|
HC HYDROXYPREGNENOLONE 17
|
Facility
|
IP
|
$88.74
|
|
|
Service Code
|
CPT 84143
|
| Hospital Charge Code |
30100399
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$79.87 |
| Rate for Payer: Aetna Commercial |
$75.43
|
| Rate for Payer: BCBS Trust/PPO |
$72.44
|
| Rate for Payer: BCN Commercial |
$68.58
|
| Rate for Payer: Cash Price |
$70.99
|
| Rate for Payer: Cofinity Commercial |
$76.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.99
|
| Rate for Payer: Healthscope Commercial |
$79.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.43
|
| Rate for Payer: Nomi Health Commercial |
$72.77
|
| Rate for Payer: PHP Commercial |
$75.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.68
|
| Rate for Payer: Priority Health HMO/PPO |
$77.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.09
|
| Rate for Payer: UHC Core |
$74.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.56
|
|
|
HC HYDROXYPROGESTERONE 17
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
30100249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna Medicare |
$11.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.38
|
| Rate for Payer: BCBS Complete |
$20.63
|
| Rate for Payer: BCBS MAPPO |
$11.50
|
| Rate for Payer: BCBS Trust/PPO |
$37.82
|
| Rate for Payer: BCN Commercial |
$35.77
|
| Rate for Payer: BCN Medicare Advantage |
$11.50
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.50
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.50
|
| Rate for Payer: Mclaren Medicaid |
$19.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.07
|
| Rate for Payer: Meridian Medicaid |
$20.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: Nomi Health Commercial |
$37.72
|
| Rate for Payer: PACE Senior Care Partners |
$10.93
|
| Rate for Payer: PACE SWMI |
$11.50
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: PHP Medicare Advantage |
$11.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health HMO/PPO |
$40.02
|
| Rate for Payer: Priority Health Medicare |
$11.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.82
|
| Rate for Payer: Railroad Medicare Medicare |
$11.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.48
|
| Rate for Payer: UHC Core |
$38.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.50
|
| Rate for Payer: UHC Exchange |
$11.50
|
| Rate for Payer: UHC Medicare Advantage |
$11.50
|
| Rate for Payer: UHCCP Medicaid |
$19.64
|
| Rate for Payer: VA VA |
$11.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.50
|
|
|
HC HYDROXYPROGESTERONE 17
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
30100249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: BCBS Trust/PPO |
$37.55
|
| Rate for Payer: BCN Commercial |
$35.55
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.10
|
| Rate for Payer: Nomi Health Commercial |
$37.72
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health HMO/PPO |
$40.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.48
|
| Rate for Payer: UHC Core |
$38.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.50
|
|
|
HC HYPERSENSITIVITY PNEUMO-CMPTS
|
Facility
|
IP
|
$28.09
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200270
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$22.93
|
| Rate for Payer: BCN Commercial |
$21.71
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: Nomi Health Commercial |
$23.03
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health HMO/PPO |
$24.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.72
|
| Rate for Payer: UHC Core |
$23.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.07
|
|
|
HC HYPERSENSITIVITY PNEUMO-CMPTS
|
Facility
|
OP
|
$28.09
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
30200270
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$7.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.78
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$7.02
|
| Rate for Payer: BCBS Trust/PPO |
$23.09
|
| Rate for Payer: BCN Commercial |
$21.84
|
| Rate for Payer: BCN Medicare Advantage |
$7.02
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.07
|
| Rate for Payer: Mclaren Medicaid |
$8.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.37
|
| Rate for Payer: Meridian Medicaid |
$9.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: Nomi Health Commercial |
$23.03
|
| Rate for Payer: PACE Senior Care Partners |
$6.67
|
| Rate for Payer: PACE SWMI |
$7.02
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: PHP Medicare Advantage |
$7.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health HMO/PPO |
$24.44
|
| Rate for Payer: Priority Health Medicare |
$7.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.72
|
| Rate for Payer: UHC Core |
$23.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.02
|
| Rate for Payer: UHC Exchange |
$7.02
|
| Rate for Payer: UHC Medicare Advantage |
$7.02
|
| Rate for Payer: UHCCP Medicaid |
$8.86
|
| Rate for Payer: VA VA |
$7.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.07
|
|
|
HC HYPERSENSITIVITY PNEUMONITIS P
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
30200223
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: BCBS Trust/PPO |
$23.78
|
| Rate for Payer: BCN Commercial |
$22.51
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO |
$25.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.63
|
| Rate for Payer: UHC Core |
$24.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC HYPERSENSITIVITY PNEUMONITIS P
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
CPT 86606
|
| Hospital Charge Code |
30200223
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.10
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS MAPPO |
$7.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.95
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: BCN Medicare Advantage |
$7.28
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Mclaren Medicaid |
