|
HC TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.55 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Aetna Commercial |
$1,118.60
|
| Rate for Payer: Aetna Medicare |
$342.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.25
|
| Rate for Payer: BCBS Complete |
$378.97
|
| Rate for Payer: BCBS MAPPO |
$329.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,023.19
|
| Rate for Payer: BCN Commercial |
$1,023.19
|
| Rate for Payer: BCN Medicare Advantage |
$329.00
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,131.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$1,184.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$987.00
|
| Rate for Payer: Mclaren Medicaid |
$360.93
|
| Rate for Payer: Meridian Medicaid |
$378.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$345.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,118.60
|
| Rate for Payer: PACE Senior Care Partners |
$312.55
|
| Rate for Payer: PACE SWMI |
$329.00
|
| Rate for Payer: PHP Commercial |
$1,118.60
|
| Rate for Payer: PHP Medicare Advantage |
$329.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,144.92
|
| Rate for Payer: Priority Health Medicare |
$329.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$802.63
|
| Rate for Payer: Railroad Medicare Medicare |
$329.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,158.08
|
| Rate for Payer: UHC Core |
$1,098.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.00
|
| Rate for Payer: UHC Medicare Advantage |
$338.87
|
| Rate for Payer: VA VA |
$329.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$987.00
|
|
|
HC TYMPANOSTOMY LOCAL/TOPICAL ANES
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$802.63 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Aetna Commercial |
$1,118.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,017.00
|
| Rate for Payer: BCN Commercial |
$1,017.00
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$1,131.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.80
|
| Rate for Payer: Healthscope Commercial |
$1,184.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$987.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,118.60
|
| Rate for Payer: PHP Commercial |
$1,118.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,144.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$802.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,158.08
|
| Rate for Payer: UHC Core |
$1,098.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$987.00
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
IP
|
$21.83
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: BCBS Trust/PPO |
$16.87
|
| Rate for Payer: BCN Commercial |
$16.87
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.21
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
|
|
HC TYPE & SCREEN ABO
|
Facility
|
OP
|
$21.83
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
30200347
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$87.99 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Medicare |
$5.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.82
|
| Rate for Payer: BCBS Complete |
$87.99
|
| Rate for Payer: BCBS MAPPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$16.97
|
| Rate for Payer: BCN Commercial |
$16.97
|
| Rate for Payer: BCN Medicare Advantage |
$5.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Mclaren Medicaid |
$83.80
|
| Rate for Payer: Meridian Medicaid |
$87.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PACE Senior Care Partners |
$5.18
|
| Rate for Payer: PACE SWMI |
$5.46
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Medicare Advantage |
$5.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.99
|
| Rate for Payer: Priority Health Medicare |
$5.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.31
|
| Rate for Payer: Railroad Medicare Medicare |
$5.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.21
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.46
|
| Rate for Payer: UHC Medicare Advantage |
$5.62
|
| Rate for Payer: VA VA |
$5.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
OP
|
$37.11
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial |
$31.54
|
| Rate for Payer: Aetna Medicare |
$9.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.60
|
| Rate for Payer: BCBS Complete |
$37.33
|
| Rate for Payer: BCBS MAPPO |
$9.28
|
| Rate for Payer: BCBS Trust/PPO |
$28.85
|
| Rate for Payer: BCN Commercial |
$28.85
|
| Rate for Payer: BCN Medicare Advantage |
$9.28
|
| Rate for Payer: Cash Price |
$29.69
|
| Rate for Payer: Cash Price |
$29.69
|
| Rate for Payer: Cofinity Commercial |
$31.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.28
|
| Rate for Payer: Healthscope Commercial |
$33.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.83
|
| Rate for Payer: Mclaren Medicaid |
$35.55
|
| Rate for Payer: Meridian Medicaid |
$37.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.54
|
| Rate for Payer: PACE Senior Care Partners |
$8.81
|
| Rate for Payer: PACE SWMI |
$9.28
|
| Rate for Payer: PHP Commercial |
$31.54
|
| Rate for Payer: PHP Medicare Advantage |
$9.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.29
|
| Rate for Payer: Priority Health Medicare |
$9.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.63
|
| Rate for Payer: Railroad Medicare Medicare |
$9.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.66
|
| Rate for Payer: UHC Core |
