|
HC US ELASTOGRAPHY EA ADDL LESION
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.56
|
| Rate for Payer: BCBS Complete |
$12.24
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$23.79
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: BCN Medicare Advantage |
$7.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Senior Care Partners |
$7.27
|
| Rate for Payer: PACE SWMI |
$7.65
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.62
|
| Rate for Payer: Priority Health Medicare |
$7.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.66
|
| Rate for Payer: Railroad Medicare Medicare |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.65
|
| Rate for Payer: UHC Medicare Advantage |
$7.88
|
| Rate for Payer: VA VA |
$7.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$124.42 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: BCBS Trust/PPO |
$157.65
|
| Rate for Payer: BCN Commercial |
$157.65
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.52
|
| Rate for Payer: UHC Core |
$170.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.00
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Aetna Commercial |
$173.40
|
| Rate for Payer: Aetna Medicare |
$53.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.75
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$158.61
|
| Rate for Payer: BCN Commercial |
$158.61
|
| Rate for Payer: BCN Medicare Advantage |
$51.00
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$175.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.00
|
| Rate for Payer: Healthscope Commercial |
$183.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.00
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.40
|
| Rate for Payer: PACE Senior Care Partners |
$48.45
|
| Rate for Payer: PACE SWMI |
$51.00
|
| Rate for Payer: PHP Commercial |
$173.40
|
| Rate for Payer: PHP Medicare Advantage |
$51.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.48
|
| Rate for Payer: Priority Health Medicare |
$51.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.42
|
| Rate for Payer: Railroad Medicare Medicare |
$51.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.52
|
| Rate for Payer: UHC Core |
$170.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.00
|
| Rate for Payer: UHC Medicare Advantage |
$52.53
|
| Rate for Payer: VA VA |
$51.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.00
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
IP
|
$463.88
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$282.92 |
| Max. Negotiated Rate |
$417.49 |
| Rate for Payer: Aetna Commercial |
$394.30
|
| Rate for Payer: BCBS Trust/PPO |
$358.49
|
| Rate for Payer: BCN Commercial |
$358.49
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cofinity Commercial |
$398.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.10
|
| Rate for Payer: Healthscope Commercial |
$417.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.30
|
| Rate for Payer: PHP Commercial |
$394.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$403.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$408.21
|
| Rate for Payer: UHC Core |
$387.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.91
|
|
|
HC USE OF SPEECH DEVICE SERVICE
|
Facility
|
OP
|
$463.88
|
|
|
Service Code
|
CPT 92609
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$110.17 |
| Max. Negotiated Rate |
$417.49 |
| Rate for Payer: Aetna Commercial |
$394.30
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$144.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$144.96
|
| Rate for Payer: BCBS Complete |
$185.55
|
| Rate for Payer: BCBS MAPPO |
$115.97
|
| Rate for Payer: BCBS Trust/PPO |
$360.67
|
| Rate for Payer: BCN Commercial |
$360.67
|
| Rate for Payer: BCN Medicare Advantage |
$115.97
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cofinity Commercial |
$398.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.97
|
| Rate for Payer: Healthscope Commercial |
$417.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$121.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$394.30
|
| Rate for Payer: PACE Senior Care Partners |
$110.17
|
| Rate for Payer: PACE SWMI |
$115.97
|
| Rate for Payer: PHP Commercial |
$394.30
|
| Rate for Payer: PHP Medicare Advantage |
$115.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$403.58
|
| Rate for Payer: Priority Health Medicare |
$115.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.92
|
| Rate for Payer: Railroad Medicare Medicare |
$115.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$408.21
|
| Rate for Payer: UHC Core |
$387.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.97
|
| Rate for Payer: UHC Medicare Advantage |
$119.45
|
| Rate for Payer: VA VA |
$115.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.91