$10.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.65
|
| Rate for Payer: Meridian Medicaid |
$11.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PACE Senior Care Partners |
$6.92
|
| Rate for Payer: PACE SWMI |
$7.28
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: PHP Medicare Advantage |
$7.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO |
$25.34
|
| Rate for Payer: Priority Health Medicare |
$7.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.52
|
| Rate for Payer: Railroad Medicare Medicare |
$7.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.63
|
| Rate for Payer: UHC Core |
$24.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.28
|
| Rate for Payer: UHC Exchange |
$7.28
|
| Rate for Payer: UHC Medicare Advantage |
$7.28
|
| Rate for Payer: UHCCP Medicaid |
$10.88
|
| Rate for Payer: VA VA |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC HYPERSENSITIVITY PNEUMO PANEL
|
Facility
|
OP
|
$22.75
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna Commercial |
$19.34
|
| Rate for Payer: Aetna Medicare |
$5.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.11
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS MAPPO |
$5.69
|
| Rate for Payer: BCBS Trust/PPO |
$18.70
|
| Rate for Payer: BCN Commercial |
$17.69
|
| Rate for Payer: BCN Medicare Advantage |
$5.69
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.69
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.06
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.97
|
| Rate for Payer: Meridian Medicaid |
$5.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: PACE Senior Care Partners |
$5.40
|
| Rate for Payer: PACE SWMI |
$5.69
|
| Rate for Payer: PHP Commercial |
$19.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.79
|
| Rate for Payer: Priority Health HMO/PPO |
$19.79
|
| Rate for Payer: Priority Health Medicare |
$5.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.24
|
| Rate for Payer: Railroad Medicare Medicare |
$5.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.02
|
| Rate for Payer: UHC Core |
$19.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.69
|
| Rate for Payer: UHC Exchange |
$5.69
|
| Rate for Payer: UHC Medicare Advantage |
$5.69
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: VA VA |
$5.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.06
|
|
|
HC HYPERSENSITIVITY PNEUMO PANEL
|
Facility
|
IP
|
$22.75
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
30200496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.79 |
| Max. Negotiated Rate |
$20.48 |
| Rate for Payer: Aetna Commercial |
$19.34
|
| Rate for Payer: BCBS Trust/PPO |
$18.57
|
| Rate for Payer: BCN Commercial |
$17.58
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$19.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Healthscope Commercial |
$20.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Nomi Health Commercial |
$18.66
|
| Rate for Payer: PHP Commercial |
$19.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.79
|
| Rate for Payer: Priority Health HMO/PPO |
$19.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.02
|
| Rate for Payer: UHC Core |
$19.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.06
|
|
|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$4,093.79
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$972.28 |
| Max. Negotiated Rate |
$3,684.41 |
| Rate for Payer: Aetna Commercial |
$3,479.72
|
| Rate for Payer: Aetna Medicare |
$1,064.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,279.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,279.31
|
| Rate for Payer: BCBS Complete |
$2,413.90
|
| Rate for Payer: BCBS MAPPO |
$1,023.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,365.50
|
| Rate for Payer: BCN Commercial |
$3,182.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.45
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$3,520.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.45
|
| Rate for Payer: Healthscope Commercial |
$3,684.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,070.34
|
| Rate for Payer: Mclaren Medicaid |
$2,298.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,074.62
|
| Rate for Payer: Meridian Medicaid |
$2,413.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,176.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: Nomi Health Commercial |
$3,356.91
|
| Rate for Payer: PACE Senior Care Partners |
$972.28
|
| Rate for Payer: PACE SWMI |
$1,023.45
|
| Rate for Payer: PHP Commercial |
$3,479.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: Priority Health HMO/PPO |
$3,561.60
|
| Rate for Payer: Priority Health Medicare |
$1,033.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,742.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,023.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,602.54
|
| Rate for Payer: UHC Core |
$3,418.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,023.45
|
| Rate for Payer: UHC Exchange |
$1,023.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,023.45
|
| Rate for Payer: UHCCP Medicaid |
$2,298.80
|
| Rate for Payer: VA VA |
$1,023.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,070.34
|
|
|
HC HYSTEROSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$4,093.79
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
76100303
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,660.96 |
| Max. Negotiated Rate |
$3,684.41 |
| Rate for Payer: Aetna Commercial |
$3,479.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,341.76
|
| Rate for Payer: BCN Commercial |
$3,163.68
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$3,520.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Healthscope Commercial |
$3,684.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,070.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: Nomi Health Commercial |
$3,356.91
|
