139.49
|
| Rate for Payer: PHP Commercial |
$144.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.57
|
| Rate for Payer: Priority Health HMO/PPO |
$148.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.70
|
| Rate for Payer: UHC Core |
$142.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.58
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
IP
|
$662.41
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$430.57 |
| Max. Negotiated Rate |
$596.17 |
| Rate for Payer: Aetna Commercial |
$563.05
|
| Rate for Payer: BCBS Trust/PPO |
$540.73
|
| Rate for Payer: BCN Commercial |
$511.91
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cofinity Commercial |
$569.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.93
|
| Rate for Payer: Healthscope Commercial |
$596.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.05
|
| Rate for Payer: Nomi Health Commercial |
$543.18
|
| Rate for Payer: PHP Commercial |
$563.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health HMO/PPO |
$576.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$443.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.92
|
| Rate for Payer: UHC Core |
$553.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.81
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
OP
|
$662.41
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.32 |
| Max. Negotiated Rate |
$596.17 |
| Rate for Payer: Aetna Commercial |
$563.05
|
| Rate for Payer: Aetna Medicare |
$172.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$207.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$207.00
|
| Rate for Payer: BCBS Complete |
$264.96
|
| Rate for Payer: BCBS MAPPO |
$165.60
|
| Rate for Payer: BCBS Trust/PPO |
$544.57
|
| Rate for Payer: BCN Commercial |
$515.02
|
| Rate for Payer: BCN Medicare Advantage |
$165.60
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cofinity Commercial |
$569.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.60
|
| Rate for Payer: Healthscope Commercial |
$596.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.05
|
| Rate for Payer: Nomi Health Commercial |
$543.18
|
| Rate for Payer: PACE Senior Care Partners |
$157.32
|
| Rate for Payer: PACE SWMI |
$165.60
|
| Rate for Payer: PHP Commercial |
$563.05
|
| Rate for Payer: PHP Medicare Advantage |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health HMO/PPO |
$576.30
|
| Rate for Payer: Priority Health Medicare |
$167.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$443.81
|
| Rate for Payer: Railroad Medicare Medicare |
$165.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.92
|
| Rate for Payer: UHC Core |
$553.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.60
|
| Rate for Payer: UHC Exchange |
$165.60
|
| Rate for Payer: UHC Medicare Advantage |
$165.60
|
| Rate for Payer: VA VA |
$165.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.81
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
OP
|
$3,663.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$869.96 |
| Max. Negotiated Rate |
$7,744.38 |
| Rate for Payer: Aetna Commercial |
$3,113.55
|
| Rate for Payer: Aetna Medicare |
$952.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,144.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,144.69
|
| Rate for Payer: BCBS Complete |
$7,744.38
|
| Rate for Payer: BCBS MAPPO |
$915.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,011.35
|
| Rate for Payer: BCN Commercial |
$2,847.98
|
| Rate for Payer: BCN Medicare Advantage |
$915.75
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cofinity Commercial |
$3,150.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,930.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$915.75
|
| Rate for Payer: Healthscope Commercial |
$3,296.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,747.25
|
| Rate for Payer: Mclaren Medicaid |
$7,375.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$961.54
|
| Rate for Payer: Meridian Medicaid |
$7,744.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,053.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,113.55
|
| Rate for Payer: Nomi Health Commercial |
$3,003.66
|
| Rate for Payer: PACE Senior Care Partners |
$869.96
|
| Rate for Payer: PACE SWMI |
$915.75
|
| Rate for Payer: PHP Commercial |
$3,113.55
|
| Rate for Payer: PHP Medicare Advantage |
$915.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,375.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,380.95
|
| Rate for Payer: Priority Health HMO/PPO |
$3,186.81
|
| Rate for Payer: Priority Health Medicare |
$924.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,454.21
|
| Rate for Payer: Railroad Medicare Medicare |
$915.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,223.44
|
| Rate for Payer: UHC Core |
$3,058.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$915.75
|
| Rate for Payer: UHC Exchange |
$915.75
|
| Rate for Payer: UHC Medicare Advantage |
$915.75
|
| Rate for Payer: UHCCP Medicaid |
$7,375.11
|
| Rate for Payer: VA VA |
$915.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,747.25
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
IP
|
