|
HC UA DIPSTICK AUTO
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$5.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.63
|
| Rate for Payer: BCBS Complete |
$1.71
|
| Rate for Payer: BCBS MAPPO |
$5.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCN Commercial |
$16.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.30
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Mclaren Medicaid |
$1.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.57
|
| Rate for Payer: Meridian Medicaid |
$1.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Nomi Health Commercial |
$17.40
|
| Rate for Payer: PACE Senior Care Partners |
$5.04
|
| Rate for Payer: PACE SWMI |
$5.30
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: PHP Medicare Advantage |
$5.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health HMO/PPO |
$18.46
|
| Rate for Payer: Priority Health Medicare |
$5.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.67
|
| Rate for Payer: UHC Core |
$17.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.30
|
| Rate for Payer: UHC Exchange |
$5.30
|
| Rate for Payer: UHC Medicare Advantage |
$5.30
|
| Rate for Payer: UHCCP Medicaid |
$1.63
|
| Rate for Payer: VA VA |
$5.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC UA DIPSTICK AUTO
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: BCBS Trust/PPO |
$17.32
|
| Rate for Payer: BCN Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: Nomi Health Commercial |
$17.40
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health HMO/PPO |
$18.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.67
|
| Rate for Payer: UHC Core |
$17.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC UA DIPSTICK MANUAL
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna Medicare |
$3.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.90
|
| Rate for Payer: BCBS Complete |
$2.64
|
| Rate for Payer: BCBS MAPPO |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$10.26
|
| Rate for Payer: BCN Commercial |
$9.70
|
| Rate for Payer: BCN Medicare Advantage |
$3.12
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.36
|
| Rate for Payer: Mclaren Medicaid |
$2.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.28
|
| Rate for Payer: Meridian Medicaid |
$2.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: PACE Senior Care Partners |
$2.96
|
| Rate for Payer: PACE SWMI |
$3.12
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: PHP Medicare Advantage |
$3.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health HMO/PPO |
$10.86
|
| Rate for Payer: Priority Health Medicare |
$3.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.98
|
| Rate for Payer: UHC Core |
$10.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.12
|
| Rate for Payer: UHC Exchange |
$3.12
|
| Rate for Payer: UHC Medicare Advantage |
$3.12
|
| Rate for Payer: UHCCP Medicaid |
$2.52
|
| Rate for Payer: VA VA |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.36
|
|
|
HC UA DIPSTICK MANUAL
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700009
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$10.19
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health HMO/PPO |
$10.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.98
|
| Rate for Payer: UHC Core |
$10.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.36
|
|
|
HC UA MICROSCOPIC ONLY
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
30700015
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.08
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: BCBS MAPPO |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$31.78
|
| Rate for Payer: BCN Commercial |
$30.06
|
| Rate for Payer: BCN Medicare Advantage |
$9.66
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.66
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.00
|
| Rate for Payer: Mclaren Medicaid |
$2.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.15
|
| Rate for Payer: Meridian Medicaid |
$2.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: PACE Senior Care Partners |
$9.18
|
| Rate for Payer: PACE SWMI |
$9.66
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: PHP Medicare Advantage |
$9.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health HMO/PPO |
$33.63
|
| Rate for Payer: Priority Health Medicare |
$9.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.90
|
| Rate for Payer: Railroad Medicare Medicare |
$9.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.02
|
| Rate for Payer: UHC Core |