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
IP
|
$673.54
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$410.79 |
| Max. Negotiated Rate |
$606.19 |
| Rate for Payer: Aetna Commercial |
$572.51
|
| Rate for Payer: BCBS Trust/PPO |
$520.51
|
| Rate for Payer: BCN Commercial |
$520.51
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cofinity Commercial |
$579.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.83
|
| Rate for Payer: Healthscope Commercial |
$606.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$505.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.51
|
| Rate for Payer: PHP Commercial |
$572.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$585.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.72
|
| Rate for Payer: UHC Core |
$562.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$505.16
|
|
|
HC US EXTREMITY NONVASC LTD
|
Facility
|
OP
|
$673.54
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
40200038
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.69 |
| Max. Negotiated Rate |
$606.19 |
| Rate for Payer: Aetna Commercial |
$572.51
|
| Rate for Payer: Aetna Medicare |
$175.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.48
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$168.38
|
| Rate for Payer: BCBS Trust/PPO |
$523.68
|
| Rate for Payer: BCCCP Commercial |
$43.69
|
| Rate for Payer: BCN Commercial |
$523.68
|
| Rate for Payer: BCN Medicare Advantage |
$168.38
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cofinity Commercial |
$579.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.38
|
| Rate for Payer: Healthscope Commercial |
$606.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$505.16
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$176.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.51
|
| Rate for Payer: PACE Senior Care Partners |
$159.97
|
| Rate for Payer: PACE SWMI |
$168.38
|
| Rate for Payer: PHP Commercial |
$572.51
|
| Rate for Payer: PHP Medicare Advantage |
$168.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$585.98
|
| Rate for Payer: Priority Health Medicare |
$168.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.79
|
| Rate for Payer: Railroad Medicare Medicare |
$168.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.72
|
| Rate for Payer: UHC Core |
$562.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.38
|
| Rate for Payer: UHC Medicare Advantage |
$173.44
|
| Rate for Payer: VA VA |
$168.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$505.16
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
IP
|
$673.54
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$410.79 |
| Max. Negotiated Rate |
$606.19 |
| Rate for Payer: Aetna Commercial |
$572.51
|
| Rate for Payer: BCBS Trust/PPO |
$520.51
|
| Rate for Payer: BCN Commercial |
$520.51
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cofinity Commercial |
$579.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.83
|
| Rate for Payer: Healthscope Commercial |
$606.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$505.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.51
|
| Rate for Payer: PHP Commercial |
$572.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$585.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.72
|
| Rate for Payer: UHC Core |
$562.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$505.16
|
|
|
HC US EXTREMITY NONVASCULAR COMP
|
Facility
|
OP
|
$673.54
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
40200037
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$606.19 |
| Rate for Payer: Aetna Commercial |
$572.51
|
| Rate for Payer: Aetna Medicare |
$175.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.48
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$168.38
|
| Rate for Payer: BCBS Trust/PPO |
$523.68
|
| Rate for Payer: BCN Commercial |
$523.68
|
| Rate for Payer: BCN Medicare Advantage |
$168.38
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cash Price |
$538.83
|
| Rate for Payer: Cofinity Commercial |
$579.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.38
|
| Rate for Payer: Healthscope Commercial |
$606.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$505.16
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$176.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$572.51
|
| Rate for Payer: PACE Senior Care Partners |
$159.97
|
| Rate for Payer: PACE SWMI |
$168.38
|
| Rate for Payer: PHP Commercial |
$572.51
|
| Rate for Payer: PHP Medicare Advantage |
$168.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$585.98
|
| Rate for Payer: Priority Health Medicare |
$168.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.79
|
| Rate for Payer: Railroad Medicare Medicare |