$30.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.28
|
| Rate for Payer: UHC Medicare Advantage |
$9.56
|
| Rate for Payer: VA VA |
$9.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.83
|
|
|
HC TYPE & SCREEN ANTIBODY
|
Facility
|
IP
|
$37.11
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
30200340
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$33.40 |
| Rate for Payer: Aetna Commercial |
$31.54
|
| Rate for Payer: BCBS Trust/PPO |
$28.68
|
| Rate for Payer: BCN Commercial |
$28.68
|
| Rate for Payer: Cash Price |
$29.69
|
| Rate for Payer: Cofinity Commercial |
$31.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.69
|
| Rate for Payer: Healthscope Commercial |
$33.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.54
|
| Rate for Payer: PHP Commercial |
$31.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.66
|
| Rate for Payer: UHC Core |
$30.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.83
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
IP
|
$2,750.00
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,677.22 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna Commercial |
$2,337.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,125.20
|
| Rate for Payer: BCN Commercial |
$2,125.20
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cofinity Commercial |
$2,365.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,200.00
|
| Rate for Payer: Healthscope Commercial |
$2,475.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,062.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,337.50
|
| Rate for Payer: PHP Commercial |
$2,337.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,392.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,677.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,420.00
|
| Rate for Payer: UHC Core |
$2,296.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,062.50
|
|
|
HC TYRX ANTIBACTERIAL POUCH
|
Facility
|
OP
|
$2,750.00
|
|
| Hospital Charge Code |
27800115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.12 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna Commercial |
$2,337.50
|
| Rate for Payer: Aetna Medicare |
$715.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$859.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$859.38
|
| Rate for Payer: BCBS Complete |
$1,100.00
|
| Rate for Payer: BCBS MAPPO |
$687.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,138.12
|
| Rate for Payer: BCN Commercial |
$2,138.12
|
| Rate for Payer: BCN Medicare Advantage |
$687.50
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cofinity Commercial |
$2,365.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,200.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.50
|
| Rate for Payer: Healthscope Commercial |
$2,475.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,062.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$721.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$790.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,337.50
|
| Rate for Payer: PACE Senior Care Partners |
$653.12
|
| Rate for Payer: PACE SWMI |
$687.50
|
| Rate for Payer: PHP Commercial |
$2,337.50
|
| Rate for Payer: PHP Medicare Advantage |
$687.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,925.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,392.50
|
| Rate for Payer: Priority Health Medicare |
$687.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,677.22
|
| Rate for Payer: Railroad Medicare Medicare |
$687.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,420.00
|
| Rate for Payer: UHC Core |
$2,296.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$687.50
|
| Rate for Payer: UHC Medicare Advantage |
$708.12
|
| Rate for Payer: VA VA |
$687.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,062.50
|
|
|
HC UA - KETONE
|
Facility
|
OP
|
$12.24
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.82
|
| Rate for Payer: BCBS Complete |
$2.70
|
| Rate for Payer: BCBS MAPPO |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$9.52
|
| Rate for Payer: BCN Commercial |
$9.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.06
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Mclaren Medicaid |
$2.57
|
| Rate for Payer: Meridian Medicaid |
$2.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PACE Senior Care Partners |
$2.91
|
| Rate for Payer: PACE SWMI |
$3.06
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Medicare |
$3.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.06
|
| Rate for Payer: UHC Medicare Advantage |
$3.15
|
| Rate for Payer: VA VA |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC UA - KETONE
|
Facility
|
IP
|
$12.24
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$7.47 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$9.46
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: BCBS Trust/PPO |
$63.85
|
| Rate for Payer: BCN Commercial |
$63.85
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.71
|
| Rate for Payer: UHC Core |
$68.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.96
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$21.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.82
|
| Rate for Payer: BCBS Complete |
$33.05
|
| Rate for Payer: BCBS MAPPO |
$20.66
|
| Rate for Payer: BCBS Trust/PPO |
$64.24
|
| Rate for Payer: BCN Commercial |
$64.24
|
| Rate for Payer: BCN Medicare Advantage |
$20.66
