|
HC ENDOFORM 4X4
|
Facility
|
OP
|
$135.72
|
|
| Hospital Charge Code |
27000460
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$122.15 |
| Rate for Payer: Aetna Commercial |
$115.36
|
| Rate for Payer: Aetna Medicare |
$35.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.41
|
| Rate for Payer: BCBS Complete |
$54.29
|
| Rate for Payer: BCBS MAPPO |
$33.93
|
| Rate for Payer: BCBS Trust/PPO |
$111.58
|
| Rate for Payer: BCN Commercial |
$105.52
|
| Rate for Payer: BCN Medicare Advantage |
$33.93
|
| Rate for Payer: Cash Price |
$108.58
|
| Rate for Payer: Cofinity Commercial |
$116.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.93
|
| Rate for Payer: Healthscope Commercial |
$122.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.36
|
| Rate for Payer: Nomi Health Commercial |
$111.29
|
| Rate for Payer: PACE Senior Care Partners |
$32.23
|
| Rate for Payer: PACE SWMI |
$33.93
|
| Rate for Payer: PHP Commercial |
$115.36
|
| Rate for Payer: PHP Medicare Advantage |
$33.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.22
|
| Rate for Payer: Priority Health HMO/PPO |
$118.08
|
| Rate for Payer: Priority Health Medicare |
$34.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.93
|
| Rate for Payer: Railroad Medicare Medicare |
$33.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.43
|
| Rate for Payer: UHC Core |
$113.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.93
|
| Rate for Payer: UHC Exchange |
$33.93
|
| Rate for Payer: UHC Medicare Advantage |
$33.93
|
| Rate for Payer: VA VA |
$33.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.79
|
|
|
HC ENDO HEMOSTASIS
|
Facility
|
OP
|
$125.46
|
|
| Hospital Charge Code |
36000116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$112.91 |
| Rate for Payer: Aetna Commercial |
$106.64
|
| Rate for Payer: Aetna Medicare |
$32.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.21
|
| Rate for Payer: BCBS Complete |
$50.18
|
| Rate for Payer: BCBS MAPPO |
$31.36
|
| Rate for Payer: BCBS Trust/PPO |
$103.14
|
| Rate for Payer: BCN Commercial |
$97.55
|
| Rate for Payer: BCN Medicare Advantage |
$31.36
|
| Rate for Payer: Cash Price |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$107.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.36
|
| Rate for Payer: Healthscope Commercial |
$112.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.64
|
| Rate for Payer: Nomi Health Commercial |
$102.88
|
| Rate for Payer: PACE Senior Care Partners |
$29.80
|
| Rate for Payer: PACE SWMI |
$31.36
|
| Rate for Payer: PHP Commercial |
$106.64
|
| Rate for Payer: PHP Medicare Advantage |
$31.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.55
|
| Rate for Payer: Priority Health HMO/PPO |
$109.15
|
| Rate for Payer: Priority Health Medicare |
$31.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.06
|
| Rate for Payer: Railroad Medicare Medicare |
$31.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.40
|
| Rate for Payer: UHC Core |
$104.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.36
|
| Rate for Payer: UHC Exchange |
$31.36
|
| Rate for Payer: UHC Medicare Advantage |
$31.36
|
| Rate for Payer: VA VA |
$31.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.09
|
|
|
HC ENDO HEMOSTASIS
|
Facility
|
IP
|
$125.46
|
|
| Hospital Charge Code |
36000116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$112.91 |
| Rate for Payer: Aetna Commercial |
$106.64
|
| Rate for Payer: BCBS Trust/PPO |
$102.41
|
| Rate for Payer: BCN Commercial |
$96.96
|
| Rate for Payer: Cash Price |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$107.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.37
|
| Rate for Payer: Healthscope Commercial |
$112.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.64
|
| Rate for Payer: Nomi Health Commercial |
$102.88
|
| Rate for Payer: PHP Commercial |
$106.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.55
|
| Rate for Payer: Priority Health HMO/PPO |
$109.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.40
|
| Rate for Payer: UHC Core |
$104.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.09
|
|
|
HC ENDOLUMINAL BIOPSY OF BILIARY TREE
|
Facility
|
IP
|
$662.41
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
36100500
|
|
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 ENDOLUMINAL BIOPSY OF BILIARY TREE
|
Facility
|
OP
|
$662.41
|
|
|
Service Code
|
CPT 47543
|
| Hospital Charge Code |
36100500
|
|
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 ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC
|
Facility
|
OP
|
$5,097.96
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
36100615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,210.77 |
| Max. Negotiated Rate |
$4,588.16 |
| Rate for Payer: Aetna Commercial |
$4,333.27
|
| Rate for Payer: Aetna Medicare |
$1,325.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,593.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,593.11
|
| Rate for Payer: BCBS Complete |
$2,039.18
|