$168.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.72
|
| Rate for Payer: UHC Core |
$562.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.38
|
| Rate for Payer: UHC Medicare Advantage |
$173.44
|
| Rate for Payer: VA VA |
$168.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$505.16
|
|
|
HC US EYE B MODE
|
Facility
|
IP
|
$1,188.71
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$724.99 |
| Max. Negotiated Rate |
$1,069.84 |
| Rate for Payer: Aetna Commercial |
$1,010.40
|
| Rate for Payer: BCBS Trust/PPO |
$918.64
|
| Rate for Payer: BCN Commercial |
$918.64
|
| Rate for Payer: Cash Price |
$950.97
|
| Rate for Payer: Cofinity Commercial |
$1,022.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.97
|
| Rate for Payer: Healthscope Commercial |
$1,069.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.40
|
| Rate for Payer: PHP Commercial |
$1,010.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,046.06
|
| Rate for Payer: UHC Core |
$992.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.53
|
|
|
HC US EYE B MODE
|
Facility
|
OP
|
$1,188.71
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$1,069.84 |
| Rate for Payer: Aetna Commercial |
$1,010.40
|
| Rate for Payer: Aetna Medicare |
$309.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$371.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$371.47
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$297.18
|
| Rate for Payer: BCBS Trust/PPO |
$924.22
|
| Rate for Payer: BCN Commercial |
$924.22
|
| Rate for Payer: BCN Medicare Advantage |
$297.18
|
| Rate for Payer: Cash Price |
$950.97
|
| Rate for Payer: Cash Price |
$950.97
|
| Rate for Payer: Cofinity Commercial |
$1,022.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.18
|
| Rate for Payer: Healthscope Commercial |
$1,069.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.53
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$312.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.40
|
| Rate for Payer: PACE Senior Care Partners |
$282.32
|
| Rate for Payer: PACE SWMI |
$297.18
|
| Rate for Payer: PHP Commercial |
$1,010.40
|
| Rate for Payer: PHP Medicare Advantage |
$297.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.18
|
| Rate for Payer: Priority Health Medicare |
$297.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.99
|
| Rate for Payer: Railroad Medicare Medicare |
$297.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,046.06
|
| Rate for Payer: UHC Core |
$992.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.18
|
| Rate for Payer: UHC Medicare Advantage |
$306.09
|
| Rate for Payer: VA VA |
$297.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.53
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
OP
|
$2,377.54
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$2,139.79 |
| Rate for Payer: Aetna Commercial |
$2,020.91
|
| Rate for Payer: Aetna Medicare |
$618.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$742.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$742.98
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$594.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,848.54
|
| Rate for Payer: BCN Commercial |
$1,848.54
|
| Rate for Payer: BCN Medicare Advantage |
$594.38
|
| Rate for Payer: Cash Price |
$1,902.03
|
| Rate for Payer: Cash Price |
$1,902.03
|
| Rate for Payer: Cofinity Commercial |
$2,044.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,902.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$594.38
|
| Rate for Payer: Healthscope Commercial |
$2,139.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,783.16
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$624.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$683.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,020.91
|
| Rate for Payer: PACE Senior Care Partners |
$564.67
|
| Rate for Payer: PACE SWMI |
$594.38
|
| Rate for Payer: PHP Commercial |
$2,020.91
|
| Rate for Payer: PHP Medicare Advantage |
$594.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,664.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,068.46
|
| Rate for Payer: Priority Health Medicare |
$594.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,450.06
|
| Rate for Payer: Railroad Medicare Medicare |
$594.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,092.24
|
| Rate for Payer: UHC Core |
$1,985.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$594.38
|
| Rate for Payer: UHC Medicare Advantage |
$612.22
|
| Rate for Payer: VA VA |
$594.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,783.16
|
|
|
HC US EYE B MODE BILAT
|
Facility
|
IP
|
$2,377.54
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
40200005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,450.06 |
| Max. Negotiated Rate |
$2,139.79 |
