|
HC US OB NT EACH ADDL FETUS
|
Facility
|
IP
|
$173.03
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$105.53 |
| Max. Negotiated Rate |
$155.73 |
| Rate for Payer: Aetna Commercial |
$147.08
|
| Rate for Payer: BCBS Trust/PPO |
$133.72
|
| Rate for Payer: BCN Commercial |
$133.72
|
| Rate for Payer: Cash Price |
$138.42
|
| Rate for Payer: Cofinity Commercial |
$148.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.42
|
| Rate for Payer: Healthscope Commercial |
$155.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.08
|
| Rate for Payer: PHP Commercial |
$147.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.27
|
| Rate for Payer: UHC Core |
$144.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.77
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
OP
|
$449.40
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$404.46 |
| Rate for Payer: Aetna Commercial |
$381.99
|
| Rate for Payer: Aetna Medicare |
$116.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.44
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$112.35
|
| Rate for Payer: BCBS Trust/PPO |
$349.41
|
| Rate for Payer: BCN Commercial |
$349.41
|
| Rate for Payer: BCN Medicare Advantage |
$112.35
|
| Rate for Payer: Cash Price |
$359.52
|
| Rate for Payer: Cash Price |
$359.52
|
| Rate for Payer: Cofinity Commercial |
$386.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.35
|
| Rate for Payer: Healthscope Commercial |
$404.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.05
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$117.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.99
|
| Rate for Payer: PACE Senior Care Partners |
$106.73
|
| Rate for Payer: PACE SWMI |
$112.35
|
| Rate for Payer: PHP Commercial |
$381.99
|
| Rate for Payer: PHP Medicare Advantage |
$112.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.98
|
| Rate for Payer: Priority Health Medicare |
$112.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.09
|
| Rate for Payer: Railroad Medicare Medicare |
$112.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.47
|
| Rate for Payer: UHC Core |
$375.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.35
|
| Rate for Payer: UHC Medicare Advantage |
$115.72
|
| Rate for Payer: VA VA |
$112.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.05
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
IP
|
$449.40
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$274.09 |
| Max. Negotiated Rate |
$404.46 |
| Rate for Payer: Aetna Commercial |
$381.99
|
| Rate for Payer: BCBS Trust/PPO |
$347.30
|
| Rate for Payer: BCN Commercial |
$347.30
|
| Rate for Payer: Cash Price |
$359.52
|
| Rate for Payer: Cofinity Commercial |
$386.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.52
|
| Rate for Payer: Healthscope Commercial |
$404.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.99
|
| Rate for Payer: PHP Commercial |
$381.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.47
|
| Rate for Payer: UHC Core |
$375.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.05
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
IP
|
$390.46
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$238.14 |
| Max. Negotiated Rate |
$351.41 |
| Rate for Payer: Aetna Commercial |
$331.89
|
| Rate for Payer: BCBS Trust/PPO |
$301.75
|
| Rate for Payer: BCN Commercial |
$301.75
|
| Rate for Payer: Cash Price |
$312.37
|
| Rate for Payer: Cofinity Commercial |
$335.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.37
|
| Rate for Payer: Healthscope Commercial |
$351.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.89
|
| Rate for Payer: PHP Commercial |
$331.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$339.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.60
|
| Rate for Payer: UHC Core |
$326.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.84
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
OP
|
$390.46
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$351.41 |
| Rate for Payer: Aetna Commercial |
$331.89
|
| Rate for Payer: Aetna Medicare |
$101.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.02
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$97.62
|
| Rate for Payer: BCBS Trust/PPO |
$303.58
|
| Rate for Payer: BCN Commercial |
$303.58
|
| Rate for Payer: BCN Medicare Advantage |
$97.62
|
| Rate for Payer: Cash Price |
$312.37
|
| Rate for Payer: Cash Price |
$312.37
|
| Rate for Payer: Cofinity Commercial |
$335.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.62
|
| Rate for Payer: Healthscope Commercial |
$351.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.84
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.89
|
| Rate for Payer: PACE Senior Care Partners |
$92.73
|
| Rate for Payer: PACE SWMI |
$97.62
|
| Rate for Payer: PHP Commercial |
$331.89
|
| Rate for Payer: PHP Medicare Advantage |
$97.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$339.70
|