| Rate for Payer: BCBS MAPPO |
$1,274.49
|
| Rate for Payer: BCBS Trust/PPO |
$4,191.03
|
| Rate for Payer: BCN Commercial |
$3,963.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,274.49
|
| Rate for Payer: Cash Price |
$4,078.37
|
| Rate for Payer: Cofinity Commercial |
$4,384.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,078.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,274.49
|
| Rate for Payer: Healthscope Commercial |
$4,588.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,823.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,338.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,465.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,333.27
|
| Rate for Payer: Nomi Health Commercial |
$4,180.33
|
| Rate for Payer: PACE Senior Care Partners |
$1,210.77
|
| Rate for Payer: PACE SWMI |
$1,274.49
|
| Rate for Payer: PHP Commercial |
$4,333.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,274.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,313.67
|
| Rate for Payer: Priority Health HMO/PPO |
$4,435.23
|
| Rate for Payer: Priority Health Medicare |
$1,287.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,415.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1,274.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,486.20
|
| Rate for Payer: UHC Core |
$4,256.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,274.49
|
| Rate for Payer: UHC Exchange |
$1,274.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,274.49
|
| Rate for Payer: VA VA |
$1,274.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,823.47
|
|
|
HC ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC
|
Facility
|
IP
|
$5,097.96
|
|
|
Service Code
|
CPT 50606
|
| Hospital Charge Code |
36100615
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,313.67 |
| Max. Negotiated Rate |
$4,588.16 |
| Rate for Payer: Aetna Commercial |
$4,333.27
|
| Rate for Payer: BCBS Trust/PPO |
$4,161.46
|
| Rate for Payer: BCN Commercial |
$3,939.70
|
| Rate for Payer: Cash Price |
$4,078.37
|
| Rate for Payer: Cofinity Commercial |
$4,384.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,078.37
|
| Rate for Payer: Healthscope Commercial |
$4,588.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,823.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,333.27
|
| Rate for Payer: Nomi Health Commercial |
$4,180.33
|
| Rate for Payer: PHP Commercial |
$4,333.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,313.67
|
| Rate for Payer: Priority Health HMO/PPO |
$4,435.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,415.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,486.20
|
| Rate for Payer: UHC Core |
$4,256.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,823.47
|
|
|
HC ENDOMETR ABLATE THERMAL
|
Facility
|
IP
|
$13,353.53
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,679.79 |
| Max. Negotiated Rate |
$12,018.18 |
| Rate for Payer: Aetna Commercial |
$11,350.50
|
| Rate for Payer: BCBS Trust/PPO |
$10,900.49
|
| Rate for Payer: BCN Commercial |
$10,319.61
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$11,484.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Healthscope Commercial |
$12,018.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,015.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: Nomi Health Commercial |
$10,949.89
|
| Rate for Payer: PHP Commercial |
$11,350.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health HMO/PPO |
$11,617.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,946.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,751.11
|
| Rate for Payer: UHC Core |
$11,150.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,015.15
|
|
|
HC ENDOMETR ABLATE THERMAL
|
Facility
|
OP
|
$13,353.53
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
76100336
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,171.46 |
| Max. Negotiated Rate |
$12,018.18 |
| Rate for Payer: Aetna Commercial |
$11,350.50
|
| Rate for Payer: Aetna Medicare |
$3,471.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,172.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,172.98
|
| Rate for Payer: BCBS Complete |
$3,747.75
|
| Rate for Payer: BCBS MAPPO |
$3,338.38
|
| Rate for Payer: BCBS Trust/PPO |
$10,977.94
|
| Rate for Payer: BCN Commercial |
$10,382.37
|
| Rate for Payer: BCN Medicare Advantage |
$3,338.38
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cash Price |
$10,682.82
|
| Rate for Payer: Cofinity Commercial |
$11,484.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,682.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,338.38
|
| Rate for Payer: Healthscope Commercial |
$12,018.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,015.15
|
| Rate for Payer: Mclaren Medicaid |
$3,569.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,505.30
|
| Rate for Payer: Meridian Medicaid |
$3,747.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,839.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,350.50
|