$3,663.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,380.95 |
| Max. Negotiated Rate |
$3,296.70 |
| Rate for Payer: Aetna Commercial |
$3,113.55
|
| Rate for Payer: BCBS Trust/PPO |
$2,990.11
|
| Rate for Payer: BCN Commercial |
$2,830.77
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cofinity Commercial |
$3,150.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,930.40
|
| Rate for Payer: Healthscope Commercial |
$3,296.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,747.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,113.55
|
| Rate for Payer: Nomi Health Commercial |
$3,003.66
|
| Rate for Payer: PHP Commercial |
$3,113.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,380.95
|
| Rate for Payer: Priority Health HMO/PPO |
$3,186.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,454.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,223.44
|
| Rate for Payer: UHC Core |
$3,058.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,747.25
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
OP
|
$1,944.12
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$461.73 |
| Max. Negotiated Rate |
$2,625.09 |
| Rate for Payer: Aetna Commercial |
$1,652.50
|
| Rate for Payer: Aetna Medicare |
$505.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$607.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$607.54
|
| Rate for Payer: BCBS Complete |
$2,625.09
|
| Rate for Payer: BCBS MAPPO |
$486.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,598.26
|
| Rate for Payer: BCN Commercial |
$1,511.55
|
| Rate for Payer: BCN Medicare Advantage |
$486.03
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cofinity Commercial |
$1,671.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.03
|
| Rate for Payer: Healthscope Commercial |
$1,749.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,458.09
|
| Rate for Payer: Mclaren Medicaid |
$2,499.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$510.33
|
| Rate for Payer: Meridian Medicaid |
$2,625.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$558.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.50
|
| Rate for Payer: Nomi Health Commercial |
$1,594.18
|
| Rate for Payer: PACE Senior Care Partners |
$461.73
|
| Rate for Payer: PACE SWMI |
$486.03
|
| Rate for Payer: PHP Commercial |
$1,652.50
|
| Rate for Payer: PHP Medicare Advantage |
$486.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,499.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.68
|
| Rate for Payer: Priority Health HMO/PPO |
$1,691.38
|
| Rate for Payer: Priority Health Medicare |
$490.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,302.56
|
| Rate for Payer: Railroad Medicare Medicare |
$486.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,710.83
|
| Rate for Payer: UHC Core |
$1,623.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.03
|
| Rate for Payer: UHC Exchange |
$486.03
|
| Rate for Payer: UHC Medicare Advantage |
$486.03
|
| Rate for Payer: UHCCP Medicaid |
$2,499.92
|
| Rate for Payer: VA VA |
$486.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,458.09
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
IP
|
$1,944.12
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,263.68 |
| Max. Negotiated Rate |
$1,749.71 |
| Rate for Payer: Aetna Commercial |
$1,652.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,586.99
|
| Rate for Payer: BCN Commercial |
$1,502.42
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cofinity Commercial |
$1,671.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.30
|
| Rate for Payer: Healthscope Commercial |
$1,749.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,458.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.50
|
| Rate for Payer: Nomi Health Commercial |
$1,594.18
|
| Rate for Payer: PHP Commercial |
$1,652.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.68
|
| Rate for Payer: Priority Health HMO/PPO |
$1,691.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,302.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,710.83
|
| Rate for Payer: UHC Core |
$1,623.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,458.09
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
OP
|
$7,943.45
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,886.57 |
| Max. Negotiated Rate |
$7,149.10 |
| Rate for Payer: Aetna Commercial |
$6,751.93
|
| Rate for Payer: Aetna Medicare |
$2,065.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,482.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,482.33
|
| Rate for Payer: BCBS Complete |
$2,365.09
|
| Rate for Payer: BCBS MAPPO |
$1,985.86
|
| Rate for Payer: BCBS Trust/PPO |
$6,530.31
|
| Rate for Payer: BCN Commercial |
$6,176.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,985.86
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cofinity Commercial |
$6,831.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,354.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,985.86
|
| Rate for Payer: Healthscope Commercial |
$7,149.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,957.59
|
| Rate for Payer: Mclaren Medicaid |