| Rate for Payer: Aetna Commercial |
$2,020.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,837.36
|
| Rate for Payer: BCN Commercial |
$1,837.36
|
| Rate for Payer: Cash Price |
$1,902.03
|
| Rate for Payer: Cofinity Commercial |
$2,044.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,902.03
|
| Rate for Payer: Healthscope Commercial |
$2,139.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,783.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,020.91
|
| Rate for Payer: PHP Commercial |
$2,020.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,664.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,068.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,450.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,092.24
|
| Rate for Payer: UHC Core |
$1,985.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,783.16
|
|
|
HC US FETAL FLUID DRAIN INCL GUID
|
Facility
|
OP
|
$845.57
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.82 |
| Max. Negotiated Rate |
$761.01 |
| Rate for Payer: Aetna Commercial |
$718.73
|
| Rate for Payer: Aetna Medicare |
$219.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.24
|
| Rate for Payer: BCBS Complete |
$220.97
|
| Rate for Payer: BCBS MAPPO |
$211.39
|
| Rate for Payer: BCBS Trust/PPO |
$657.43
|
| Rate for Payer: BCN Commercial |
$657.43
|
| Rate for Payer: BCN Medicare Advantage |
$211.39
|
| Rate for Payer: Cash Price |
$676.46
|
| Rate for Payer: Cash Price |
$676.46
|
| Rate for Payer: Cofinity Commercial |
$727.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.39
|
| Rate for Payer: Healthscope Commercial |
$761.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.18
|
| Rate for Payer: Mclaren Medicaid |
$210.45
|
| Rate for Payer: Meridian Medicaid |
$220.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$221.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$718.73
|
| Rate for Payer: PACE Senior Care Partners |
$200.82
|
| Rate for Payer: PACE SWMI |
$211.39
|
| Rate for Payer: PHP Commercial |
$718.73
|
| Rate for Payer: PHP Medicare Advantage |
$211.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$735.65
|
| Rate for Payer: Priority Health Medicare |
$211.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$515.71
|
| Rate for Payer: Railroad Medicare Medicare |
$211.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.10
|
| Rate for Payer: UHC Core |
$706.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.39
|
| Rate for Payer: UHC Medicare Advantage |
$217.73
|
| Rate for Payer: VA VA |
$211.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.18
|
|
|
HC US FETAL FLUID DRAIN INCL GUID
|
Facility
|
IP
|
$845.57
|
|
|
Service Code
|
CPT 59074
|
| Hospital Charge Code |
36100088
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.71 |
| Max. Negotiated Rate |
$761.01 |
| Rate for Payer: Aetna Commercial |
$718.73
|
| Rate for Payer: BCBS Trust/PPO |
$653.46
|
| Rate for Payer: BCN Commercial |
$653.46
|
| Rate for Payer: Cash Price |
$676.46
|
| Rate for Payer: Cofinity Commercial |
$727.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.46
|
| Rate for Payer: Healthscope Commercial |
$761.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$634.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$718.73
|
| Rate for Payer: PHP Commercial |
$718.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$735.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$515.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.10
|
| Rate for Payer: UHC Core |
$706.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$634.18
|
|
|
HC US FETAL MCA DOPPLER VELOCIMETREY
|
Facility
|
OP
|
$286.12
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$257.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.41
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$222.46
|
| Rate for Payer: BCN Commercial |
$222.46
|
| Rate for Payer: BCN Medicare Advantage |
$71.53
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.53
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.59
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PACE Senior Care Partners |
$67.95
|
| Rate for Payer: PACE SWMI |
$71.53
|
| Rate for Payer: PHP Commercial |
$243.20
|
| Rate for Payer: PHP Medicare Advantage |
$71.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.92
|
| Rate for Payer: Priority Health Medicare |
$71.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.50
|
| Rate for Payer: Railroad Medicare Medicare |
$71.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.79
|
| Rate for Payer: UHC Core |
$238.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.53
|
| Rate for Payer: UHC Medicare Advantage |
$73.68
|
| Rate for Payer: VA VA |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.59
|
|
|
HC US FETAL MCA DOPPLER VELOCIMETREY
