|
HC US OB LTD
|
Facility
|
IP
|
$495.83
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$345.10 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Aetna Commercial |
$421.46
|
| Rate for Payer: BCBS Trust/PPO |
$409.51
|
| Rate for Payer: BCN Commercial |
$409.51
|
| Rate for Payer: Cash Price |
$396.66
|
| Rate for Payer: Cofinity Commercial |
$426.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.66
|
| Rate for Payer: Healthscope Commercial |
$446.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.46
|
| Rate for Payer: Nomi Health Commercial |
$406.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.87
|
| Rate for Payer: PHP Commercial |
$421.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$431.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$345.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.33
|
| Rate for Payer: UHC Core |
$414.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.87
|
|
|
HC US OB LTD
|
Facility
|
OP
|
$495.83
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.41 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Aetna Commercial |
$421.46
|
| Rate for Payer: Aetna Medicare |
$128.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.95
|
| Rate for Payer: BCBS Complete |
$91.78
|
| Rate for Payer: BCBS MAPPO |
$123.96
|
| Rate for Payer: BCBS Trust/PPO |
$407.62
|
| Rate for Payer: BCN Commercial |
$407.62
|
| Rate for Payer: BCN Medicare Advantage |
$123.96
|
| Rate for Payer: Cash Price |
$396.66
|
| Rate for Payer: Cofinity Commercial |
$426.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.96
|
| Rate for Payer: Healthscope Commercial |
$446.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.87
|
| Rate for Payer: Mclaren Medicaid |
$87.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.16
|
| Rate for Payer: Meridian Medicaid |
$91.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.46
|
| Rate for Payer: Nomi Health Commercial |
$406.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.87
|
| Rate for Payer: PACE Senior Care Partners |
$117.76
|
| Rate for Payer: PACE SWMI |
$123.96
|
| Rate for Payer: PHP Commercial |
$421.46
|
| Rate for Payer: PHP Medicare Advantage |
$123.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$431.37
|
| Rate for Payer: Priority Health Medicare |
$125.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$345.10
|
| Rate for Payer: Railroad Medicare Medicare |
$123.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.33
|
| Rate for Payer: UHC Core |
$414.02
|
| Rate for Payer: UHC Exchange |
$123.96
|
| Rate for Payer: UHC Medicaid |
$87.41
|
| Rate for Payer: UHC Medicare Advantage |
$123.96
|
| Rate for Payer: UHCCP Medicaid |
$87.41
|
| Rate for Payer: VA VA |
$123.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.87
|
|
|
HC US OB NT EACH ADDL FETUS
|
Facility
|
OP
|
$180.02
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$162.02 |
| Rate for Payer: Aetna Commercial |
$153.02
|
| Rate for Payer: Aetna Medicare |
$46.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.26
|
| Rate for Payer: BCBS Complete |
$33.32
|
| Rate for Payer: BCBS MAPPO |
$45.01
|
| Rate for Payer: BCBS Trust/PPO |
$147.99
|
| Rate for Payer: BCN Commercial |
$147.99
|
| Rate for Payer: BCN Medicare Advantage |
$45.01
|
| Rate for Payer: Cash Price |
$144.02
|
| Rate for Payer: Cofinity Commercial |
$154.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.01
|
| Rate for Payer: Healthscope Commercial |
$162.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.01
|
| Rate for Payer: Mclaren Medicaid |
$31.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.26
|
| Rate for Payer: Meridian Medicaid |
$33.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.02
|
| Rate for Payer: Nomi Health Commercial |
$147.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.01
|
| Rate for Payer: PACE Senior Care Partners |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.01
|
| Rate for Payer: PHP Commercial |
$153.02
|
| Rate for Payer: PHP Medicare Advantage |
$45.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.62
|
| Rate for Payer: Priority Health Medicare |
$45.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.29
|
| Rate for Payer: Railroad Medicare Medicare |
$45.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.42
|
| Rate for Payer: UHC Core |
$150.32
|
| Rate for Payer: UHC Exchange |
$45.01
|
| Rate for Payer: UHC Medicaid |
$31.74
|
| Rate for Payer: UHC Medicare Advantage |
$45.01
|
| Rate for Payer: UHCCP Medicaid |
$31.74
|
| Rate for Payer: VA VA |
$45.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.01
|
|
|
HC US OB NT EACH ADDL FETUS
|
Facility
|
IP
|
$180.02
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$125.29 |
| Max. Negotiated Rate |
$162.02 |
| Rate for Payer: Aetna Commercial |
$153.02
|
| Rate for Payer: BCBS Trust/PPO |
$148.68
|
| Rate for Payer: BCN Commercial |
$148.68
|
| Rate for Payer: Cash Price |
$144.02
|
| Rate for Payer: Cofinity Commercial |
$154.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.02