| Rate for Payer: Nomi Health Commercial |
$10,949.89
|
| Rate for Payer: PACE Senior Care Partners |
$3,171.46
|
| Rate for Payer: PACE SWMI |
$3,338.38
|
| Rate for Payer: PHP Commercial |
$11,350.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,338.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,569.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,679.79
|
| Rate for Payer: Priority Health HMO/PPO |
$11,617.57
|
| Rate for Payer: Priority Health Medicare |
$3,371.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,946.87
|
| Rate for Payer: Railroad Medicare Medicare |
$3,338.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,751.11
|
| Rate for Payer: UHC Core |
$11,150.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,338.38
|
| Rate for Payer: UHC Exchange |
$3,338.38
|
| Rate for Payer: UHC Medicare Advantage |
$3,338.38
|
| Rate for Payer: UHCCP Medicaid |
$3,569.05
|
| Rate for Payer: VA VA |
$3,338.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,015.15
|
|
|
HC ENDOMETR BX CONJUNCT W/COLP
|
Facility
|
IP
|
$723.08
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.00 |
| Max. Negotiated Rate |
$650.77 |
| Rate for Payer: Aetna Commercial |
$614.62
|
| Rate for Payer: BCBS Trust/PPO |
$590.25
|
| Rate for Payer: BCN Commercial |
$558.80
|
| Rate for Payer: Cash Price |
$578.46
|
| Rate for Payer: Cofinity Commercial |
$621.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.46
|
| Rate for Payer: Healthscope Commercial |
$650.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$542.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.62
|
| Rate for Payer: Nomi Health Commercial |
$592.93
|
| Rate for Payer: PHP Commercial |
$614.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.00
|
| Rate for Payer: Priority Health HMO/PPO |
$629.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$484.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$636.31
|
| Rate for Payer: UHC Core |
$603.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$542.31
|
|
|
HC ENDOMETR BX CONJUNCT W/COLP
|
Facility
|
OP
|
$723.08
|
|
|
Service Code
|
CPT 58110
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.73 |
| Max. Negotiated Rate |
$650.77 |
| Rate for Payer: Aetna Commercial |
$614.62
|
| Rate for Payer: Aetna Medicare |
$188.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.96
|
| Rate for Payer: BCBS Complete |
$289.23
|
| Rate for Payer: BCBS MAPPO |
$180.77
|
| Rate for Payer: BCBS Trust/PPO |
$594.44
|
| Rate for Payer: BCN Commercial |
$562.19
|
| Rate for Payer: BCN Medicare Advantage |
$180.77
|
| Rate for Payer: Cash Price |
$578.46
|
| Rate for Payer: Cofinity Commercial |
$621.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$578.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.77
|
| Rate for Payer: Healthscope Commercial |
$650.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$542.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$614.62
|
| Rate for Payer: Nomi Health Commercial |
$592.93
|
| Rate for Payer: PACE Senior Care Partners |
$171.73
|
| Rate for Payer: PACE SWMI |
$180.77
|
| Rate for Payer: PHP Commercial |
$614.62
|
| Rate for Payer: PHP Medicare Advantage |
$180.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.00
|
| Rate for Payer: Priority Health HMO/PPO |
$629.08
|
| Rate for Payer: Priority Health Medicare |
$182.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$484.46
|
| Rate for Payer: Railroad Medicare Medicare |
$180.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$636.31
|
| Rate for Payer: UHC Core |
$603.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.77
|
| Rate for Payer: UHC Exchange |
$180.77
|
| Rate for Payer: UHC Medicare Advantage |
$180.77
|
| Rate for Payer: VA VA |
$180.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$542.31
|
|
|
HC ENDOMETRIAL SAMPLING
|
Facility
|
OP
|
$219.52
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$197.57 |
| Rate for Payer: Aetna Commercial |
$186.59
|
| Rate for Payer: Aetna Medicare |
$57.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.60
|
| Rate for Payer: BCBS Complete |
$152.73
|
| Rate for Payer: BCBS MAPPO |
$54.88
|
| Rate for Payer: BCBS Trust/PPO |
$180.47
|
| Rate for Payer: BCN Commercial |
$170.68
|
| Rate for Payer: BCN Medicare Advantage |
$54.88
|
| Rate for Payer: Cash Price |
$175.62
|
| Rate for Payer: Cash Price |
$175.62
|
| Rate for Payer: Cofinity Commercial |
$188.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.88
|
| Rate for Payer: Healthscope Commercial |
$197.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.64
|
| Rate for Payer: Mclaren Medicaid |
$145.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.62
|
| Rate for Payer: Meridian Medicaid |
$152.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.59
|
| Rate for Payer: Nomi Health Commercial |
$180.01
|
| Rate for Payer: PACE Senior Care Partners |
$52.14
|
| Rate for Payer: PACE SWMI |
$54.88
|
| Rate for Payer: PHP Commercial |
$186.59
|