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.66
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.23
|
| Rate for Payer: PACE Senior Care Partners |
$19.62
|
| Rate for Payer: PACE SWMI |
$20.66
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: PHP Medicare Advantage |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.88
|
| Rate for Payer: Priority Health Medicare |
$20.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.39
|
| Rate for Payer: Railroad Medicare Medicare |
$20.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.71
|
| Rate for Payer: UHC Core |
$68.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.66
|
| Rate for Payer: UHC Medicare Advantage |
$21.27
|
| Rate for Payer: VA VA |
$20.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.96
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
IP
|
$9,446.22
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,761.25 |
| Max. Negotiated Rate |
$8,501.60 |
| Rate for Payer: Aetna Commercial |
$8,029.29
|
| Rate for Payer: BCBS Trust/PPO |
$7,300.04
|
| Rate for Payer: BCN Commercial |
$7,300.04
|
| Rate for Payer: Cash Price |
$7,556.98
|
| Rate for Payer: Cofinity Commercial |
$8,123.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,556.98
|
| Rate for Payer: Healthscope Commercial |
$8,501.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,084.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,029.29
|
| Rate for Payer: PHP Commercial |
$8,029.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,612.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,218.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,761.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,312.67
|
| Rate for Payer: UHC Core |
$7,887.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,084.66
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
OP
|
$9,446.22
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,243.48 |
| Max. Negotiated Rate |
$8,501.60 |
| Rate for Payer: Aetna Commercial |
$8,029.29
|
| Rate for Payer: Aetna Medicare |
$2,456.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,951.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,951.94
|
| Rate for Payer: BCBS Complete |
$5,204.88
|
| Rate for Payer: BCBS MAPPO |
$2,361.56
|
| Rate for Payer: BCBS Trust/PPO |
$7,344.44
|
| Rate for Payer: BCN Commercial |
$7,344.44
|
| Rate for Payer: BCN Medicare Advantage |
$2,361.56
|
| Rate for Payer: Cash Price |
$7,556.98
|
| Rate for Payer: Cash Price |
$7,556.98
|
| Rate for Payer: Cofinity Commercial |
$8,123.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,556.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,361.56
|
| Rate for Payer: Healthscope Commercial |
$8,501.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,084.66
|
| Rate for Payer: Mclaren Medicaid |
$4,957.03
|
| Rate for Payer: Meridian Medicaid |
$5,204.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,479.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,715.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,029.29
|
| Rate for Payer: PACE Senior Care Partners |
$2,243.48
|
| Rate for Payer: PACE SWMI |
$2,361.56
|
| Rate for Payer: PHP Commercial |
$8,029.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,361.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,957.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,612.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,218.21
|
| Rate for Payer: Priority Health Medicare |
$2,361.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,761.25
|
| Rate for Payer: Railroad Medicare Medicare |
$2,361.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,312.67
|
| Rate for Payer: UHC Core |
$7,887.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,361.56
|
| Rate for Payer: UHC Medicare Advantage |
$2,432.40
|
| Rate for Payer: VA VA |
$2,361.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,084.66
|
|
|
HC ULTRATAG RBC PER STUDY
|
Facility
|
OP
|
$210.24
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
34300023
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$49.93 |
| Max. Negotiated Rate |
$189.22 |
| Rate for Payer: Aetna Commercial |
$178.70
|
| Rate for Payer: Aetna Medicare |
$54.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.70
|
| Rate for Payer: BCBS Complete |
$84.10
|
| Rate for Payer: BCBS MAPPO |
$52.56
|
| Rate for Payer: BCBS Trust/PPO |
$163.46
|
| Rate for Payer: BCN Commercial |
$163.46
|
| Rate for Payer: BCN Medicare Advantage |
$52.56
|
| Rate for Payer: Cash Price |
$168.19
|
| Rate for Payer: Cofinity Commercial |
$180.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.56
|
| Rate for Payer: Healthscope Commercial |
$189.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.70
|
| Rate for Payer: PACE Senior Care Partners |
$49.93
|
| Rate for Payer: PACE SWMI |
$52.56
|
| Rate for Payer: PHP Commercial |
$178.70
|
| Rate for Payer: PHP Medicare Advantage |
$52.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.91
|
| Rate for Payer: Priority Health Medicare |
$52.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.23
|
| Rate for Payer: Railroad Medicare Medicare |
$52.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.01
|
| Rate for Payer: UHC Core |
$175.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.56
|
| Rate for Payer: UHC Medicare Advantage |
$54.14
|
| Rate for Payer: VA VA |
$52.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.68