$32.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.66
|
| Rate for Payer: UHC Exchange |
$9.66
|
| Rate for Payer: UHC Medicare Advantage |
$9.66
|
| Rate for Payer: UHCCP Medicaid |
$2.21
|
| Rate for Payer: VA VA |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.00
|
|
|
HC UA MICROSCOPIC ONLY
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
30700015
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: BCBS Trust/PPO |
$31.56
|
| Rate for Payer: BCN Commercial |
$29.88
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health HMO/PPO |
$33.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.02
|
| Rate for Payer: UHC Core |
$32.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.00
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
OP
|
$84.27
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.01 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$21.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.33
|
| Rate for Payer: BCBS Complete |
$33.71
|
| Rate for Payer: BCBS MAPPO |
$21.07
|
| Rate for Payer: BCBS Trust/PPO |
$69.28
|
| Rate for Payer: BCN Commercial |
$65.52
|
| Rate for Payer: BCN Medicare Advantage |
$21.07
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.07
|
| Rate for Payer: Healthscope Commercial |
$75.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: PACE Senior Care Partners |
$20.01
|
| Rate for Payer: PACE SWMI |
$21.07
|
| Rate for Payer: PHP Commercial |
$71.63
|
| Rate for Payer: PHP Medicare Advantage |
$21.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: Priority Health HMO/PPO |
$73.31
|
| Rate for Payer: Priority Health Medicare |
$21.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.46
|
| Rate for Payer: Railroad Medicare Medicare |
$21.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.16
|
| Rate for Payer: UHC Core |
$70.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.07
|
| Rate for Payer: UHC Exchange |
$21.07
|
| Rate for Payer: UHC Medicare Advantage |
$21.07
|
| Rate for Payer: VA VA |
$21.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.20
|
|
|
HC ULTRASOUND EACH 15 MIN
|
Facility
|
IP
|
$84.27
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
42000018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: BCBS Trust/PPO |
$68.79
|
| Rate for Payer: BCN Commercial |
$65.12
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Healthscope Commercial |
$75.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.63
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: PHP Commercial |
$71.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.78
|
| Rate for Payer: Priority Health HMO/PPO |
$73.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.16
|
| Rate for Payer: UHC Core |
$70.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.20
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
IP
|
$9,635.14
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,262.84 |
| Max. Negotiated Rate |
$8,671.63 |
| Rate for Payer: Aetna Commercial |
$8,189.87
|
| Rate for Payer: BCBS Trust/PPO |
$7,865.16
|
| Rate for Payer: BCN Commercial |
$7,446.04
|
| Rate for Payer: Cash Price |
$7,708.11
|
| Rate for Payer: Cofinity Commercial |
$8,286.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,708.11
|
| Rate for Payer: Healthscope Commercial |
$8,671.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,226.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,189.87
|
| Rate for Payer: Nomi Health Commercial |
$7,900.81
|
| Rate for Payer: PHP Commercial |
$8,189.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,262.84
|
| Rate for Payer: Priority Health HMO/PPO |
$8,382.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,455.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,478.92
|
| Rate for Payer: UHC Core |
$8,045.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,226.36
|
|
|
HC ULTRASOUND RF UTERINE FIBROID ABLATION TRANSCERVICAL
|
Facility
|
OP
|
$9,635.14
|
|
|
Service Code
|
CPT 58580
|
| Hospital Charge Code |
36100485
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,288.35 |
| Max. Negotiated Rate |
$8,671.63 |
| Rate for Payer: Aetna Commercial |
$8,189.87
|
| Rate for Payer: Aetna Medicare |
$2,505.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,010.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,010.98
|
| Rate for Payer: BCBS Complete |
$5,500.62
|
| Rate for Payer: BCBS MAPPO |
$2,408.78
|
| Rate for Payer: BCBS Trust/PPO |
$7,921.05
|