$2,252.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,085.16
|
| Rate for Payer: Meridian Medicaid |
$2,365.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,283.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,751.93
|
| Rate for Payer: Nomi Health Commercial |
$6,513.63
|
| Rate for Payer: PACE Senior Care Partners |
$1,886.57
|
| Rate for Payer: PACE SWMI |
$1,985.86
|
| Rate for Payer: PHP Commercial |
$6,751.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,985.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,252.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.24
|
| Rate for Payer: Priority Health HMO/PPO |
$6,910.80
|
| Rate for Payer: Priority Health Medicare |
$2,005.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,322.11
|
| Rate for Payer: Railroad Medicare Medicare |
$1,985.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,990.24
|
| Rate for Payer: UHC Core |
$6,632.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,985.86
|
| Rate for Payer: UHC Exchange |
$1,985.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,985.86
|
| Rate for Payer: UHCCP Medicaid |
$2,252.32
|
| Rate for Payer: VA VA |
$1,985.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,957.59
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
IP
|
$7,943.45
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,163.24 |
| Max. Negotiated Rate |
$7,149.10 |
| Rate for Payer: Aetna Commercial |
$6,751.93
|
| Rate for Payer: BCBS Trust/PPO |
$6,484.24
|
| Rate for Payer: BCN Commercial |
$6,138.70
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cofinity Commercial |
$6,831.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,354.76
|
| Rate for Payer: Healthscope Commercial |
$7,149.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,957.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,751.93
|
| Rate for Payer: Nomi Health Commercial |
$6,513.63
|
| Rate for Payer: PHP Commercial |
$6,751.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.24
|
| Rate for Payer: Priority Health HMO/PPO |
$6,910.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,322.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,990.24
|
| Rate for Payer: UHC Core |
$6,632.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,957.59
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
OP
|
$215.91
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.28 |
| Max. Negotiated Rate |
$194.32 |
| Rate for Payer: Aetna Commercial |
$183.52
|
| Rate for Payer: Aetna Medicare |
$56.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.47
|
| Rate for Payer: BCBS Complete |
$116.39
|
| Rate for Payer: BCBS MAPPO |
$53.98
|
| Rate for Payer: BCBS Trust/PPO |
$177.50
|
| Rate for Payer: BCN Commercial |
$167.87
|
| Rate for Payer: BCN Medicare Advantage |
$53.98
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cofinity Commercial |
$185.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.98
|
| Rate for Payer: Healthscope Commercial |
$194.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.93
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.68
|
| Rate for Payer: Meridian Medicaid |
$116.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.52
|
| Rate for Payer: Nomi Health Commercial |
$177.05
|
| Rate for Payer: PACE Senior Care Partners |
$51.28
|
| Rate for Payer: PACE SWMI |
$53.98
|
| Rate for Payer: PHP Commercial |
$183.52
|
| Rate for Payer: PHP Medicare Advantage |
$53.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.34
|
| Rate for Payer: Priority Health HMO/PPO |
$187.84
|
| Rate for Payer: Priority Health Medicare |
$54.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.66
|
| Rate for Payer: Railroad Medicare Medicare |
$53.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.00
|
| Rate for Payer: UHC Core |
$180.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.98
|
| Rate for Payer: UHC Exchange |
$53.98
|
| Rate for Payer: UHC Medicare Advantage |
$53.98
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$53.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.93
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
IP
|
$215.91
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.34 |
| Max. Negotiated Rate |
$194.32 |
| Rate for Payer: Aetna Commercial |
$183.52
|
| Rate for Payer: BCBS Trust/PPO |
$176.25
|
| Rate for Payer: BCN Commercial |
$166.86
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cofinity Commercial |
$185.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.73
|
| Rate for Payer: Healthscope Commercial |
$194.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.52
|
| Rate for Payer: Nomi Health Commercial |
$177.05
|
| Rate for Payer: PHP Commercial |
$183.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.34
|
| Rate for Payer: Priority Health HMO/PPO |
$187.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.00
|
| Rate for Payer: UHC Core |
$180.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.93
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
OP
|
$366.59
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.07 |
| Max. Negotiated Rate |