| Rate for Payer: PHP Medicare Advantage |
$54.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.69
|
| Rate for Payer: Priority Health HMO/PPO |
$190.98
|
| Rate for Payer: Priority Health Medicare |
$55.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.08
|
| Rate for Payer: Railroad Medicare Medicare |
$54.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.18
|
| Rate for Payer: UHC Core |
$183.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.88
|
| Rate for Payer: UHC Exchange |
$54.88
|
| Rate for Payer: UHC Medicare Advantage |
$54.88
|
| Rate for Payer: UHCCP Medicaid |
$145.45
|
| Rate for Payer: VA VA |
$54.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.64
|
|
|
HC ENDOMETRIAL SAMPLING
|
Facility
|
IP
|
$219.52
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
76100141
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$197.57 |
| Rate for Payer: Aetna Commercial |
$186.59
|
| Rate for Payer: BCBS Trust/PPO |
$179.19
|
| Rate for Payer: BCN Commercial |
$169.65
|
| Rate for Payer: Cash Price |
$175.62
|
| Rate for Payer: Cofinity Commercial |
$188.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.62
|
| Rate for Payer: Healthscope Commercial |
$197.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.59
|
| Rate for Payer: Nomi Health Commercial |
$180.01
|
| Rate for Payer: PHP Commercial |
$186.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.69
|
| Rate for Payer: Priority Health HMO/PPO |
$190.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.18
|
| Rate for Payer: UHC Core |
$183.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.64
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
IP
|
$2,865.80
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,862.77 |
| Max. Negotiated Rate |
$2,579.22 |
| Rate for Payer: Aetna Commercial |
$2,435.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,339.35
|
| Rate for Payer: BCN Commercial |
$2,214.69
|
| Rate for Payer: Cash Price |
$2,292.64
|
| Rate for Payer: Cofinity Commercial |
$2,464.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.64
|
| Rate for Payer: Healthscope Commercial |
$2,579.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,149.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,435.93
|
| Rate for Payer: Nomi Health Commercial |
$2,349.96
|
| Rate for Payer: PHP Commercial |
$2,435.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,862.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2,493.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,920.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,521.90
|
| Rate for Payer: UHC Core |
$2,392.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,149.35
|
|
|
HC ENDOMYOCARDIAL BIOPSY
|
Facility
|
OP
|
$2,865.80
|
|
|
Service Code
|
CPT 93505
|
| Hospital Charge Code |
48100025
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$680.63 |
| Max. Negotiated Rate |
$2,579.22 |
| Rate for Payer: Aetna Commercial |
$2,435.93
|
| Rate for Payer: Aetna Medicare |
$745.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$895.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$895.56
|
| Rate for Payer: BCBS Complete |
$2,389.58
|
| Rate for Payer: BCBS MAPPO |
$716.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,355.97
|
| Rate for Payer: BCN Commercial |
$2,228.16
|
| Rate for Payer: BCN Medicare Advantage |
$716.45
|
| Rate for Payer: Cash Price |
$2,292.64
|
| Rate for Payer: Cash Price |
$2,292.64
|
| Rate for Payer: Cofinity Commercial |
$2,464.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,292.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.45
|
| Rate for Payer: Healthscope Commercial |
$2,579.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,149.35
|
| Rate for Payer: Mclaren Medicaid |
$2,275.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.27
|
| Rate for Payer: Meridian Medicaid |
$2,389.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$823.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,435.93
|
| Rate for Payer: Nomi Health Commercial |
$2,349.96
|
| Rate for Payer: PACE Senior Care Partners |
$680.63
|
| Rate for Payer: PACE SWMI |
$716.45
|
| Rate for Payer: PHP Commercial |
$2,435.93
|
| Rate for Payer: PHP Medicare Advantage |
$716.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,275.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,862.77
|
| Rate for Payer: Priority Health HMO/PPO |
$2,493.25
|
| Rate for Payer: Priority Health Medicare |
$723.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,920.09
|
| Rate for Payer: Railroad Medicare Medicare |
$716.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,521.90
|
| Rate for Payer: UHC Core |
$2,392.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.45
|
| Rate for Payer: UHC Exchange |
$716.45
|
| Rate for Payer: UHC Medicare Advantage |
$716.45
|
| Rate for Payer: UHCCP Medicaid |
$2,275.64
|
| Rate for Payer: VA VA |
$716.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,149.35
|
|
|
HC ENDOMYSIAL IGA ANTIBODY.