| Rate for Payer: BCN Commercial |
$7,491.32
|
| Rate for Payer: BCN Medicare Advantage |
$2,408.78
|
| Rate for Payer: Cash Price |
$7,708.11
|
| Rate for Payer: Cash Price |
$7,708.11
|
| Rate for Payer: Cofinity Commercial |
$8,286.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,708.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,408.78
|
| Rate for Payer: Healthscope Commercial |
$8,671.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,226.36
|
| Rate for Payer: Mclaren Medicaid |
$5,238.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,529.22
|
| Rate for Payer: Meridian Medicaid |
$5,500.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,770.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,189.87
|
| Rate for Payer: Nomi Health Commercial |
$7,900.81
|
| Rate for Payer: PACE Senior Care Partners |
$2,288.35
|
| Rate for Payer: PACE SWMI |
$2,408.78
|
| Rate for Payer: PHP Commercial |
$8,189.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,408.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,238.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,262.84
|
| Rate for Payer: Priority Health HMO/PPO |
$8,382.57
|
| Rate for Payer: Priority Health Medicare |
$2,432.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,455.54
|
| Rate for Payer: Railroad Medicare Medicare |
$2,408.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,478.92
|
| Rate for Payer: UHC Core |
$8,045.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,408.78
|
| Rate for Payer: UHC Exchange |
$2,408.78
|
| Rate for Payer: UHC Medicare Advantage |
$2,408.78
|
| Rate for Payer: UHCCP Medicaid |
$5,238.34
|
| Rate for Payer: VA VA |
$2,408.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,226.36
|
|
|
HC ULTRATAG RBC PER STUDY
|
Facility
|
IP
|
$244.45
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
34300023
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$158.89 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$207.78
|
| Rate for Payer: BCBS Trust/PPO |
$199.54
|
| Rate for Payer: BCN Commercial |
$188.91
|
| Rate for Payer: Cash Price |
$195.56
|
| Rate for Payer: Cofinity Commercial |
$210.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.56
|
| Rate for Payer: Healthscope Commercial |
$220.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.78
|
| Rate for Payer: Nomi Health Commercial |
$200.45
|
| Rate for Payer: PHP Commercial |
$207.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.89
|
| Rate for Payer: Priority Health HMO/PPO |
$212.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.12
|
| Rate for Payer: UHC Core |
$204.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.34
|
|
|
HC ULTRATAG RBC PER STUDY
|
Facility
|
OP
|
$244.45
|
|
|
Service Code
|
HCPCS A9560
|
| Hospital Charge Code |
34300023
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$58.06 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$207.78
|
| Rate for Payer: Aetna Medicare |
$63.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.39
|
| Rate for Payer: BCBS Complete |
$97.78
|
| Rate for Payer: BCBS MAPPO |
$61.11
|
| Rate for Payer: BCBS Trust/PPO |
$200.96
|
| Rate for Payer: BCN Commercial |
$190.06
|
| Rate for Payer: BCN Medicare Advantage |
$61.11
|
| Rate for Payer: Cash Price |
$195.56
|
| Rate for Payer: Cofinity Commercial |
$210.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.11
|
| Rate for Payer: Healthscope Commercial |
$220.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.78
|
| Rate for Payer: Nomi Health Commercial |
$200.45
|
| Rate for Payer: PACE Senior Care Partners |
$58.06
|
| Rate for Payer: PACE SWMI |
$61.11
|
| Rate for Payer: PHP Commercial |
$207.78
|
| Rate for Payer: PHP Medicare Advantage |
$61.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.89
|
| Rate for Payer: Priority Health HMO/PPO |
$212.67
|
| Rate for Payer: Priority Health Medicare |
$61.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.78
|
| Rate for Payer: Railroad Medicare Medicare |
$61.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.12
|
| Rate for Payer: UHC Core |
$204.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.11
|
| Rate for Payer: UHC Exchange |
$61.11
|
| Rate for Payer: UHC Medicare Advantage |
$61.11
|
| Rate for Payer: VA VA |
$61.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.34
|
|
|
HC UMBILICAL ARTERY CATHETER
|
Facility
|
OP
|
$213.64
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
36100602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.74 |