$329.93 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna Medicare |
$95.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.56
|
| Rate for Payer: BCBS Complete |
$180.91
|
| Rate for Payer: BCBS MAPPO |
$91.65
|
| Rate for Payer: BCBS Trust/PPO |
$301.37
|
| Rate for Payer: BCN Commercial |
$285.02
|
| Rate for Payer: BCN Medicare Advantage |
$91.65
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cofinity Commercial |
$315.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.65
|
| Rate for Payer: Healthscope Commercial |
$329.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.94
|
| Rate for Payer: Mclaren Medicaid |
$172.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.23
|
| Rate for Payer: Meridian Medicaid |
$180.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.60
|
| Rate for Payer: Nomi Health Commercial |
$300.60
|
| Rate for Payer: PACE Senior Care Partners |
$87.07
|
| Rate for Payer: PACE SWMI |
$91.65
|
| Rate for Payer: PHP Commercial |
$311.60
|
| Rate for Payer: PHP Medicare Advantage |
$91.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.28
|
| Rate for Payer: Priority Health HMO/PPO |
$318.93
|
| Rate for Payer: Priority Health Medicare |
$92.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.62
|
| Rate for Payer: Railroad Medicare Medicare |
$91.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.60
|
| Rate for Payer: UHC Core |
$306.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.65
|
| Rate for Payer: UHC Exchange |
$91.65
|
| Rate for Payer: UHC Medicare Advantage |
$91.65
|
| Rate for Payer: UHCCP Medicaid |
$172.28
|
| Rate for Payer: VA VA |
$91.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.94
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
IP
|
$366.59
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.28 |
| Max. Negotiated Rate |
$329.93 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: BCBS Trust/PPO |
$299.25
|
| Rate for Payer: BCN Commercial |
$283.30
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cofinity Commercial |
$315.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.27
|
| Rate for Payer: Healthscope Commercial |
$329.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.60
|
| Rate for Payer: Nomi Health Commercial |
$300.60
|
| Rate for Payer: PHP Commercial |
$311.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.28
|
| Rate for Payer: Priority Health HMO/PPO |
$318.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.60
|
| Rate for Payer: UHC Core |
$306.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.94
|
|
|
HC DILATOR SIZE 12
|
Facility
|
IP
|
$34.57
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$28.22
|
| Rate for Payer: BCN Commercial |
$26.72
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: Nomi Health Commercial |
$28.35
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.47
|
| Rate for Payer: Priority Health HMO/PPO |
$30.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.42
|
| Rate for Payer: UHC Core |
$28.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.93
|
|
|
HC DILATOR SIZE 12
|
Facility
|
OP
|
$34.57
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.80
|
| Rate for Payer: BCBS Complete |
$13.83
|
| Rate for Payer: BCBS MAPPO |
$8.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.42
|
| Rate for Payer: BCN Commercial |
$26.88
|
| Rate for Payer: BCN Medicare Advantage |
$8.64
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.64
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: Nomi Health Commercial |
$28.35
|
| Rate for Payer: PACE Senior Care Partners |
$8.21
|
| Rate for Payer: PACE SWMI |
$8.64
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: PHP Medicare Advantage |
$8.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.47
|
| Rate for Payer: Priority Health HMO/PPO |
$30.08
|
| Rate for Payer: Priority Health Medicare |
$8.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.16
|
| Rate for Payer: Railroad Medicare Medicare |
$8.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.42
|
| Rate for Payer: UHC Core |
$28.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.64
|
| Rate for Payer: UHC Exchange |
$8.64
|
| Rate for Payer: UHC Medicare Advantage |
$8.64
|
| Rate for Payer: VA VA |
$8.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.93
|
|
|
HC DILATOR SIZE 7
|
Facility
|
OP
|
$25.30
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.91
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS MAPPO |
$6.32
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$19.67
|
| Rate for Payer: BCN Medicare Advantage |
$6.32
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: PACE Senior Care Partners |
$6.01
|
| Rate for Payer: PACE SWMI |
$6.32
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: PHP Medicare Advantage |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health HMO/PPO |
$22.01
|
| Rate for Payer: Priority Health Medicare |
$6.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.95
|
| Rate for Payer: Railroad Medicare Medicare |
$6.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.26
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.32