| Rate for Payer: PHP Commercial |
$3,479.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: Priority Health HMO/PPO |
$3,561.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,742.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,602.54
|
| Rate for Payer: UHC Core |
$3,418.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,070.34
|
|
|
HC HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
OP
|
$13,353.53
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
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 HYSTEROSCOPY ENDOMETR ABLATION
|
Facility
|
IP
|
$13,353.53
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
76100340
|
|
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 HYSTEROSCOPY REMOVE FB
|
Facility
|
IP
|
$7,945.53
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,164.59 |
| Max. Negotiated Rate |
$7,150.98 |
| Rate for Payer: Aetna Commercial |
$6,753.70
|
| Rate for Payer: BCBS Trust/PPO |
$6,485.94
|
| Rate for Payer: BCN Commercial |
$6,140.31
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$6,833.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Healthscope Commercial |
$7,150.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,959.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: PHP Commercial |
$6,753.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO |
$6,912.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,323.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,992.07
|
| Rate for Payer: UHC Core |
$6,634.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,959.15
|
|
|
HC HYSTEROSCOPY REMOVE FB
|
Facility
|
OP
|
$7,945.53
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
76100339
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,887.06 |
| Max. Negotiated Rate |
$7,150.98 |
| Rate for Payer: Aetna Commercial |
$6,753.70
|
| Rate for Payer: Aetna Medicare |
$2,065.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,482.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,482.98
|
| Rate for Payer: BCBS Complete |
$2,413.90
|
| Rate for Payer: BCBS MAPPO |
$1,986.38
|
| Rate for Payer: BCBS Trust/PPO |
$6,532.02
|
| Rate for Payer: BCN Commercial |
$6,177.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,986.38
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cash Price |
$6,356.42
|
| Rate for Payer: Cofinity Commercial |
$6,833.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,986.38
|
| Rate for Payer: Healthscope Commercial |
$7,150.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,959.15
|
| Rate for Payer: Mclaren Medicaid |
$2,298.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,085.70
|
| Rate for Payer: Meridian Medicaid |
$2,413.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,284.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,753.70
|
| Rate for Payer: Nomi Health Commercial |
$6,515.33
|
| Rate for Payer: PACE Senior Care Partners |
$1,887.06
|
| Rate for Payer: PACE SWMI |
$1,986.38
|
| Rate for Payer: PHP Commercial |
$6,753.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,986.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,164.59
|
| Rate for Payer: Priority Health HMO/PPO |
$6,912.61
|
| Rate for Payer: Priority Health Medicare |
$2,006.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,323.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1,986.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,992.07
|
| Rate for Payer: UHC Core |
$6,634.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,986.38
|
| Rate for Payer: UHC Exchange |
$1,986.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,986.38
|
| Rate for Payer: UHCCP Medicaid |
$2,298.80
|
| Rate for Payer: VA VA |
$1,986.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,959.15
|
|
|
HC HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
IP
|
$13,353.53
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
76100338
|
|
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 HYSTEROSCOPY REMOVE MYOMA
|
Facility
|
OP
|
$13,353.53
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
76100338
|
|
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 HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
IP
|
$13,353.53
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
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 HYSTEROSCOPY RESECT SEPTUM
|
Facility
|
OP
|
$13,353.53
|
|
|
Service Code
|
CPT 58560
|
| Hospital Charge Code |
76100337
|
|
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 HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
IP
|
$4,093.79
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,660.96 |
| Max. Negotiated Rate |
$3,684.41 |
| Rate for Payer: Aetna Commercial |
$3,479.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,341.76
|
| Rate for Payer: BCN Commercial |
$3,163.68
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$3,520.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Healthscope Commercial |
$3,684.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,070.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: Nomi Health Commercial |
$3,356.91
|
| Rate for Payer: PHP Commercial |
$3,479.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: Priority Health HMO/PPO |
$3,561.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,742.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,602.54
|
| Rate for Payer: UHC Core |
$3,418.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,070.34
|
|
|
HC HYSTEROSCOPY W BX AND/OR POLYPECTOMY W OR WO D&C
|
Facility
|
OP
|
$4,093.79
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
76100304
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$972.28 |
| Max. Negotiated Rate |
$3,684.41 |
| Rate for Payer: Aetna Commercial |
$3,479.72
|
| Rate for Payer: Aetna Medicare |
$1,064.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,279.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,279.31