| Rate for Payer: Priority Health Medicare |
$97.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.14
|
| Rate for Payer: Railroad Medicare Medicare |
$97.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.60
|
| Rate for Payer: UHC Core |
$326.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.62
|
| Rate for Payer: UHC Medicare Advantage |
$100.54
|
| Rate for Payer: VA VA |
$97.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.84
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
IP
|
$1,067.65
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$651.16 |
| Max. Negotiated Rate |
$960.88 |
| Rate for Payer: Aetna Commercial |
$907.50
|
| Rate for Payer: BCBS Trust/PPO |
$825.08
|
| Rate for Payer: BCN Commercial |
$825.08
|
| Rate for Payer: Cash Price |
$854.12
|
| Rate for Payer: Cofinity Commercial |
$918.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$854.12
|
| Rate for Payer: Healthscope Commercial |
$960.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$907.50
|
| Rate for Payer: PHP Commercial |
$907.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$928.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$651.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$939.53
|
| Rate for Payer: UHC Core |
$891.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.74
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
OP
|
$1,067.65
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.71 |
| Max. Negotiated Rate |
$960.88 |
| Rate for Payer: Aetna Commercial |
$907.50
|
| Rate for Payer: Aetna Medicare |
$277.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$333.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$333.64
|
| Rate for Payer: BCBS Complete |
$137.25
|
| Rate for Payer: BCBS MAPPO |
$266.91
|
| Rate for Payer: BCBS Trust/PPO |
$830.10
|
| Rate for Payer: BCN Commercial |
$830.10
|
| Rate for Payer: BCN Medicare Advantage |
$266.91
|
| Rate for Payer: Cash Price |
$854.12
|
| Rate for Payer: Cash Price |
$854.12
|
| Rate for Payer: Cofinity Commercial |
$918.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$854.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$266.91
|
| Rate for Payer: Healthscope Commercial |
$960.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$800.74
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Meridian Medicaid |
$137.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$280.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$907.50
|
| Rate for Payer: PACE Senior Care Partners |
$253.57
|
| Rate for Payer: PACE SWMI |
$266.91
|
| Rate for Payer: PHP Commercial |
$907.50
|
| Rate for Payer: PHP Medicare Advantage |
$266.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$928.86
|
| Rate for Payer: Priority Health Medicare |
$266.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$651.16
|
| Rate for Payer: Railroad Medicare Medicare |
$266.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$939.53
|
| Rate for Payer: UHC Core |
$891.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$266.91
|
| Rate for Payer: UHC Medicare Advantage |
$274.92
|
| Rate for Payer: VA VA |
$266.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$800.74
|
|
|
HC US PARACENTESIS
|
Facility
|
IP
|
$1,342.18
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$818.60 |
| Max. Negotiated Rate |
$1,207.96 |
| Rate for Payer: Aetna Commercial |
$1,140.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.24
|
| Rate for Payer: BCN Commercial |
$1,037.24
|
| Rate for Payer: Cash Price |
$1,073.74
|
| Rate for Payer: Cofinity Commercial |
$1,154.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.74
|
| Rate for Payer: Healthscope Commercial |
$1,207.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,140.85
|
| Rate for Payer: PHP Commercial |
$1,140.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,167.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$818.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,181.12
|
| Rate for Payer: UHC Core |
$1,120.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.64
|
|
|
HC US PARACENTESIS
|
Facility
|
OP
|
$1,342.18
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$318.77 |
| Max. Negotiated Rate |
$1,207.96 |
| Rate for Payer: Aetna Commercial |
$1,140.85
|
| Rate for Payer: Aetna Medicare |
$348.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$419.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$419.43
|
| Rate for Payer: BCBS Complete |
$624.38
|
| Rate for Payer: BCBS MAPPO |
$335.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,043.54
|
| Rate for Payer: BCN Commercial |
$1,043.54
|
| Rate for Payer: BCN Medicare Advantage |
$335.54
|
| Rate for Payer: Cash Price |
$1,073.74
|
| Rate for Payer: Cash Price |
$1,073.74
|
| Rate for Payer: Cofinity Commercial |
$1,154.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.54
|
| Rate for Payer: Healthscope Commercial |
$1,207.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.64