|
| Rate for Payer: Healthscope Commercial |
$162.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.02
|
| Rate for Payer: Nomi Health Commercial |
$147.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.01
|
| Rate for Payer: PHP Commercial |
$153.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.42
|
| Rate for Payer: UHC Core |
$150.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.01
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
IP
|
$467.56
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$325.42 |
| Max. Negotiated Rate |
$420.80 |
| Rate for Payer: Aetna Commercial |
$397.43
|
| Rate for Payer: BCBS Trust/PPO |
$386.16
|
| Rate for Payer: BCN Commercial |
$386.16
|
| Rate for Payer: Cash Price |
$374.05
|
| Rate for Payer: Cofinity Commercial |
$402.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.05
|
| Rate for Payer: Healthscope Commercial |
$420.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.43
|
| Rate for Payer: Nomi Health Commercial |
$383.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.67
|
| Rate for Payer: PHP Commercial |
$397.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$406.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.45
|
| Rate for Payer: UHC Core |
$390.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.67
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
OP
|
$467.56
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$420.80 |
| Rate for Payer: Aetna Commercial |
$397.43
|
| Rate for Payer: Aetna Medicare |
$121.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.11
|
| Rate for Payer: BCBS Complete |
$86.55
|
| Rate for Payer: BCBS MAPPO |
$116.89
|
| Rate for Payer: BCBS Trust/PPO |
$384.38
|
| Rate for Payer: BCN Commercial |
$384.38
|
| Rate for Payer: BCN Medicare Advantage |
$116.89
|
| Rate for Payer: Cash Price |
$374.05
|
| Rate for Payer: Cofinity Commercial |
$402.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.89
|
| Rate for Payer: Healthscope Commercial |
$420.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.67
|
| Rate for Payer: Mclaren Medicaid |
$82.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.73
|
| Rate for Payer: Meridian Medicaid |
$86.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.43
|
| Rate for Payer: Nomi Health Commercial |
$383.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.67
|
| Rate for Payer: PACE Senior Care Partners |
$111.05
|
| Rate for Payer: PACE SWMI |
$116.89
|
| Rate for Payer: PHP Commercial |
$397.43
|
| Rate for Payer: PHP Medicare Advantage |
$116.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$406.78
|
| Rate for Payer: Priority Health Medicare |
$118.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.42
|
| Rate for Payer: Railroad Medicare Medicare |
$116.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.45
|
| Rate for Payer: UHC Core |
$390.41
|
| Rate for Payer: UHC Exchange |
$116.89
|
| Rate for Payer: UHC Medicaid |
$82.43
|
| Rate for Payer: UHC Medicare Advantage |
$116.89
|
| Rate for Payer: UHCCP Medicaid |
$82.43
|
| Rate for Payer: VA VA |
$116.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.67
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
OP
|
$406.24
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.62 |
| Max. Negotiated Rate |
$365.62 |
| Rate for Payer: Aetna Commercial |
$345.30
|
| Rate for Payer: Aetna Medicare |
$105.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.95
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$101.56
|
| Rate for Payer: BCBS Trust/PPO |
$333.97
|
| Rate for Payer: BCN Commercial |
$333.97
|
| Rate for Payer: BCN Medicare Advantage |
$101.56
|
| Rate for Payer: Cash Price |
$324.99
|
| Rate for Payer: Cofinity Commercial |
$349.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.56
|
| Rate for Payer: Healthscope Commercial |
$365.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.68
|
| Rate for Payer: Mclaren Medicaid |
$71.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.64
|
| Rate for Payer: Meridian Medicaid |
$75.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.30
|
| Rate for Payer: Nomi Health Commercial |
$333.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.68
|
| Rate for Payer: PACE Senior Care Partners |
$96.48
|
| Rate for Payer: PACE SWMI |
$101.56
|
| Rate for Payer: PHP Commercial |
$345.30
|
| Rate for Payer: PHP Medicare Advantage |
$101.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$353.43
|
| Rate for Payer: Priority Health Medicare |
$102.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.74
|
| Rate for Payer: Railroad Medicare Medicare |
$101.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.49
|
| Rate for Payer: UHC Core |
$339.21
|
| Rate for Payer: UHC Exchange |
$101.56
|
| Rate for Payer: UHC Medicaid |
$71.62
|
| Rate for Payer: UHC Medicare Advantage |
$101.56
|
| Rate for Payer: UHCCP Medicaid |
$71.62
|
| Rate for Payer: VA VA |
$101.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.68
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