|
Facility
|
IP
|
$80.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200426
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.07 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: BCBS Trust/PPO |
$65.39
|
| Rate for Payer: BCN Commercial |
$61.91
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Healthscope Commercial |
$72.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Nomi Health Commercial |
$65.69
|
| Rate for Payer: PHP Commercial |
$68.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.07
|
| Rate for Payer: Priority Health HMO/PPO |
$69.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.50
|
| Rate for Payer: UHC Core |
$66.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.08
|
|
|
HC ENDOMYSIAL IGA ANTIBODY.
|
Facility
|
OP
|
$80.11
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200426
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: Aetna Medicare |
$20.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.03
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$20.03
|
| Rate for Payer: BCBS Trust/PPO |
$65.86
|
| Rate for Payer: BCN Commercial |
$62.29
|
| Rate for Payer: BCN Medicare Advantage |
$20.03
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$72.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.08
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.03
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Nomi Health Commercial |
$65.69
|
| Rate for Payer: PACE Senior Care Partners |
$19.03
|
| Rate for Payer: PACE SWMI |
$20.03
|
| Rate for Payer: PHP Commercial |
$68.09
|
| Rate for Payer: PHP Medicare Advantage |
$20.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.07
|
| Rate for Payer: Priority Health HMO/PPO |
$69.70
|
| Rate for Payer: Priority Health Medicare |
$20.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.67
|
| Rate for Payer: Railroad Medicare Medicare |
$20.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.50
|
| Rate for Payer: UHC Core |
$66.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.03
|
| Rate for Payer: UHC Exchange |
$20.03
|
| Rate for Payer: UHC Medicare Advantage |
$20.03
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$20.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.08
|
|
|
HC ENDOMYSIAL IGA TITER.
|
Facility
|
IP
|
$160.04
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
30200494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$104.03 |
| Max. Negotiated Rate |
$144.04 |
| Rate for Payer: Aetna Commercial |
$136.03
|
| Rate for Payer: BCBS Trust/PPO |
$130.64
|
| Rate for Payer: BCN Commercial |
$123.68
|
| Rate for Payer: Cash Price |
$128.03
|
| Rate for Payer: Cofinity Commercial |
$137.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.03
|
| Rate for Payer: Healthscope Commercial |
$144.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.03
|
| Rate for Payer: Nomi Health Commercial |
$131.23
|
| Rate for Payer: PHP Commercial |
$136.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.03
|
| Rate for Payer: Priority Health HMO/PPO |
$139.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.84
|
| Rate for Payer: UHC Core |
$133.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.03
|
|
|
HC ENDOMYSIAL IGA TITER.