|
|
|
HC ULTRATAG RBC PER STUDY
|
Facility
|
IP
|
$210.24
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
34300023
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$189.22 |
| Rate for Payer: Aetna Commercial |
$178.70
|
| Rate for Payer: BCBS Trust/PPO |
$162.47
|
| Rate for Payer: BCN Commercial |
$162.47
|
| Rate for Payer: Cash Price |
$168.19
|
| Rate for Payer: Cofinity Commercial |
$180.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.19
|
| Rate for Payer: Healthscope Commercial |
$189.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.70
|
| Rate for Payer: PHP Commercial |
$178.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.01
|
| Rate for Payer: UHC Core |
$175.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.68
|
|
|
HC UMBILICAL ARTERY CATHETER
|
Facility
|
IP
|
$209.45
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
36100602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.74 |
| Max. Negotiated Rate |
$188.50 |
| Rate for Payer: Aetna Commercial |
$178.03
|
| Rate for Payer: BCBS Trust/PPO |
$161.86
|
| Rate for Payer: BCN Commercial |
$161.86
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cofinity Commercial |
$180.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.56
|
| Rate for Payer: Healthscope Commercial |
$188.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.03
|
| Rate for Payer: PHP Commercial |
$178.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.32
|
| Rate for Payer: UHC Core |
$174.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.09
|
|
|
HC UMBILICAL ARTERY CATHETER
|
Facility
|
OP
|
$209.45
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
36100602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.74 |
| Max. Negotiated Rate |
$188.50 |
| Rate for Payer: Aetna Commercial |
$178.03
|
| Rate for Payer: Aetna Medicare |
$54.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.45
|
| Rate for Payer: BCBS Complete |
$83.78
|
| Rate for Payer: BCBS MAPPO |
$52.36
|
| Rate for Payer: BCBS Trust/PPO |
$162.85
|
| Rate for Payer: BCN Commercial |
$162.85
|
| Rate for Payer: BCN Medicare Advantage |
$52.36
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cofinity Commercial |
$180.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.36
|
| Rate for Payer: Healthscope Commercial |
$188.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.03
|
| Rate for Payer: PACE Senior Care Partners |
$49.74
|
| Rate for Payer: PACE SWMI |
$52.36
|
| Rate for Payer: PHP Commercial |
$178.03
|
| Rate for Payer: PHP Medicare Advantage |
$52.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.22
|
| Rate for Payer: Priority Health Medicare |
$52.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.74
|
| Rate for Payer: Railroad Medicare Medicare |
$52.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.32
|
| Rate for Payer: UHC Core |
$174.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.36
|
| Rate for Payer: UHC Medicare Advantage |
$53.93
|
| Rate for Payer: VA VA |
$52.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.09
|
|
|
HC UMBILICAL VEIN CATHETER
|
Facility
|
IP
|
$209.45
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
36100584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.74 |
| Max. Negotiated Rate |
$188.50 |
| Rate for Payer: Aetna Commercial |
$178.03
|
| Rate for Payer: BCBS Trust/PPO |
$161.86
|
| Rate for Payer: BCN Commercial |
$161.86
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cofinity Commercial |
$180.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.56
|
| Rate for Payer: Healthscope Commercial |
$188.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.03
|
| Rate for Payer: PHP Commercial |
$178.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.32
|
| Rate for Payer: UHC Core |
$174.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.09
|
|
|
HC UMBILICAL VEIN CATHETER
|
Facility
|
OP
|
$209.45
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
36100584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.74 |
| Max. Negotiated Rate |
$188.50 |
| Rate for Payer: Aetna Commercial |
$178.03
|
| Rate for Payer: Aetna Medicare |
$54.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.45
|
| Rate for Payer: BCBS Complete |
$83.78
|
| Rate for Payer: BCBS MAPPO |
$52.36
|
| Rate for Payer: BCBS Trust/PPO |
$162.85
|
| Rate for Payer: BCN Commercial |
$162.85
|
| Rate for Payer: BCN Medicare Advantage |
$52.36
|
| Rate for Payer: Cash Price |
$167.56
|
| Rate for Payer: Cofinity Commercial |
$180.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.36
|
| Rate for Payer: Healthscope Commercial |
$188.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.03
|
| Rate for Payer: PACE Senior Care Partners |
$49.74
|
| Rate for Payer: PACE SWMI |
$52.36
|
| Rate for Payer: PHP Commercial |
$178.03
|
| Rate for Payer: PHP Medicare Advantage |
$52.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.22
|
| Rate for Payer: Priority Health Medicare |
$52.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.74
|
| Rate for Payer: Railroad Medicare Medicare |
$52.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.32
|
| Rate for Payer: UHC Core |
$174.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.36
|
| Rate for Payer: UHC Medicare Advantage |
$53.93
|
| Rate for Payer: VA VA |
$52.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.09