|
Facility
|
IP
|
$286.12
|
|
|
Service Code
|
CPT 76821
|
| Hospital Charge Code |
40200029
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$257.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: BCBS Trust/PPO |
$221.11
|
| Rate for Payer: BCN Commercial |
$221.11
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PHP Commercial |
$243.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.79
|
| Rate for Payer: UHC Core |
$238.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.59
|
|
|
HC US FETAL UMBILICAL ART DOPPLER
|
Facility
|
IP
|
$286.12
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$257.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: BCBS Trust/PPO |
$221.11
|
| Rate for Payer: BCN Commercial |
$221.11
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PHP Commercial |
$243.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.79
|
| Rate for Payer: UHC Core |
$238.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.59
|
|
|
HC US FETAL UMBILICAL ART DOPPLER
|
Facility
|
OP
|
$286.12
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
40200028
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$257.51 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.41
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$222.46
|
| Rate for Payer: BCN Commercial |
$222.46
|
| Rate for Payer: BCN Medicare Advantage |
$71.53
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cash Price |
$228.90
|
| Rate for Payer: Cofinity Commercial |
$246.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.53
|
| Rate for Payer: Healthscope Commercial |
$257.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.59
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.20
|
| Rate for Payer: PACE Senior Care Partners |
$67.95
|
| Rate for Payer: PACE SWMI |
$71.53
|
| Rate for Payer: PHP Commercial |
$243.20
|
| Rate for Payer: PHP Medicare Advantage |
$71.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.92
|
| Rate for Payer: Priority Health Medicare |
$71.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.50
|
| Rate for Payer: Railroad Medicare Medicare |
$71.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.79
|
| Rate for Payer: UHC Core |
$238.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.53
|
| Rate for Payer: UHC Medicare Advantage |
$73.68
|
| Rate for Payer: VA VA |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.59
|
|
|
HC US GUIDED INTERSTITIAL THERAPY
|
Facility
|
OP
|
$405.25
|
|
|
Service Code
|
CPT 76965
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$364.72 |
| Rate for Payer: Aetna Commercial |
$344.46
|
| Rate for Payer: Aetna Medicare |
$105.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.64
|
| Rate for Payer: BCBS Complete |
$162.10
|
| Rate for Payer: BCBS MAPPO |
$101.31
|
| Rate for Payer: BCBS Trust/PPO |
$315.08
|
| Rate for Payer: BCN Commercial |
$315.08
|
| Rate for Payer: BCN Medicare Advantage |
$101.31
|
| Rate for Payer: Cash Price |
$324.20
|
| Rate for Payer: Cofinity Commercial |
$348.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.31
|
| Rate for Payer: Healthscope Commercial |
$364.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$344.46
|
| Rate for Payer: PACE Senior Care Partners |
$96.25
|
| Rate for Payer: PACE SWMI |
$101.31
|
| Rate for Payer: PHP Commercial |
$344.46
|
| Rate for Payer: PHP Medicare Advantage |
$101.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.57
|
| Rate for Payer: Priority Health Medicare |
$101.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.16
|
| Rate for Payer: Railroad Medicare Medicare |
$101.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.62
|
| Rate for Payer: UHC Core |
$338.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.31
|
| Rate for Payer: UHC Medicare Advantage |
$104.35
|
| Rate for Payer: VA VA |
$101.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.94
|
|
|
HC US GUIDED INTERSTITIAL THERAPY
|
Facility
|
IP
|
$405.25
|
|
|
Service Code
|
CPT 76965
|
| Hospital Charge Code |
40200063
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$247.16 |
| Max. Negotiated Rate |
$364.72 |
| Rate for Payer: Aetna Commercial |
$344.46
|
| Rate for Payer: BCBS Trust/PPO |
$313.18
|
| Rate for Payer: BCN Commercial |
$313.18
|
| Rate for Payer: Cash Price |
$324.20
|
| Rate for Payer: Cofinity Commercial |
$348.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.20
|
| Rate for Payer: Healthscope Commercial |
$364.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$344.46
|
| Rate for Payer: PHP Commercial |
$344.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.62
|
| Rate for Payer: UHC Core |
$338.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.94
|
|
|
HC US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
