|
HC US CHEST
|
Facility
|
OP
|
$561.59
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
40200007
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$505.43 |
| Rate for Payer: Aetna Commercial |
$477.35
|
| Rate for Payer: Aetna Medicare |
$146.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.50
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$140.40
|
| Rate for Payer: BCBS Trust/PPO |
$461.68
|
| Rate for Payer: BCN Commercial |
$436.64
|
| Rate for Payer: BCN Medicare Advantage |
$140.40
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cash Price |
$449.27
|
| Rate for Payer: Cofinity Commercial |
$482.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.40
|
| Rate for Payer: Healthscope Commercial |
$505.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$421.19
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.42
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.35
|
| Rate for Payer: Nomi Health Commercial |
$460.50
|
| Rate for Payer: PACE Senior Care Partners |
$133.38
|
| Rate for Payer: PACE SWMI |
$140.40
|
| Rate for Payer: PHP Commercial |
$477.35
|
| Rate for Payer: PHP Medicare Advantage |
$140.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.03
|
| Rate for Payer: Priority Health HMO/PPO |
$488.58
|
| Rate for Payer: Priority Health Medicare |
$141.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.27
|
| Rate for Payer: Railroad Medicare Medicare |
$140.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.20
|
| Rate for Payer: UHC Core |
$468.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.40
|
| Rate for Payer: UHC Exchange |
$140.40
|
| Rate for Payer: UHC Medicare Advantage |
$140.40
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$140.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$421.19
|
|
|
HC US CHORIONIC VILLIS SAMPLE
|
Facility
|
OP
|
$573.60
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
40200048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$136.23 |
| Max. Negotiated Rate |
$516.24 |
| Rate for Payer: Aetna Commercial |
$487.56
|
| Rate for Payer: Aetna Medicare |
$149.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.25
|
| Rate for Payer: BCBS Complete |
$229.44
|
| Rate for Payer: BCBS MAPPO |
$143.40
|
| Rate for Payer: BCBS Trust/PPO |
$471.56
|
| Rate for Payer: BCN Commercial |
$445.97
|
| Rate for Payer: BCN Medicare Advantage |
$143.40
|
| Rate for Payer: Cash Price |
$458.88
|
| Rate for Payer: Cofinity Commercial |
$493.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.40
|
| Rate for Payer: Healthscope Commercial |
$516.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.56
|
| Rate for Payer: Nomi Health Commercial |
$470.35
|
| Rate for Payer: PACE Senior Care Partners |
$136.23
|
| Rate for Payer: PACE SWMI |
$143.40
|
| Rate for Payer: PHP Commercial |
$487.56
|
| Rate for Payer: PHP Medicare Advantage |
$143.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.84
|
| Rate for Payer: Priority Health HMO/PPO |
$499.03
|
| Rate for Payer: Priority Health Medicare |
$144.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$384.31
|
| Rate for Payer: Railroad Medicare Medicare |
$143.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.77
|
| Rate for Payer: UHC Core |
$478.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$143.40
|
| Rate for Payer: UHC Exchange |
$143.40
|
| Rate for Payer: UHC Medicare Advantage |
$143.40
|
| Rate for Payer: VA VA |
$143.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.20
|
|
|
HC US CHORIONIC VILLIS SAMPLE
|
Facility
|
IP
|
$573.60
|
|
|
Service Code
|
CPT 76945
|
| Hospital Charge Code |
40200048
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$372.84 |
| Max. Negotiated Rate |
$516.24 |
| Rate for Payer: Aetna Commercial |
$487.56
|
| Rate for Payer: BCBS Trust/PPO |
$468.23
|
| Rate for Payer: BCN Commercial |
$443.28
|
| Rate for Payer: Cash Price |
$458.88
|
| Rate for Payer: Cofinity Commercial |
$493.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.88
|
| Rate for Payer: Healthscope Commercial |
$516.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.56
|
| Rate for Payer: Nomi Health Commercial |
$470.35
|
| Rate for Payer: PHP Commercial |
$487.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.84
|
| Rate for Payer: Priority Health HMO/PPO |
$499.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$384.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.77
|
| Rate for Payer: UHC Core |
$478.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.20
|
|
|
HC US CRANIAL
|
Facility
|
OP
|
$826.35
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
40200053
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$743.72 |
| Rate for Payer: Aetna Commercial |
$702.40
|
| Rate for Payer: Aetna Medicare |
$214.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.23