|
Facility
|
OP
|
$160.04
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
30200494
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$144.04 |
| Rate for Payer: Aetna Commercial |
$136.03
|
| Rate for Payer: Aetna Medicare |
$41.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.01
|
| Rate for Payer: BCBS Complete |
$9.18
|
| Rate for Payer: BCBS MAPPO |
$40.01
|
| Rate for Payer: BCBS Trust/PPO |
$131.57
|
| Rate for Payer: BCN Commercial |
$124.43
|
| Rate for Payer: BCN Medicare Advantage |
$40.01
|
| Rate for Payer: Cash Price |
$128.03
|
| Rate for Payer: Cash Price |
$128.03
|
| Rate for Payer: Cofinity Commercial |
$137.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.01
|
| Rate for Payer: Healthscope Commercial |
$144.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.03
|
| Rate for Payer: Mclaren Medicaid |
$8.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.01
|
| Rate for Payer: Meridian Medicaid |
$9.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.03
|
| Rate for Payer: Nomi Health Commercial |
$131.23
|
| Rate for Payer: PACE Senior Care Partners |
$38.01
|
| Rate for Payer: PACE SWMI |
$40.01
|
| Rate for Payer: PHP Commercial |
$136.03
|
| Rate for Payer: PHP Medicare Advantage |
$40.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.03
|
| Rate for Payer: Priority Health HMO/PPO |
$139.23
|
| Rate for Payer: Priority Health Medicare |
$40.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.23
|
| Rate for Payer: Railroad Medicare Medicare |
$40.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.84
|
| Rate for Payer: UHC Core |
$133.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.01
|
| Rate for Payer: UHC Exchange |
$40.01
|
| Rate for Payer: UHC Medicare Advantage |
$40.01
|
| Rate for Payer: UHCCP Medicaid |
$8.74
|
| Rate for Payer: VA VA |
$40.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.03
|
|
|
HC ENDOPLEGE
|
Facility
|
OP
|
$5,298.73
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,258.45 |
| Max. Negotiated Rate |
$4,768.86 |
| Rate for Payer: Aetna Commercial |
$4,503.92
|
| Rate for Payer: Aetna Medicare |
$1,377.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,655.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,655.85
|
| Rate for Payer: BCBS Complete |
$2,119.49
|
| Rate for Payer: BCBS MAPPO |
$1,324.68
|
| Rate for Payer: BCBS Trust/PPO |
$4,356.09
|
| Rate for Payer: BCN Commercial |
$4,119.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,324.68
|
| Rate for Payer: Cash Price |
$4,238.98
|
| Rate for Payer: Cofinity Commercial |
$4,556.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,238.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,324.68
|
| Rate for Payer: Healthscope Commercial |
$4,768.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,974.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,390.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,523.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,503.92
|
| Rate for Payer: Nomi Health Commercial |
$4,344.96
|
| Rate for Payer: PACE Senior Care Partners |
$1,258.45
|
| Rate for Payer: PACE SWMI |
$1,324.68
|
| Rate for Payer: PHP Commercial |
$4,503.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,324.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,444.17
|
| Rate for Payer: Priority Health HMO/PPO |
$4,609.90
|
| Rate for Payer: Priority Health Medicare |
$1,337.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,550.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,324.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,662.88
|
| Rate for Payer: UHC Core |
$4,424.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,324.68
|
| Rate for Payer: UHC Exchange |
$1,324.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,324.68
|
| Rate for Payer: VA VA |
$1,324.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,974.05
|
|
|
HC ENDOPLEGE
|
Facility
|
IP
|
$5,298.73
|
|
| Hospital Charge Code |
27000098
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,444.17 |
| Max. Negotiated Rate |
$4,768.86 |
| Rate for Payer: Aetna Commercial |
$4,503.92
|
| Rate for Payer: BCBS Trust/PPO |
$4,325.35
|
| Rate for Payer: BCN Commercial |
$4,094.86
|
| Rate for Payer: Cash Price |
$4,238.98
|
| Rate for Payer: Cofinity Commercial |
$4,556.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,238.98
|
| Rate for Payer: Healthscope Commercial |
$4,768.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,974.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,503.92
|
| Rate for Payer: Nomi Health Commercial |
$4,344.96
|
| Rate for Payer: PHP Commercial |
$4,503.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,444.17
|
| Rate for Payer: Priority Health HMO/PPO |
$4,609.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,550.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,662.88
|
| Rate for Payer: UHC Core |
$4,424.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,974.05
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
IP
|
$9,474.00
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,158.10 |
| Max. Negotiated Rate |
$8,526.60 |
| Rate for Payer: Aetna Commercial |
$8,052.90
|
| Rate for Payer: BCBS Trust/PPO |
$7,733.63
|
| Rate for Payer: BCN Commercial |
$7,321.51
|
| Rate for Payer: Cash Price |
$7,579.20
|