IP
|
$406.24
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$282.74 |
| Max. Negotiated Rate |
$365.62 |
| Rate for Payer: Aetna Commercial |
$345.30
|
| Rate for Payer: BCBS Trust/PPO |
$335.51
|
| Rate for Payer: BCN Commercial |
$335.51
|
| Rate for Payer: Cash Price |
$324.99
|
| Rate for Payer: Cofinity Commercial |
$349.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.99
|
| Rate for Payer: Healthscope Commercial |
$365.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.30
|
| Rate for Payer: Nomi Health Commercial |
$333.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.68
|
| Rate for Payer: PHP Commercial |
$345.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$353.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.49
|
| Rate for Payer: UHC Core |
$339.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.68
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
IP
|
$1,110.78
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$773.10 |
| Max. Negotiated Rate |
$999.70 |
| Rate for Payer: Aetna Commercial |
$944.16
|
| Rate for Payer: BCBS Trust/PPO |
$917.39
|
| Rate for Payer: BCN Commercial |
$917.39
|
| Rate for Payer: Cash Price |
$888.62
|
| Rate for Payer: Cofinity Commercial |
$955.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$888.62
|
| Rate for Payer: Healthscope Commercial |
$999.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$833.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$944.16
|
| Rate for Payer: Nomi Health Commercial |
$910.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.09
|
| Rate for Payer: PHP Commercial |
$944.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$966.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$773.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$977.49
|
| Rate for Payer: UHC Core |
$927.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$833.09
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
OP
|
$1,110.78
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$195.83 |
| Max. Negotiated Rate |
$999.70 |
| Rate for Payer: Aetna Commercial |
$944.16
|
| Rate for Payer: Aetna Medicare |
$288.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$347.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$347.12
|
| Rate for Payer: BCBS Complete |
$205.61
|
| Rate for Payer: BCBS MAPPO |
$277.69
|
| Rate for Payer: BCBS Trust/PPO |
$913.17
|
| Rate for Payer: BCN Commercial |
$913.17
|
| Rate for Payer: BCN Medicare Advantage |
$277.69
|
| Rate for Payer: Cash Price |
$888.62
|
| Rate for Payer: Cofinity Commercial |
$955.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$888.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$277.69
|
| Rate for Payer: Healthscope Commercial |
$999.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$833.09
|
| Rate for Payer: Mclaren Medicaid |
$195.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.58
|
| Rate for Payer: Meridian Medicaid |
$205.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$305.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$944.16
|
| Rate for Payer: Nomi Health Commercial |
$910.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$833.09
|
| Rate for Payer: PACE Senior Care Partners |
$263.81
|
| Rate for Payer: PACE SWMI |
$277.69
|
| Rate for Payer: PHP Commercial |
$944.16
|
| Rate for Payer: PHP Medicare Advantage |
$277.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$966.38
|
| Rate for Payer: Priority Health Medicare |
$280.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$773.10
|
| Rate for Payer: Railroad Medicare Medicare |
$277.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$977.49
|
| Rate for Payer: UHC Core |
$927.50
|
| Rate for Payer: UHC Exchange |
$277.69
|
| Rate for Payer: UHC Medicaid |
$195.83
|
| Rate for Payer: UHC Medicare Advantage |
$277.69
|
| Rate for Payer: UHCCP Medicaid |
$195.83
|
| Rate for Payer: VA VA |
$277.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$833.09
|
|
|
HC US PARACENTESIS
|
Facility
|
OP
|
$1,437.47
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$253.43 |
| Max. Negotiated Rate |
$1,293.72 |
| Rate for Payer: Aetna Commercial |
$1,221.85
|
| Rate for Payer: Aetna Medicare |
$373.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$449.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$449.21
|
| Rate for Payer: BCBS Complete |
$266.08
|
| Rate for Payer: BCBS MAPPO |
$359.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,181.74
|
| Rate for Payer: BCN Commercial |
$1,181.74
|
| Rate for Payer: BCN Medicare Advantage |
$359.37
|
| Rate for Payer: Cash Price |
$1,149.98
|
| Rate for Payer: Cofinity Commercial |
$1,236.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,149.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.37
|
| Rate for Payer: Healthscope Commercial |
$1,293.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,078.10
|
| Rate for Payer: Mclaren Medicaid |
$253.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$377.34
|