|
| Rate for Payer: Mclaren Medicaid |
$594.64
|
| Rate for Payer: Meridian Medicaid |
$624.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$352.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$385.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,140.85
|
| Rate for Payer: PACE Senior Care Partners |
$318.77
|
| Rate for Payer: PACE SWMI |
$335.54
|
| Rate for Payer: PHP Commercial |
$1,140.85
|
| Rate for Payer: PHP Medicare Advantage |
$335.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,167.70
|
| Rate for Payer: Priority Health Medicare |
$335.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$818.60
|
| Rate for Payer: Railroad Medicare Medicare |
$335.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,181.12
|
| Rate for Payer: UHC Core |
$1,120.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.54
|
| Rate for Payer: UHC Medicare Advantage |
$345.61
|
| Rate for Payer: VA VA |
$335.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.64
|
|
|
HC US PELVIS LTD
|
Facility
|
OP
|
$500.38
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$450.34 |
| Rate for Payer: Aetna Commercial |
$425.32
|
| Rate for Payer: Aetna Medicare |
$130.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.37
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$125.10
|
| Rate for Payer: BCBS Trust/PPO |
$389.05
|
| Rate for Payer: BCN Commercial |
$389.05
|
| Rate for Payer: BCN Medicare Advantage |
$125.10
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$430.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$450.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.28
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: PACE Senior Care Partners |
$118.84
|
| Rate for Payer: PACE SWMI |
$125.10
|
| Rate for Payer: PHP Commercial |
$425.32
|
| Rate for Payer: PHP Medicare Advantage |
$125.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.33
|
| Rate for Payer: Priority Health Medicare |
$125.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.18
|
| Rate for Payer: Railroad Medicare Medicare |
$125.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.33
|
| Rate for Payer: UHC Core |
$417.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.10
|
| Rate for Payer: UHC Medicare Advantage |
$128.85
|
| Rate for Payer: VA VA |
$125.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.28
|
|
|
HC US PELVIS LTD
|
Facility
|
IP
|
$500.38
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$305.18 |
| Max. Negotiated Rate |
$450.34 |
| Rate for Payer: Aetna Commercial |
$425.32
|
| Rate for Payer: BCBS Trust/PPO |
$386.69
|
| Rate for Payer: BCN Commercial |
$386.69
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$430.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.30
|
| Rate for Payer: Healthscope Commercial |
$450.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: PHP Commercial |
$425.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.33
|
| Rate for Payer: UHC Core |
$417.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.28
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
OP
|
$900.70
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$810.63 |
| Rate for Payer: Aetna Commercial |
$765.60
|
| Rate for Payer: Aetna Medicare |
$234.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$281.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$281.47
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$225.18
|
| Rate for Payer: BCBS Trust/PPO |
$700.29
|
| Rate for Payer: BCN Commercial |
$700.29
|
| Rate for Payer: BCN Medicare Advantage |
$225.18
|
| Rate for Payer: Cash Price |
$720.56
|
| Rate for Payer: Cash Price |
$720.56
|
| Rate for Payer: Cofinity Commercial |
$774.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.18
|
| Rate for Payer: Healthscope Commercial |
$810.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.52
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$236.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.60
|
| Rate for Payer: PACE Senior Care Partners |
$213.92
|
| Rate for Payer: PACE SWMI |
$225.18
|
| Rate for Payer: PHP Commercial |
$765.60
|
| Rate for Payer: PHP Medicare Advantage |
$225.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$783.61
|
| Rate for Payer: Priority Health Medicare |
$225.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$549.34
|
| Rate for Payer: Railroad Medicare Medicare |
$225.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.62
|
| Rate for Payer: UHC Core |
$752.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.18
|
| Rate for Payer: UHC Medicare Advantage |
$231.93
|
| Rate for Payer: VA VA |
$225.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.52
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
IP
|
$900.70
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$549.34 |
| Max. Negotiated Rate |
$810.63 |
| Rate for Payer: Aetna Commercial |
$765.60
|
| Rate for Payer: BCBS Trust/PPO |
$696.06
|