| Max. Negotiated Rate |
$192.28 |
| Rate for Payer: Aetna Commercial |
$181.59
|
| Rate for Payer: Aetna Medicare |
$55.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.76
|
| Rate for Payer: BCBS Complete |
$85.46
|
| Rate for Payer: BCBS MAPPO |
$53.41
|
| Rate for Payer: BCBS Trust/PPO |
$175.63
|
| Rate for Payer: BCN Commercial |
$166.11
|
| Rate for Payer: BCN Medicare Advantage |
$53.41
|
| Rate for Payer: Cash Price |
$170.91
|
| Rate for Payer: Cofinity Commercial |
$183.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.41
|
| Rate for Payer: Healthscope Commercial |
$192.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.59
|
| Rate for Payer: Nomi Health Commercial |
$175.18
|
| Rate for Payer: PACE Senior Care Partners |
$50.74
|
| Rate for Payer: PACE SWMI |
$53.41
|
| Rate for Payer: PHP Commercial |
$181.59
|
| Rate for Payer: PHP Medicare Advantage |
$53.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.87
|
| Rate for Payer: Priority Health HMO/PPO |
$185.87
|
| Rate for Payer: Priority Health Medicare |
$53.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.14
|
| Rate for Payer: Railroad Medicare Medicare |
$53.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.00
|
| Rate for Payer: UHC Core |
$178.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.41
|
| Rate for Payer: UHC Exchange |
$53.41
|
| Rate for Payer: UHC Medicare Advantage |
$53.41
|
| Rate for Payer: VA VA |
$53.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.23
|
|
|
HC UMBILICAL ARTERY CATHETER
|
Facility
|
IP
|
$213.64
|
|
|
Service Code
|
CPT 36660
|
| Hospital Charge Code |
36100602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.87 |
| Max. Negotiated Rate |
$192.28 |
| Rate for Payer: Aetna Commercial |
$181.59
|
| Rate for Payer: BCBS Trust/PPO |
$174.39
|
| Rate for Payer: BCN Commercial |
$165.10
|
| Rate for Payer: Cash Price |
$170.91
|
| Rate for Payer: Cofinity Commercial |
$183.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.91
|
| Rate for Payer: Healthscope Commercial |
$192.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.59
|
| Rate for Payer: Nomi Health Commercial |
$175.18
|
| Rate for Payer: PHP Commercial |
$181.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.87
|
| Rate for Payer: Priority Health HMO/PPO |
$185.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.00
|
| Rate for Payer: UHC Core |
$178.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.23
|
|
|
HC UMBILICAL VEIN CATHETER
|
Facility
|
OP
|
$213.64
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
36100584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.74 |
| Max. Negotiated Rate |
$192.28 |
| Rate for Payer: Aetna Commercial |
$181.59
|
| Rate for Payer: Aetna Medicare |
$55.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.76
|
| Rate for Payer: BCBS Complete |
$85.46
|
| Rate for Payer: BCBS MAPPO |
$53.41
|
| Rate for Payer: BCBS Trust/PPO |
$175.63
|
| Rate for Payer: BCN Commercial |
$166.11
|
| Rate for Payer: BCN Medicare Advantage |
$53.41
|
| Rate for Payer: Cash Price |
$170.91
|
| Rate for Payer: Cofinity Commercial |
$183.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.41
|
| Rate for Payer: Healthscope Commercial |
$192.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.59
|
| Rate for Payer: Nomi Health Commercial |
$175.18
|
| Rate for Payer: PACE Senior Care Partners |
$50.74
|
| Rate for Payer: PACE SWMI |
$53.41
|
| Rate for Payer: PHP Commercial |
$181.59
|
| Rate for Payer: PHP Medicare Advantage |
$53.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.87
|
| Rate for Payer: Priority Health HMO/PPO |
$185.87
|
| Rate for Payer: Priority Health Medicare |
$53.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.14
|
| Rate for Payer: Railroad Medicare Medicare |
$53.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.00
|
| Rate for Payer: UHC Core |
$178.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.41
|
| Rate for Payer: UHC Exchange |
$53.41
|
| Rate for Payer: UHC Medicare Advantage |
$53.41
|
| Rate for Payer: VA VA |
$53.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.23
|
|
|
HC UMBILICAL VEIN CATHETER
|
Facility
|
IP
|
$213.64
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
36100584
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.87 |
| Max. Negotiated Rate |
$192.28 |
| Rate for Payer: Aetna Commercial |
$181.59
|
| Rate for Payer: BCBS Trust/PPO |
$174.39
|
| Rate for Payer: BCN Commercial |