| Rate for Payer: Meridian Medicaid |
$266.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$413.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$395.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,221.85
|
| Rate for Payer: Nomi Health Commercial |
$1,178.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,078.10
|
| Rate for Payer: PACE Senior Care Partners |
$341.40
|
| Rate for Payer: PACE SWMI |
$359.37
|
| Rate for Payer: PHP Commercial |
$1,221.85
|
| Rate for Payer: PHP Medicare Advantage |
$359.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,250.60
|
| Rate for Payer: Priority Health Medicare |
$362.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,000.48
|
| Rate for Payer: Railroad Medicare Medicare |
$359.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,264.97
|
| Rate for Payer: UHC Core |
$1,200.29
|
| Rate for Payer: UHC Exchange |
$359.37
|
| Rate for Payer: UHC Medicaid |
$253.43
|
| Rate for Payer: UHC Medicare Advantage |
$359.37
|
| Rate for Payer: UHCCP Medicaid |
$253.43
|
| Rate for Payer: VA VA |
$359.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,078.10
|
|
|
HC US PARACENTESIS
|
Facility
|
IP
|
$1,437.47
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.48 |
| Max. Negotiated Rate |
$1,293.72 |
| Rate for Payer: Aetna Commercial |
$1,221.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,187.21
|
| Rate for Payer: BCN Commercial |
$1,187.21
|
| Rate for Payer: Cash Price |
$1,149.98
|
| Rate for Payer: Cofinity Commercial |
$1,236.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,149.98
|
| Rate for Payer: Healthscope Commercial |
$1,293.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,078.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,221.85
|
| Rate for Payer: Nomi Health Commercial |
$1,178.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,078.10
|
| Rate for Payer: PHP Commercial |
$1,221.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,250.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,000.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,264.97
|
| Rate for Payer: UHC Core |
$1,200.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,078.10
|
|
|
HC US PELVIS LTD
|
Facility
|
OP
|
$520.60
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$91.78 |
| Max. Negotiated Rate |
$468.54 |
| Rate for Payer: Aetna Commercial |
$442.51
|
| Rate for Payer: Aetna Medicare |
$135.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.69
|
| Rate for Payer: BCBS Complete |
$96.36
|
| Rate for Payer: BCBS MAPPO |
$130.15
|
| Rate for Payer: BCBS Trust/PPO |
$427.99
|
| Rate for Payer: BCN Commercial |
$427.99
|
| Rate for Payer: BCN Medicare Advantage |
$130.15
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Commercial |
$447.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.15
|
| Rate for Payer: Healthscope Commercial |
$468.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.45
|
| Rate for Payer: Mclaren Medicaid |
$91.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.66
|
| Rate for Payer: Meridian Medicaid |
$96.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Nomi Health Commercial |
$426.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: PACE Senior Care Partners |
$123.64
|
| Rate for Payer: PACE SWMI |
$130.15
|
| Rate for Payer: PHP Commercial |
$442.51
|
| Rate for Payer: PHP Medicare Advantage |
$130.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$452.92
|
| Rate for Payer: Priority Health Medicare |
$131.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.34
|
| Rate for Payer: Railroad Medicare Medicare |
$130.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.13
|
| Rate for Payer: UHC Core |
$434.70
|
| Rate for Payer: UHC Exchange |
$130.15
|
| Rate for Payer: UHC Medicaid |
$91.78
|
| Rate for Payer: UHC Medicare Advantage |
$130.15
|
| Rate for Payer: UHCCP Medicaid |
$91.78
|
| Rate for Payer: VA VA |
$130.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.45
|
|
|
HC US PELVIS LTD
|
Facility
|
IP
|
$520.60
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$362.34 |
| Max. Negotiated Rate |
$468.54 |
| Rate for Payer: Aetna Commercial |
$442.51
|
| Rate for Payer: BCBS Trust/PPO |
$429.96
|
| Rate for Payer: BCN Commercial |
$429.96
|
| Rate for Payer: Cash Price |
$416.48
|
| Rate for Payer: Cofinity Commercial |
$447.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.48
|
| Rate for Payer: Healthscope Commercial |
$468.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$390.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.51
|
| Rate for Payer: Nomi Health Commercial |
$426.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.45
|
| Rate for Payer: PHP Commercial |
$442.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$452.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.13
|
| Rate for Payer: UHC Core |
$434.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$390.45
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
OP
|
$937.08
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$165.21 |