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
OP
|
$323.87
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$76.92 |
| Max. Negotiated Rate |
$291.48 |
| Rate for Payer: Aetna Commercial |
$275.29
|
| Rate for Payer: Aetna Medicare |
$84.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.21
|
| Rate for Payer: BCBS Complete |
$129.55
|
| Rate for Payer: BCBS MAPPO |
$80.97
|
| Rate for Payer: BCBS Trust/PPO |
$251.81
|
| Rate for Payer: BCCCP Commercial |
$130.78
|
| Rate for Payer: BCN Commercial |
$251.81
|
| Rate for Payer: BCN Medicare Advantage |
$80.97
|
| Rate for Payer: Cash Price |
$259.10
|
| Rate for Payer: Cash Price |
$259.10
|
| Rate for Payer: Cofinity Commercial |
$278.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.97
|
| Rate for Payer: Healthscope Commercial |
$291.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.29
|
| Rate for Payer: PACE Senior Care Partners |
$76.92
|
| Rate for Payer: PACE SWMI |
$80.97
|
| Rate for Payer: PHP Commercial |
$275.29
|
| Rate for Payer: PHP Medicare Advantage |
$80.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.77
|
| Rate for Payer: Priority Health Medicare |
$80.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.53
|
| Rate for Payer: Railroad Medicare Medicare |
$80.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.01
|
| Rate for Payer: UHC Core |
$270.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.97
|
| Rate for Payer: UHC Medicare Advantage |
$83.40
|
| Rate for Payer: VA VA |
$80.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.90
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
IP
|
$323.87
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$197.53 |
| Max. Negotiated Rate |
$291.48 |
| Rate for Payer: Aetna Commercial |
$275.29
|
| Rate for Payer: BCBS Trust/PPO |
$250.29
|
| Rate for Payer: BCN Commercial |
$250.29
|
| Rate for Payer: Cash Price |
$259.10
|
| Rate for Payer: Cofinity Commercial |
$278.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.10
|
| Rate for Payer: Healthscope Commercial |
$291.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.29
|
| Rate for Payer: PHP Commercial |
$275.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.01
|
| Rate for Payer: UHC Core |
$270.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.90
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
OP
|
$101.19
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.03 |
| Max. Negotiated Rate |
$91.07 |
| Rate for Payer: Aetna Commercial |
$86.01
|
| Rate for Payer: Aetna Medicare |
$26.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.62
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS MAPPO |
$25.30
|
| Rate for Payer: BCBS Trust/PPO |
$78.68
|
| Rate for Payer: BCN Commercial |
$78.68
|
| Rate for Payer: BCN Medicare Advantage |
$25.30
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$87.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$91.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.01
|
| Rate for Payer: PACE Senior Care Partners |
$24.03
|
| Rate for Payer: PACE SWMI |
$25.30
|
| Rate for Payer: PHP Commercial |
$86.01
|
| Rate for Payer: PHP Medicare Advantage |
$25.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.04
|
| Rate for Payer: Priority Health Medicare |
$25.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.72
|
| Rate for Payer: Railroad Medicare Medicare |
$25.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.05
|
| Rate for Payer: UHC Core |
$84.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.30
|
| Rate for Payer: UHC Medicare Advantage |
$26.06
|
| Rate for Payer: VA VA |
$25.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.89
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
IP
|
$101.19
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.72 |
| Max. Negotiated Rate |
$91.07 |
| Rate for Payer: Aetna Commercial |
$86.01
|
| Rate for Payer: BCBS Trust/PPO |
$78.20
|
| Rate for Payer: BCN Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$80.95
|
| Rate for Payer: Cofinity Commercial |
$87.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.95
|
| Rate for Payer: Healthscope Commercial |
$91.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.01
|
| Rate for Payer: PHP Commercial |
$86.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.05
|
| Rate for Payer: UHC Core |
$84.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.89
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$9,466.31
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,773.50 |
| Max. Negotiated Rate |
$8,519.68 |
| Rate for Payer: Aetna Commercial |
$8,046.36
|
| Rate for Payer: BCBS Trust/PPO |
$7,315.56
|
| Rate for Payer: BCN Commercial |
$7,315.56
|
| Rate for Payer: Cash Price |
$7,573.05
|
| Rate for Payer: Cofinity Commercial |
$8,141.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,573.05
|
| Rate for Payer: Healthscope Commercial |
$8,519.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,099.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,046.36
|
| Rate for Payer: PHP Commercial |
$8,046.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,626.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,235.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,773.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,330.35
|
| Rate for Payer: UHC Core |
$7,904.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,099.73
|
|