| Rate for Payer: BCN Commercial |
$696.06
|
| Rate for Payer: Cash Price |
$720.56
|
| Rate for Payer: Cofinity Commercial |
$774.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.56
|
| Rate for Payer: Healthscope Commercial |
$810.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.60
|
| Rate for Payer: PHP Commercial |
$765.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$783.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$549.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.62
|
| Rate for Payer: UHC Core |
$752.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.52
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
IP
|
$370.48
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$225.96 |
| Max. Negotiated Rate |
$333.43 |
| Rate for Payer: Aetna Commercial |
$314.91
|
| Rate for Payer: BCBS Trust/PPO |
$286.31
|
| Rate for Payer: BCN Commercial |
$286.31
|
| Rate for Payer: Cash Price |
$296.38
|
| Rate for Payer: Cofinity Commercial |
$318.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.38
|
| Rate for Payer: Healthscope Commercial |
$333.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.91
|
| Rate for Payer: PHP Commercial |
$314.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.02
|
| Rate for Payer: UHC Core |
$309.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.86
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
OP
|
$370.48
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$333.43 |
| Rate for Payer: Aetna Commercial |
$314.91
|
| Rate for Payer: Aetna Medicare |
$96.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.78
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$92.62
|
| Rate for Payer: BCBS Trust/PPO |
$288.05
|
| Rate for Payer: BCN Commercial |
$288.05
|
| Rate for Payer: BCN Medicare Advantage |
$92.62
|
| Rate for Payer: Cash Price |
$296.38
|
| Rate for Payer: Cash Price |
$296.38
|
| Rate for Payer: Cofinity Commercial |
$318.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.62
|
| Rate for Payer: Healthscope Commercial |
$333.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.86
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$97.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.91
|
| Rate for Payer: PACE Senior Care Partners |
$87.99
|
| Rate for Payer: PACE SWMI |
$92.62
|
| Rate for Payer: PHP Commercial |
$314.91
|
| Rate for Payer: PHP Medicare Advantage |
$92.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$322.32
|
| Rate for Payer: Priority Health Medicare |
$92.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.96
|
| Rate for Payer: Railroad Medicare Medicare |
$92.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.02
|
| Rate for Payer: UHC Core |
$309.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.62
|
| Rate for Payer: UHC Medicare Advantage |
$95.40
|
| Rate for Payer: VA VA |
$92.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.86
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$1,064.75
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$958.28 |
| Rate for Payer: Aetna Commercial |
$905.04
|
| Rate for Payer: Aetna Medicare |
$276.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$332.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$332.73
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$266.19
|
| Rate for Payer: BCBS Trust/PPO |
$827.84
|
| Rate for Payer: BCN Commercial |
$827.84
|
| Rate for Payer: BCN Medicare Advantage |
$266.19
|
| Rate for Payer: Cash Price |
$851.80
|
| Rate for Payer: Cash Price |
$851.80
|
| Rate for Payer: Cofinity Commercial |
$915.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$266.19
|
| Rate for Payer: Healthscope Commercial |
$958.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$798.56
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$279.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$905.04
|
| Rate for Payer: PACE Senior Care Partners |
$252.88
|
| Rate for Payer: PACE SWMI |
$266.19
|
| Rate for Payer: PHP Commercial |
$905.04
|
| Rate for Payer: PHP Medicare Advantage |
$266.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$926.33
|
| Rate for Payer: Priority Health Medicare |
$266.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$649.39
|
| Rate for Payer: Railroad Medicare Medicare |
$266.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$936.98
|
| Rate for Payer: UHC Core |
$889.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$266.19
|
| Rate for Payer: UHC Medicare Advantage |
$274.17
|
| Rate for Payer: VA VA |
$266.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$798.56
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$1,064.75
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$649.39 |
| Max. Negotiated Rate |
$958.28 |
| Rate for Payer: Aetna Commercial |
$905.04
|
| Rate for Payer: BCBS Trust/PPO |
$822.84
|
| Rate for Payer: BCN Commercial |
$822.84
|
| Rate for Payer: Cash Price |
$851.80
|