| Rate for Payer: Cofinity Commercial |
$8,147.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,579.20
|
| Rate for Payer: Healthscope Commercial |
$8,526.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,105.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,052.90
|
| Rate for Payer: Nomi Health Commercial |
$7,768.68
|
| Rate for Payer: PHP Commercial |
$8,052.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,158.10
|
| Rate for Payer: Priority Health HMO/PPO |
$8,242.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,347.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,337.12
|
| Rate for Payer: UHC Core |
$7,910.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,105.50
|
|
|
HC ENDOSC INJ IMPLT MATRL URT &/BLDR NECK
|
Facility
|
OP
|
$9,474.00
|
|
|
Service Code
|
CPT 51715
|
| Hospital Charge Code |
76100356
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,250.07 |
| Max. Negotiated Rate |
$8,526.60 |
| Rate for Payer: Aetna Commercial |
$8,052.90
|
| Rate for Payer: Aetna Medicare |
$2,463.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,960.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,960.62
|
| Rate for Payer: BCBS Complete |
$2,618.46
|
| Rate for Payer: BCBS MAPPO |
$2,368.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,788.58
|
| Rate for Payer: BCN Commercial |
$7,366.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,368.50
|
| Rate for Payer: Cash Price |
$7,579.20
|
| Rate for Payer: Cash Price |
$7,579.20
|
| Rate for Payer: Cofinity Commercial |
$8,147.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,579.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,368.50
|
| Rate for Payer: Healthscope Commercial |
$8,526.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,105.50
|
| Rate for Payer: Mclaren Medicaid |
$2,493.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,486.93
|
| Rate for Payer: Meridian Medicaid |
$2,618.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,723.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,052.90
|
| Rate for Payer: Nomi Health Commercial |
$7,768.68
|
| Rate for Payer: PACE Senior Care Partners |
$2,250.07
|
| Rate for Payer: PACE SWMI |
$2,368.50
|
| Rate for Payer: PHP Commercial |
$8,052.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,368.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,493.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,158.10
|
| Rate for Payer: Priority Health HMO/PPO |
$8,242.38
|
| Rate for Payer: Priority Health Medicare |
$2,392.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,347.58
|
| Rate for Payer: Railroad Medicare Medicare |
$2,368.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,337.12
|
| Rate for Payer: UHC Core |
$7,910.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,368.50
|
| Rate for Payer: UHC Exchange |
$2,368.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,368.50
|
| Rate for Payer: UHCCP Medicaid |
$2,493.61
|
| Rate for Payer: VA VA |
$2,368.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,105.50
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna Commercial |
$420.75
|
| Rate for Payer: BCBS Trust/PPO |
$404.07
|
| Rate for Payer: BCN Commercial |
$382.54
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$425.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$445.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: Nomi Health Commercial |
$405.90
|
| Rate for Payer: PHP Commercial |
$420.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: Priority Health HMO/PPO |
$430.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.60
|
| Rate for Payer: UHC Core |
$413.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.25
|
|
|
HC ENDOSCOPE SINGLE USE URINARY TRACT
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
27200351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.56 |
| Max. Negotiated Rate |
$445.50 |
| Rate for Payer: Aetna Commercial |
$420.75
|
| Rate for Payer: Aetna Medicare |
$128.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.69
|
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: BCBS MAPPO |
$123.75
|
| Rate for Payer: BCBS Trust/PPO |
$406.94
|
| Rate for Payer: BCN Commercial |
$384.86
|
| Rate for Payer: BCN Medicare Advantage |
$123.75
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$425.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.75
|
| Rate for Payer: Healthscope Commercial |
$445.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.75
|
| Rate for Payer: Nomi Health Commercial |
$405.90
|
| Rate for Payer: PACE Senior Care Partners |
$117.56
|
| Rate for Payer: PACE SWMI |
$123.75
|
| Rate for Payer: PHP Commercial |
$420.75
|
| Rate for Payer: PHP Medicare Advantage |
$123.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: Priority Health HMO/PPO |
$430.65
|
| Rate for Payer: Priority Health Medicare |
$124.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.65
|
| Rate for Payer: Railroad Medicare Medicare |
$123.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.60
|
| Rate for Payer: UHC Core |
$413.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.75
|
| Rate for Payer: UHC Exchange |
$123.75
|
| Rate for Payer: UHC Medicare Advantage |
$123.75
|
| Rate for Payer: VA VA |
$123.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.25
|
|