$165.10
|
| Rate for Payer: Cash Price |
$170.91
|
| Rate for Payer: Cofinity Commercial |
$183.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.91
|
| Rate for Payer: Healthscope Commercial |
$192.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.59
|
| Rate for Payer: Nomi Health Commercial |
$175.18
|
| Rate for Payer: PHP Commercial |
$181.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.87
|
| Rate for Payer: Priority Health HMO/PPO |
$185.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.00
|
| Rate for Payer: UHC Core |
$178.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.23
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
IP
|
$330.35
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$214.73 |
| Max. Negotiated Rate |
$297.32 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: BCBS Trust/PPO |
$269.66
|
| Rate for Payer: BCN Commercial |
$255.29
|
| Rate for Payer: Cash Price |
$264.28
|
| Rate for Payer: Cofinity Commercial |
$284.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.28
|
| Rate for Payer: Healthscope Commercial |
$297.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.80
|
| Rate for Payer: Nomi Health Commercial |
$270.89
|
| Rate for Payer: PHP Commercial |
$280.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.73
|
| Rate for Payer: Priority Health HMO/PPO |
$287.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.71
|
| Rate for Payer: UHC Core |
$275.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.76
|
|
|
HC UNILATERAL SCREENING MAMM WITH CAD
|
Facility
|
OP
|
$330.35
|
|
|
Service Code
|
HCPCS 77067
|
| Hospital Charge Code |
40300007
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$78.46 |
| Max. Negotiated Rate |
$297.32 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.23
|
| Rate for Payer: BCBS Complete |
$132.14
|
| Rate for Payer: BCBS MAPPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$271.58
|
| Rate for Payer: BCCCP Commercial |
$119.92
|
| Rate for Payer: BCN Commercial |
$256.85
|
| Rate for Payer: BCN Medicare Advantage |
$82.59
|
| Rate for Payer: Cash Price |
$264.28
|
| Rate for Payer: Cash Price |
$264.28
|
| Rate for Payer: Cofinity Commercial |
$284.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$297.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.80
|
| Rate for Payer: Nomi Health Commercial |
$270.89
|
| Rate for Payer: PACE Senior Care Partners |
$78.46
|
| Rate for Payer: PACE SWMI |
$82.59
|
| Rate for Payer: PHP Commercial |
$280.80
|
| Rate for Payer: PHP Medicare Advantage |
$82.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.73
|
| Rate for Payer: Priority Health HMO/PPO |
$287.40
|
| Rate for Payer: Priority Health Medicare |
$83.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.33
|
| Rate for Payer: Railroad Medicare Medicare |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.71
|
| Rate for Payer: UHC Core |
$275.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.59
|
| Rate for Payer: UHC Exchange |
$82.59
|
| Rate for Payer: UHC Medicare Advantage |
$82.59
|
| Rate for Payer: VA VA |
$82.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.76
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
OP
|
$103.21
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$92.89 |
| Rate for Payer: Aetna Commercial |
$87.73
|
| Rate for Payer: Aetna Medicare |
$26.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.25
|
| Rate for Payer: BCBS Complete |
$41.28
|
| Rate for Payer: BCBS MAPPO |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$84.85
|
| Rate for Payer: BCN Commercial |
$80.25
|
| Rate for Payer: BCN Medicare Advantage |
$25.80
|
| Rate for Payer: Cash Price |
$82.57
|
| Rate for Payer: Cofinity Commercial |
$88.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$92.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.73
|
| Rate for Payer: Nomi Health Commercial |
$84.63
|
| Rate for Payer: PACE Senior Care Partners |
$24.51
|
| Rate for Payer: PACE SWMI |
$25.80
|
| Rate for Payer: PHP Commercial |
$87.73
|
| Rate for Payer: PHP Medicare Advantage |
$25.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.09
|
| Rate for Payer: Priority Health HMO/PPO |
$89.79
|
| Rate for Payer: Priority Health Medicare |
$26.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.15
|
| Rate for Payer: Railroad Medicare Medicare |
$25.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.82
|
| Rate for Payer: UHC Core |
$86.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.80