| Rate for Payer: Cofinity Commercial |
$915.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.80
|
| Rate for Payer: Healthscope Commercial |
$958.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$798.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$905.04
|
| Rate for Payer: PHP Commercial |
$905.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$926.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$649.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$936.98
|
| Rate for Payer: UHC Core |
$889.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$798.56
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
OP
|
$285.60
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$67.83 |
| Max. Negotiated Rate |
$257.04 |
| Rate for Payer: Aetna Commercial |
$242.76
|
| Rate for Payer: Aetna Medicare |
$74.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.25
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$71.40
|
| Rate for Payer: BCBS Trust/PPO |
$222.05
|
| Rate for Payer: BCN Commercial |
$222.05
|
| Rate for Payer: BCN Medicare Advantage |
$71.40
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.40
|
| Rate for Payer: Healthscope Commercial |
$257.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.20
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$74.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.76
|
| Rate for Payer: PACE Senior Care Partners |
$67.83
|
| Rate for Payer: PACE SWMI |
$71.40
|
| Rate for Payer: PHP Commercial |
$242.76
|
| Rate for Payer: PHP Medicare Advantage |
$71.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.47
|
| Rate for Payer: Priority Health Medicare |
$71.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.19
|
| Rate for Payer: Railroad Medicare Medicare |
$71.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.33
|
| Rate for Payer: UHC Core |
$238.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.40
|
| Rate for Payer: UHC Medicare Advantage |
$73.54
|
| Rate for Payer: VA VA |
$71.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.20
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
IP
|
$285.60
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$174.19 |
| Max. Negotiated Rate |
$257.04 |
| Rate for Payer: Aetna Commercial |
$242.76
|
| Rate for Payer: BCBS Trust/PPO |
$220.71
|
| Rate for Payer: BCN Commercial |
$220.71
|
| Rate for Payer: Cash Price |
$228.48
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.48
|
| Rate for Payer: Healthscope Commercial |
$257.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.76
|
| Rate for Payer: PHP Commercial |
$242.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.33
|
| Rate for Payer: UHC Core |
$238.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.20
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$750.70
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$675.63 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Medicare |
$195.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$234.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$234.59
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$187.68
|
| Rate for Payer: BCBS Trust/PPO |
$583.67
|
| Rate for Payer: BCN Commercial |
$583.67
|
| Rate for Payer: BCN Medicare Advantage |
$187.68
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cofinity Commercial |
$645.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$675.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.02
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$197.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$638.10
|
| Rate for Payer: PACE Senior Care Partners |
$178.29
|
| Rate for Payer: PACE SWMI |
$187.68
|
| Rate for Payer: PHP Commercial |
$638.10
|
| Rate for Payer: PHP Medicare Advantage |
$187.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.11
|
| Rate for Payer: Priority Health Medicare |
$187.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$457.85
|
| Rate for Payer: Railroad Medicare Medicare |
$187.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.62
|
| Rate for Payer: UHC Core |
$626.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.68
|
| Rate for Payer: UHC Medicare Advantage |
$193.31
|
| Rate for Payer: VA VA |
$187.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.02
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$750.70
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$457.85 |
| Max. Negotiated Rate |
$675.63 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: BCBS Trust/PPO |
$580.14
|
| Rate for Payer: BCN Commercial |
$580.14
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cofinity Commercial |
$645.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.56
|
| Rate for Payer: Healthscope Commercial |
$675.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$638.10
|
| Rate for Payer: PHP Commercial |
$638.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$457.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.62