|
| Rate for Payer: BCBS Complete |
$2,413.90
|
| Rate for Payer: BCBS MAPPO |
$1,023.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,365.50
|
| Rate for Payer: BCN Commercial |
$3,182.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.45
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cash Price |
$3,275.03
|
| Rate for Payer: Cofinity Commercial |
$3,520.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,275.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.45
|
| Rate for Payer: Healthscope Commercial |
$3,684.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,070.34
|
| Rate for Payer: Mclaren Medicaid |
$2,298.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,074.62
|
| Rate for Payer: Meridian Medicaid |
$2,413.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,176.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,479.72
|
| Rate for Payer: Nomi Health Commercial |
$3,356.91
|
| Rate for Payer: PACE Senior Care Partners |
$972.28
|
| Rate for Payer: PACE SWMI |
$1,023.45
|
| Rate for Payer: PHP Commercial |
$3,479.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,660.96
|
| Rate for Payer: Priority Health HMO/PPO |
$3,561.60
|
| Rate for Payer: Priority Health Medicare |
$1,033.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,742.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,023.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,602.54
|
| Rate for Payer: UHC Core |
$3,418.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,023.45
|
| Rate for Payer: UHC Exchange |
$1,023.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,023.45
|
| Rate for Payer: UHCCP Medicaid |
$2,298.80
|
| Rate for Payer: VA VA |
$1,023.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,070.34
|
|
|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
OP
|
$105.67
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$25.10 |
| 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 |
$42.27
|
| 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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.74
|
| 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 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: VA VA |
$26.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.25
|
|
|
HC I-123 CAPSULE PER 100 UCI
|
Facility
|
IP
|
$105.67
|
|
|
Service Code
|
HCPCS A9516
|
| Hospital Charge Code |
34300009
|
|
Hospital Revenue Code
|
343
|
| 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 I-123 MIBG PER STUDY
|
Facility
|
IP
|
$12,176.80
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7,914.92 |
| Max. Negotiated Rate |
$10,959.12 |
| Rate for Payer: Aetna Commercial |
$10,350.28
|
| Rate for Payer: BCBS Trust/PPO |
$9,939.92
|
| Rate for Payer: BCN Commercial |
$9,410.23
|
| Rate for Payer: Cash Price |
$9,741.44
|
| Rate for Payer: Cofinity Commercial |
$10,472.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,741.44
|
| Rate for Payer: Healthscope Commercial |
$10,959.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,132.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,350.28
|
| Rate for Payer: Nomi Health Commercial |
$9,984.98
|
| Rate for Payer: PHP Commercial |
$10,350.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,914.92
|
| Rate for Payer: Priority Health HMO/PPO |
$10,593.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,158.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,715.58
|
| Rate for Payer: UHC Core |
$10,167.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,132.60
|
|
|
HC I-123 MIBG PER STUDY
|
Facility
|
OP
|
$12,176.80
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
34300010
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,500.09 |
| Max. Negotiated Rate |
$10,959.12 |
| Rate for Payer: Aetna Commercial |
$10,350.28
|
| Rate for Payer: Aetna Medicare |
$3,165.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,805.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,805.25
|
| Rate for Payer: BCBS Complete |
$1,575.20
|
| Rate for Payer: BCBS MAPPO |
$3,044.20
|
| Rate for Payer: BCBS Trust/PPO |
$10,010.55
|
| Rate for Payer: BCN Commercial |
$9,467.46
|
| Rate for Payer: BCN Medicare Advantage |
$3,044.20
|
| Rate for Payer: Cash Price |
$9,741.44
|
| Rate for Payer: Cash Price |
$9,741.44
|
| Rate for Payer: Cofinity Commercial |
$10,472.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,741.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,044.20
|
| Rate for Payer: Healthscope Commercial |
$10,959.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,132.60
|
| Rate for Payer: Mclaren Medicaid |
$1,500.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,196.41
|
| Rate for Payer: Meridian Medicaid |
$1,575.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,500.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,350.28
|
| Rate for Payer: Nomi Health Commercial |
$9,984.98
|
| Rate for Payer: PACE Senior Care Partners |
$2,891.99
|
| Rate for Payer: PACE SWMI |
$3,044.20
|
| Rate for Payer: PHP Commercial |
$10,350.28
|
| Rate for Payer: PHP Medicare Advantage |
$3,044.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,500.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,914.92
|
| Rate for Payer: Priority Health HMO/PPO |
$10,593.82
|
| Rate for Payer: Priority Health Medicare |
$3,074.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,158.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3,044.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,715.58
|
| Rate for Payer: UHC Core |
$10,167.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,044.20
|
| Rate for Payer: UHC Exchange |
$3,044.20
|
| Rate for Payer: UHC Medicare Advantage |
$3,044.20
|
| Rate for Payer: UHCCP Medicaid |
$1,500.09
|
| Rate for Payer: VA VA |
$3,044.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,132.60
|
|