|
| Rate for Payer: UHC Exchange |
$25.80
|
| Rate for Payer: UHC Medicare Advantage |
$25.80
|
| Rate for Payer: VA VA |
$25.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.41
|
|
|
HC UNILATERAL TOMOSYNTHESIS
|
Facility
|
IP
|
$103.21
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
32000299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.09 |
| Max. Negotiated Rate |
$92.89 |
| Rate for Payer: Aetna Commercial |
$87.73
|
| Rate for Payer: BCBS Trust/PPO |
$84.25
|
| Rate for Payer: BCN Commercial |
$79.76
|
| Rate for Payer: Cash Price |
$82.57
|
| Rate for Payer: Cofinity Commercial |
$88.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.57
|
| Rate for Payer: Healthscope Commercial |
$92.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.73
|
| Rate for Payer: Nomi Health Commercial |
$84.63
|
| Rate for Payer: PHP Commercial |
$87.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.09
|
| Rate for Payer: Priority Health HMO/PPO |
$89.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.82
|
| Rate for Payer: UHC Core |
$86.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.41
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
OP
|
$9,655.64
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,293.21 |
| Max. Negotiated Rate |
$8,690.08 |
| Rate for Payer: Aetna Commercial |
$8,207.29
|
| Rate for Payer: Aetna Medicare |
$2,510.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,017.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,017.39
|
| Rate for Payer: BCBS Complete |
$4,881.81
|
| Rate for Payer: BCBS MAPPO |
$2,413.91
|
| Rate for Payer: BCBS Trust/PPO |
$7,937.90
|
| Rate for Payer: BCN Commercial |
$7,507.26
|
| Rate for Payer: BCN Medicare Advantage |
$2,413.91
|
| Rate for Payer: Cash Price |
$7,724.51
|
| Rate for Payer: Cash Price |
$7,724.51
|
| Rate for Payer: Cofinity Commercial |
$8,303.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,724.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,413.91
|
| Rate for Payer: Healthscope Commercial |
$8,690.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,241.73
|
| Rate for Payer: Mclaren Medicaid |
$4,649.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,534.61
|
| Rate for Payer: Meridian Medicaid |
$4,881.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,776.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,207.29
|
| Rate for Payer: Nomi Health Commercial |
$7,917.62
|
| Rate for Payer: PACE Senior Care Partners |
$2,293.21
|
| Rate for Payer: PACE SWMI |
$2,413.91
|
| Rate for Payer: PHP Commercial |
$8,207.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,413.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,649.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,276.17
|
| Rate for Payer: Priority Health HMO/PPO |
$8,400.41
|
| Rate for Payer: Priority Health Medicare |
$2,438.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,469.28
|
| Rate for Payer: Railroad Medicare Medicare |
$2,413.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,496.96
|
| Rate for Payer: UHC Core |
$8,062.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,413.91
|
| Rate for Payer: UHC Exchange |
$2,413.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,413.91
|
| Rate for Payer: UHCCP Medicaid |
$4,649.03
|
| Rate for Payer: VA VA |
$2,413.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,241.73
|
|
|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$9,655.64
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,276.17 |
| Max. Negotiated Rate |
$8,690.08 |
| Rate for Payer: Aetna Commercial |
$8,207.29
|
| Rate for Payer: BCBS Trust/PPO |
$7,881.90
|
| Rate for Payer: BCN Commercial |
$7,461.88
|
| Rate for Payer: Cash Price |
$7,724.51
|
| Rate for Payer: Cofinity Commercial |
$8,303.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,724.51
|
| Rate for Payer: Healthscope Commercial |
$8,690.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,241.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,207.29
|
| Rate for Payer: Nomi Health Commercial |
$7,917.62
|
| Rate for Payer: PHP Commercial |
$8,207.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,276.17
|
| Rate for Payer: Priority Health HMO/PPO |
$8,400.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,469.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,496.96
|
| Rate for Payer: UHC Core |
$8,062.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,241.73