| Max. Negotiated Rate |
$843.37 |
| Rate for Payer: Aetna Commercial |
$796.52
|
| Rate for Payer: Aetna Medicare |
$243.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.84
|
| Rate for Payer: BCBS Complete |
$173.45
|
| Rate for Payer: BCBS MAPPO |
$234.27
|
| Rate for Payer: BCBS Trust/PPO |
$770.37
|
| Rate for Payer: BCN Commercial |
$770.37
|
| Rate for Payer: BCN Medicare Advantage |
$234.27
|
| Rate for Payer: Cash Price |
$749.66
|
| Rate for Payer: Cofinity Commercial |
$805.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.27
|
| Rate for Payer: Healthscope Commercial |
$843.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$702.81
|
| Rate for Payer: Mclaren Medicaid |
$165.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.98
|
| Rate for Payer: Meridian Medicaid |
$173.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$257.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.52
|
| Rate for Payer: Nomi Health Commercial |
$768.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.81
|
| Rate for Payer: PACE Senior Care Partners |
$222.56
|
| Rate for Payer: PACE SWMI |
$234.27
|
| Rate for Payer: PHP Commercial |
$796.52
|
| Rate for Payer: PHP Medicare Advantage |
$234.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$815.26
|
| Rate for Payer: Priority Health Medicare |
$236.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$652.21
|
| Rate for Payer: Railroad Medicare Medicare |
$234.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$824.63
|
| Rate for Payer: UHC Core |
$782.46
|
| Rate for Payer: UHC Exchange |
$234.27
|
| Rate for Payer: UHC Medicaid |
$165.21
|
| Rate for Payer: UHC Medicare Advantage |
$234.27
|
| Rate for Payer: UHCCP Medicaid |
$165.21
|
| Rate for Payer: VA VA |
$234.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$702.81
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
IP
|
$937.08
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$652.21 |
| Max. Negotiated Rate |
$843.37 |
| Rate for Payer: Aetna Commercial |
$796.52
|
| Rate for Payer: BCBS Trust/PPO |
$773.93
|
| Rate for Payer: BCN Commercial |
$773.93
|
| Rate for Payer: Cash Price |
$749.66
|
| Rate for Payer: Cofinity Commercial |
$805.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.66
|
| Rate for Payer: Healthscope Commercial |
$843.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$702.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.52
|
| Rate for Payer: Nomi Health Commercial |
$768.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.81
|
| Rate for Payer: PHP Commercial |
$796.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$815.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$652.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$824.63
|
| Rate for Payer: UHC Core |
$782.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$702.81
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
OP
|
$385.45
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$346.90 |
| Rate for Payer: Aetna Commercial |
$327.63
|
| Rate for Payer: Aetna Medicare |
$100.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.45
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$96.36
|
| Rate for Payer: BCBS Trust/PPO |
$316.88
|
| Rate for Payer: BCN Commercial |
$316.88
|
| Rate for Payer: BCN Medicare Advantage |
$96.36
|
| Rate for Payer: Cash Price |
$308.36
|
| Rate for Payer: Cofinity Commercial |
$331.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.36
|
| Rate for Payer: Healthscope Commercial |
$346.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.09
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.18
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$106.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.63
|
| Rate for Payer: Nomi Health Commercial |
$316.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.09
|
| Rate for Payer: PACE Senior Care Partners |
$91.54
|
| Rate for Payer: PACE SWMI |
$96.36
|
| Rate for Payer: PHP Commercial |
$327.63
|
| Rate for Payer: PHP Medicare Advantage |
$96.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$335.34
|
| Rate for Payer: Priority Health Medicare |
$97.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.27
|
| Rate for Payer: Railroad Medicare Medicare |
$96.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.20
|
| Rate for Payer: UHC Core |
$321.85
|
| Rate for Payer: UHC Exchange |
$96.36
|
| Rate for Payer: UHC Medicaid |
$67.95
|
| Rate for Payer: UHC Medicare Advantage |
$96.36
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
| Rate for Payer: VA VA |
$96.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.09
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
IP
|
$385.45
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$268.27 |
| Max. Negotiated Rate |
$346.90 |
| Rate for Payer: Aetna Commercial |
$327.63
|
| Rate for Payer: BCBS Trust/PPO |
$318.34
|
| Rate for Payer: BCN Commercial |
$318.34
|
| Rate for Payer: Cash Price |
$308.36
|
| Rate for Payer: Cofinity Commercial |