|
| Rate for Payer: UHC Exchange |
$6.32
|
| Rate for Payer: UHC Medicare Advantage |
$6.32
|
| Rate for Payer: VA VA |
$6.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
HC DILATOR SIZE 7
|
Facility
|
IP
|
$25.30
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.44 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$20.65
|
| Rate for Payer: BCN Commercial |
$19.55
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health HMO/PPO |
$22.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.26
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
HC DILATOR SIZE 9
|
Facility
|
IP
|
$25.30
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.44 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$20.65
|
| Rate for Payer: BCN Commercial |
$19.55
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health HMO/PPO |
$22.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.26
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
HC DILATOR SIZE 9
|
Facility
|
OP
|
$25.30
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.91
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS MAPPO |
$6.32
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$19.67
|
| Rate for Payer: BCN Medicare Advantage |
$6.32
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: PACE Senior Care Partners |
$6.01
|
| Rate for Payer: PACE SWMI |
$6.32
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: PHP Medicare Advantage |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health HMO/PPO |
$22.01
|
| Rate for Payer: Priority Health Medicare |
$6.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.95
|
| Rate for Payer: Railroad Medicare Medicare |
$6.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.26
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.32
|
| Rate for Payer: UHC Exchange |
$6.32
|
| Rate for Payer: UHC Medicare Advantage |
$6.32
|
| Rate for Payer: VA VA |
$6.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
OP
|
$4,567.36
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,084.75 |
| Max. Negotiated Rate |
$4,110.62 |
| Rate for Payer: Aetna Commercial |
$3,882.26
|
| Rate for Payer: Aetna Medicare |
$1,187.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,427.30
|
| Rate for Payer: BCBS Complete |
$2,565.51
|
| Rate for Payer: BCBS MAPPO |
$1,141.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,754.83
|
| Rate for Payer: BCN Commercial |
$3,551.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,141.84
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cofinity Commercial |
$3,927.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,653.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,141.84
|
| Rate for Payer: Healthscope Commercial |
$4,110.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,425.52
|
| Rate for Payer: Mclaren Medicaid |
$2,443.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,198.93
|
| Rate for Payer: Meridian Medicaid |
$2,565.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,313.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,882.26
|
| Rate for Payer: Nomi Health Commercial |
$3,745.24
|
| Rate for Payer: PACE Senior Care Partners |
$1,084.75
|
| Rate for Payer: PACE SWMI |
$1,141.84
|
| Rate for Payer: PHP Commercial |
$3,882.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,141.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,443.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,968.78
|
| Rate for Payer: Priority Health HMO/PPO |
$3,973.60
|
| Rate for Payer: Priority Health Medicare |
$1,153.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,060.13
|
| Rate for Payer: Railroad Medicare Medicare |
$1,141.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,019.28
|
| Rate for Payer: UHC Core |
$3,813.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,141.84
|
| Rate for Payer: UHC Exchange |
$1,141.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,141.84
|
| Rate for Payer: UHCCP Medicaid |
$2,443.18
|
| Rate for Payer: VA VA |
$1,141.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,425.52
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
IP
|
$4,567.36
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,968.78 |
| Max. Negotiated Rate |
$4,110.62 |
| Rate for Payer: Aetna Commercial |
$3,882.26
|
| Rate for Payer: BCBS Trust/PPO |
$3,728.34
|
| Rate for Payer: BCN Commercial |
$3,529.66
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cofinity Commercial |
$3,927.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,653.89
|
| Rate for Payer: Healthscope Commercial |
$4,110.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,425.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,882.26
|
| Rate for Payer: Nomi Health Commercial |
$3,745.24
|
| Rate for Payer: PHP Commercial |
$3,882.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,968.78
|
| Rate for Payer: Priority Health HMO/PPO |
$3,973.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,060.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,019.28
|
| Rate for Payer: UHC Core |
$3,813.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,425.52
|
|