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
IP
|
$1,125.34
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$731.47 |
| Max. Negotiated Rate |
$1,012.81 |
| Rate for Payer: Aetna Commercial |
$956.54
|
| Rate for Payer: BCBS Trust/PPO |
$918.62
|
| Rate for Payer: BCN Commercial |
$869.66
|
| Rate for Payer: Cash Price |
$900.27
|
| Rate for Payer: Cofinity Commercial |
$967.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.27
|
| Rate for Payer: Healthscope Commercial |
$1,012.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$844.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.54
|
| Rate for Payer: Nomi Health Commercial |
$922.78
|
| Rate for Payer: PHP Commercial |
$956.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.47
|
| Rate for Payer: Priority Health HMO/PPO |
$979.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$753.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.30
|
| Rate for Payer: UHC Core |
$939.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$844.00
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
OP
|
$1,125.34
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$1,012.81 |
| Rate for Payer: Aetna Commercial |
$956.54
|
| Rate for Payer: Aetna Medicare |
$292.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$351.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$351.67
|
| Rate for Payer: BCBS Complete |
$149.64
|
| Rate for Payer: BCBS MAPPO |
$281.34
|
| Rate for Payer: BCBS Trust/PPO |
$925.14
|
| Rate for Payer: BCN Commercial |
$874.95
|
| Rate for Payer: BCN Medicare Advantage |
$281.34
|
| Rate for Payer: Cash Price |
$900.27
|
| Rate for Payer: Cash Price |
$900.27
|
| Rate for Payer: Cofinity Commercial |
$967.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$900.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.34
|
| Rate for Payer: Healthscope Commercial |
$1,012.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$844.00
|
| Rate for Payer: Mclaren Medicaid |
$142.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$295.40
|
| Rate for Payer: Meridian Medicaid |
$149.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.54
|
| Rate for Payer: Nomi Health Commercial |
$922.78
|
| Rate for Payer: PACE Senior Care Partners |
$267.27
|
| Rate for Payer: PACE SWMI |
$281.34
|
| Rate for Payer: PHP Commercial |
$956.54
|
| Rate for Payer: PHP Medicare Advantage |
$281.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.47
|
| Rate for Payer: Priority Health HMO/PPO |
$979.05
|
| Rate for Payer: Priority Health Medicare |
$284.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$753.98
|
| Rate for Payer: Railroad Medicare Medicare |
$281.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$990.30
|
| Rate for Payer: UHC Core |
$939.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.34
|
| Rate for Payer: UHC Exchange |
$281.34
|
| Rate for Payer: UHC Medicare Advantage |
$281.34
|
| Rate for Payer: UHCCP Medicaid |
$142.50
|
| Rate for Payer: VA VA |
$281.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$844.00
|
|
|
HC UNLISTED PROCEDURE, FEMUR OR KNEE
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
CPT 27599
|
| Hospital Charge Code |
76100418
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$605.88 |
| Rate for Payer: Aetna Commercial |
$572.22
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: BCBS Complete |
$178.43
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$553.44
|
| Rate for Payer: BCN Commercial |
$523.41
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$578.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Healthscope Commercial |
$605.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.90
|
| Rate for Payer: Mclaren Medicaid |
$169.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: Meridian Medicaid |
$178.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PACE Senior Care Partners |
$159.88
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PHP Commercial |
$572.22
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO |
$585.68
|
| Rate for Payer: Priority Health Medicare |
$169.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.04
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.42
|
| Rate for Payer: UHC Core |
$562.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Exchange |
$168.30
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: UHCCP Medicaid |
$169.93
|
| Rate for Payer: VA VA |
$168.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.90
|
|