$331.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.36
|
| Rate for Payer: Healthscope Commercial |
$346.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.63
|
| Rate for Payer: Nomi Health Commercial |
$316.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$289.09
|
| Rate for Payer: PHP Commercial |
$327.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$335.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.20
|
| Rate for Payer: UHC Core |
$321.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.09
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$1,107.77
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$996.99 |
| Rate for Payer: Aetna Commercial |
$941.60
|
| Rate for Payer: Aetna Medicare |
$288.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$346.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$346.18
|
| Rate for Payer: BCBS Complete |
$205.05
|
| Rate for Payer: BCBS MAPPO |
$276.94
|
| Rate for Payer: BCBS Trust/PPO |
$910.70
|
| Rate for Payer: BCN Commercial |
$910.70
|
| Rate for Payer: BCN Medicare Advantage |
$276.94
|
| Rate for Payer: Cash Price |
$886.22
|
| Rate for Payer: Cofinity Commercial |
$952.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$886.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.94
|
| Rate for Payer: Healthscope Commercial |
$996.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$830.83
|
| Rate for Payer: Mclaren Medicaid |
$195.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$290.79
|
| Rate for Payer: Meridian Medicaid |
$205.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$304.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$941.60
|
| Rate for Payer: Nomi Health Commercial |
$908.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$830.83
|
| Rate for Payer: PACE Senior Care Partners |
$263.10
|
| Rate for Payer: PACE SWMI |
$276.94
|
| Rate for Payer: PHP Commercial |
$941.60
|
| Rate for Payer: PHP Medicare Advantage |
$276.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$963.76
|
| Rate for Payer: Priority Health Medicare |
$279.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$771.01
|
| Rate for Payer: Railroad Medicare Medicare |
$276.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.84
|
| Rate for Payer: UHC Core |
$924.99
|
| Rate for Payer: UHC Exchange |
$276.94
|
| Rate for Payer: UHC Medicaid |
$195.30
|
| Rate for Payer: UHC Medicare Advantage |
$276.94
|
| Rate for Payer: UHCCP Medicaid |
$195.30
|
| Rate for Payer: VA VA |
$276.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$830.83
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$1,107.77
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$771.01 |
| Max. Negotiated Rate |
$996.99 |
| Rate for Payer: Aetna Commercial |
$941.60
|
| Rate for Payer: BCBS Trust/PPO |
$914.91
|
| Rate for Payer: BCN Commercial |
$914.91
|
| Rate for Payer: Cash Price |
$886.22
|
| Rate for Payer: Cofinity Commercial |
$952.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$886.22
|
| Rate for Payer: Healthscope Commercial |
$996.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$830.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$941.60
|
| Rate for Payer: Nomi Health Commercial |
$908.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$830.83
|
| Rate for Payer: PHP Commercial |
$941.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$963.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$771.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.84
|
| Rate for Payer: UHC Core |
$924.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$830.83
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
IP
|
$297.14
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$206.81 |
| Max. Negotiated Rate |
$267.43 |
| Rate for Payer: Aetna Commercial |
$252.57
|
| Rate for Payer: BCBS Trust/PPO |
$245.41
|
| Rate for Payer: BCN Commercial |
$245.41
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.71
|
| Rate for Payer: Healthscope Commercial |
$267.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.57
|
| Rate for Payer: Nomi Health Commercial |
$243.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.85
|
| Rate for Payer: PHP Commercial |
$252.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$258.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.48
|
| Rate for Payer: UHC Core |
$248.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.85
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
OP
|
$297.14
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$267.43 |
| Rate for Payer: Aetna Commercial |
$252.57
|
| Rate for Payer: Aetna Medicare |
$77.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.86
|
| Rate for Payer: BCBS Complete |
$55.00
|
| Rate for Payer: BCBS MAPPO |
$74.28
|
| Rate for Payer: BCBS Trust/PPO |
$244.28
|
| Rate for Payer: BCN Commercial |
$244.28
|
| Rate for Payer: BCN Medicare Advantage |
$74.28
|
| Rate for Payer: Cash Price |
$237.71
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.28
|
| Rate for Payer: Healthscope Commercial |