|
| Rate for Payer: UHC Core |
$626.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.02
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
IP
|
$750.70
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$457.85 |
| Max. Negotiated Rate |
$675.63 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: BCBS Trust/PPO |
$580.14
|
| Rate for Payer: BCN Commercial |
$580.14
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cofinity Commercial |
$645.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.56
|
| Rate for Payer: Healthscope Commercial |
$675.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$638.10
|
| Rate for Payer: PHP Commercial |
$638.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$457.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.62
|
| Rate for Payer: UHC Core |
$626.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.02
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
OP
|
$750.70
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$675.63 |
| Rate for Payer: Aetna Commercial |
$638.10
|
| Rate for Payer: Aetna Medicare |
$195.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$234.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$234.59
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$187.68
|
| Rate for Payer: BCBS Trust/PPO |
$583.67
|
| Rate for Payer: BCN Commercial |
$583.67
|
| Rate for Payer: BCN Medicare Advantage |
$187.68
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cash Price |
$600.56
|
| Rate for Payer: Cofinity Commercial |
$645.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$675.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$563.02
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$197.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$638.10
|
| Rate for Payer: PACE Senior Care Partners |
$178.29
|
| Rate for Payer: PACE SWMI |
$187.68
|
| Rate for Payer: PHP Commercial |
$638.10
|
| Rate for Payer: PHP Medicare Advantage |
$187.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.11
|
| Rate for Payer: Priority Health Medicare |
$187.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$457.85
|
| Rate for Payer: Railroad Medicare Medicare |
$187.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.62
|
| Rate for Payer: UHC Core |
$626.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.68
|
| Rate for Payer: UHC Medicare Advantage |
$193.31
|
| Rate for Payer: VA VA |
$187.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$563.02
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
OP
|
$700.61
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$630.55 |
| Rate for Payer: Aetna Commercial |
$595.52
|
| Rate for Payer: Aetna Medicare |
$182.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.94
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$175.15
|
| Rate for Payer: BCBS Trust/PPO |
$544.72
|
| Rate for Payer: BCN Commercial |
$544.72
|
| Rate for Payer: BCN Medicare Advantage |
$175.15
|
| Rate for Payer: Cash Price |
$560.49
|
| Rate for Payer: Cash Price |
$560.49
|
| Rate for Payer: Cofinity Commercial |
$602.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.15
|
| Rate for Payer: Healthscope Commercial |
$630.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.46
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$183.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.52
|
| Rate for Payer: PACE Senior Care Partners |
$166.39
|
| Rate for Payer: PACE SWMI |
$175.15
|
| Rate for Payer: PHP Commercial |
$595.52
|
| Rate for Payer: PHP Medicare Advantage |
$175.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$609.53
|
| Rate for Payer: Priority Health Medicare |
$175.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.30
|
| Rate for Payer: Railroad Medicare Medicare |
$175.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.54
|
| Rate for Payer: UHC Core |
$585.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.15
|
| Rate for Payer: UHC Medicare Advantage |
$180.41
|
| Rate for Payer: VA VA |
$175.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.46
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
IP
|
$700.61
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$427.30 |
| Max. Negotiated Rate |
$630.55 |
| Rate for Payer: Aetna Commercial |
$595.52
|
| Rate for Payer: BCBS Trust/PPO |
$541.43
|
| Rate for Payer: BCN Commercial |
$541.43
|
| Rate for Payer: Cash Price |
$560.49
|
| Rate for Payer: Cofinity Commercial |
$602.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.49
|
| Rate for Payer: Healthscope Commercial |
$630.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.52
|
| Rate for Payer: PHP Commercial |
$595.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$609.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$427.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.54
|
| Rate for Payer: UHC Core |
$585.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.46
|
|