IP
|
$631.32
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$385.04 |
| Max. Negotiated Rate |
$568.19 |
| Rate for Payer: Aetna Commercial |
$536.62
|
| Rate for Payer: BCBS Trust/PPO |
$487.88
|
| Rate for Payer: BCN Commercial |
$487.88
|
| Rate for Payer: Cash Price |
$505.06
|
| Rate for Payer: Cofinity Commercial |
$542.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.06
|
| Rate for Payer: Healthscope Commercial |
$568.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$536.62
|
| Rate for Payer: PHP Commercial |
$536.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$549.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$385.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.56
|
| Rate for Payer: UHC Core |
$527.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.49
|
|
|
HC US GUIDE FOR NEEDLE PLACEMENT
|
Facility
|
OP
|
$631.32
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
40200045
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.82 |
| Max. Negotiated Rate |
$568.19 |
| Rate for Payer: Aetna Commercial |
$536.62
|
| Rate for Payer: Aetna Medicare |
$164.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$197.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$197.29
|
| Rate for Payer: BCBS Complete |
$252.53
|
| Rate for Payer: BCBS MAPPO |
$157.83
|
| Rate for Payer: BCBS Trust/PPO |
$490.85
|
| Rate for Payer: BCCCP Commercial |
$59.82
|
| Rate for Payer: BCN Commercial |
$490.85
|
| Rate for Payer: BCN Medicare Advantage |
$157.83
|
| Rate for Payer: Cash Price |
$505.06
|
| Rate for Payer: Cash Price |
$505.06
|
| Rate for Payer: Cofinity Commercial |
$542.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.83
|
| Rate for Payer: Healthscope Commercial |
$568.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$165.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$536.62
|
| Rate for Payer: PACE Senior Care Partners |
$149.94
|
| Rate for Payer: PACE SWMI |
$157.83
|
| Rate for Payer: PHP Commercial |
$536.62
|
| Rate for Payer: PHP Medicare Advantage |
$157.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$549.25
|
| Rate for Payer: Priority Health Medicare |
$157.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$385.04
|
| Rate for Payer: Railroad Medicare Medicare |
$157.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.56
|
| Rate for Payer: UHC Core |
$527.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.83
|
| Rate for Payer: UHC Medicare Advantage |
$162.56
|
| Rate for Payer: VA VA |
$157.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.49
|
|
|
HC US HYSTEROSONOGRAM
|
Facility
|
OP
|
$350.37
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.21 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: Aetna Medicare |
$91.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.49
|
| Rate for Payer: BCBS Complete |
$168.78
|
| Rate for Payer: BCBS MAPPO |
$87.59
|
| Rate for Payer: BCBS Trust/PPO |
$272.41
|
| Rate for Payer: BCN Commercial |
$272.41
|
| Rate for Payer: BCN Medicare Advantage |
$87.59
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.59
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.78
|
| Rate for Payer: Mclaren Medicaid |
$160.74
|
| Rate for Payer: Meridian Medicaid |
$168.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$91.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PACE Senior Care Partners |
$83.21
|
| Rate for Payer: PACE SWMI |
$87.59
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: PHP Medicare Advantage |
$87.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.82
|
| Rate for Payer: Priority Health Medicare |
$87.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.69
|
| Rate for Payer: Railroad Medicare Medicare |
$87.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.33
|
| Rate for Payer: UHC Core |
$292.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.59
|
| Rate for Payer: UHC Medicare Advantage |
$90.22
|
| Rate for Payer: VA VA |
$87.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.78
|
|
|
HC US HYSTEROSONOGRAM
|
Facility
|
IP
|
$350.37
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
40200032
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$213.69 |
| Max. Negotiated Rate |
$315.33 |
| Rate for Payer: Aetna Commercial |
$297.81
|
| Rate for Payer: BCBS Trust/PPO |
$270.77
|
| Rate for Payer: BCN Commercial |
$270.77
|
| Rate for Payer: Cash Price |
$280.30
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.30
|
| Rate for Payer: Healthscope Commercial |
$315.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.81
|
| Rate for Payer: PHP Commercial |
$297.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.33
|
| Rate for Payer: UHC Core |
$292.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.78
|
|