$267.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.85
|
| Rate for Payer: Mclaren Medicaid |
$52.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.00
|
| Rate for Payer: Meridian Medicaid |
$55.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.57
|
| Rate for Payer: Nomi Health Commercial |
$243.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.85
|
| Rate for Payer: PACE Senior Care Partners |
$70.57
|
| Rate for Payer: PACE SWMI |
$74.28
|
| Rate for Payer: PHP Commercial |
$252.57
|
| Rate for Payer: PHP Medicare Advantage |
$74.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$258.51
|
| Rate for Payer: Priority Health Medicare |
$75.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.81
|
| Rate for Payer: Railroad Medicare Medicare |
$74.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.48
|
| Rate for Payer: UHC Core |
$248.11
|
| Rate for Payer: UHC Exchange |
$74.28
|
| Rate for Payer: UHC Medicaid |
$52.39
|
| Rate for Payer: UHC Medicare Advantage |
$74.28
|
| Rate for Payer: UHCCP Medicaid |
$52.39
|
| Rate for Payer: VA VA |
$74.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.85
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$781.02
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$702.92 |
| Rate for Payer: Aetna Commercial |
$663.87
|
| Rate for Payer: Aetna Medicare |
$203.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$244.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$244.07
|
| Rate for Payer: BCBS Complete |
$144.57
|
| Rate for Payer: BCBS MAPPO |
$195.25
|
| Rate for Payer: BCBS Trust/PPO |
$642.08
|
| Rate for Payer: BCN Commercial |
$642.08
|
| Rate for Payer: BCN Medicare Advantage |
$195.25
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cofinity Commercial |
$671.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.25
|
| Rate for Payer: Healthscope Commercial |
$702.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.76
|
| Rate for Payer: Mclaren Medicaid |
$137.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$205.02
|
| Rate for Payer: Meridian Medicaid |
$144.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$214.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.87
|
| Rate for Payer: Nomi Health Commercial |
$640.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.76
|
| Rate for Payer: PACE Senior Care Partners |
$185.49
|
| Rate for Payer: PACE SWMI |
$195.25
|
| Rate for Payer: PHP Commercial |
$663.87
|
| Rate for Payer: PHP Medicare Advantage |
$195.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$679.49
|
| Rate for Payer: Priority Health Medicare |
$197.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$543.59
|
| Rate for Payer: Railroad Medicare Medicare |
$195.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.30
|
| Rate for Payer: UHC Core |
$652.15
|
| Rate for Payer: UHC Exchange |
$195.25
|
| Rate for Payer: UHC Medicaid |
$137.69
|
| Rate for Payer: UHC Medicare Advantage |
$195.25
|
| Rate for Payer: UHCCP Medicaid |
$137.69
|
| Rate for Payer: VA VA |
$195.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.76
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$781.02
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$543.59 |
| Max. Negotiated Rate |
$702.92 |
| Rate for Payer: Aetna Commercial |
$663.87
|
| Rate for Payer: BCBS Trust/PPO |
$645.04
|
| Rate for Payer: BCN Commercial |
$645.04
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cofinity Commercial |
$671.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.82
|
| Rate for Payer: Healthscope Commercial |
$702.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.87
|
| Rate for Payer: Nomi Health Commercial |
$640.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.76
|
| Rate for Payer: PHP Commercial |
$663.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$679.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$543.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.30
|
| Rate for Payer: UHC Core |
$652.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.76
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
IP
|
$781.02
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$543.59 |
| Max. Negotiated Rate |
$702.92 |
| Rate for Payer: Aetna Commercial |
$663.87
|
| Rate for Payer: BCBS Trust/PPO |
$645.04
|
| Rate for Payer: BCN Commercial |
$645.04
|
| Rate for Payer: Cash Price |
$624.82
|
| Rate for Payer: Cofinity Commercial |
$671.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.82
|
| Rate for Payer: Healthscope Commercial |
$702.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.87
|
| Rate for Payer: Nomi Health Commercial |
$640.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.76
|
| Rate for Payer: PHP Commercial |
$663.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$679.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$543.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.30
|
| Rate for Payer: UHC Core |
$652.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.76
|
|