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$206.59
|
| Rate for Payer: BCBS Trust/PPO |
$679.34
|
| Rate for Payer: BCN Commercial |
$642.49
|
| Rate for Payer: BCN Medicare Advantage |
$206.59
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$710.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.59
|
| Rate for Payer: Healthscope Commercial |
$743.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.76
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.92
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$677.61
|
| Rate for Payer: PACE Senior Care Partners |
$196.26
|
| Rate for Payer: PACE SWMI |
$206.59
|
| Rate for Payer: PHP Commercial |
$702.40
|
| Rate for Payer: PHP Medicare Advantage |
$206.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: Priority Health HMO/PPO |
$718.92
|
| Rate for Payer: Priority Health Medicare |
$208.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$553.65
|
| Rate for Payer: Railroad Medicare Medicare |
$206.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.19
|
| Rate for Payer: UHC Core |
$690.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.59
|
| Rate for Payer: UHC Exchange |
$206.59
|
| Rate for Payer: UHC Medicare Advantage |
$206.59
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$206.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.76
|
|
|
HC US CRANIAL
|
Facility
|
IP
|
$826.35
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
40200053
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$537.13 |
| Max. Negotiated Rate |
$743.72 |
| Rate for Payer: Aetna Commercial |
$702.40
|
| Rate for Payer: BCBS Trust/PPO |
$674.55
|
| Rate for Payer: BCN Commercial |
$638.60
|
| Rate for Payer: Cash Price |
$661.08
|
| Rate for Payer: Cofinity Commercial |
$710.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.08
|
| Rate for Payer: Healthscope Commercial |
$743.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$619.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$702.40
|
| Rate for Payer: Nomi Health Commercial |
$677.61
|
| Rate for Payer: PHP Commercial |
$702.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.13
|
| Rate for Payer: Priority Health HMO/PPO |
$718.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$553.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.19
|
| Rate for Payer: UHC Core |
$690.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$619.76
|
|
|
HC US DUPLX DOP ABD PEL SCROT LTD
|
Facility
|
IP
|
$1,011.43
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
92100014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$657.43 |
| Max. Negotiated Rate |
$910.29 |
| Rate for Payer: Aetna Commercial |
$859.72
|
| Rate for Payer: BCBS Trust/PPO |
$825.63
|
| Rate for Payer: BCN Commercial |
$781.63
|
| Rate for Payer: Cash Price |
$809.14
|
| Rate for Payer: Cofinity Commercial |
$869.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.14
|
| Rate for Payer: Healthscope Commercial |
$910.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.72
|
| Rate for Payer: Nomi Health Commercial |
$829.37
|
| Rate for Payer: PHP Commercial |
$859.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.43
|
| Rate for Payer: Priority Health HMO/PPO |
$879.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$677.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$890.06
|
| Rate for Payer: UHC Core |
$844.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.57
|
|
|
HC US DUPLX DOP ABD PEL SCROT LTD
|
Facility
|
OP
|
$1,011.43
|
|
|
Service Code
|
CPT 93976
|
| Hospital Charge Code |
92100014
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$910.29 |
| Rate for Payer: Aetna Commercial |
$859.72
|
| Rate for Payer: Aetna Medicare |
$262.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$316.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$316.07
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$252.86
|
| Rate for Payer: BCBS Trust/PPO |
$831.50
|
| Rate for Payer: BCN Commercial |
$786.39
|
| Rate for Payer: BCN Medicare Advantage |
$252.86
|
| Rate for Payer: Cash Price |
$809.14
|
| Rate for Payer: Cash Price |
$809.14
|
| Rate for Payer: Cofinity Commercial |
$869.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$809.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.86
|
| Rate for Payer: Healthscope Commercial |
$910.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.57
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$265.50
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$290.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.72
|
| Rate for Payer: Nomi Health Commercial |
$829.37
|
| Rate for Payer: PACE Senior Care Partners |
$240.21
|
| Rate for Payer: PACE SWMI |
$252.86
|
| Rate for Payer: PHP Commercial |
$859.72
|
| Rate for Payer: PHP Medicare Advantage |
$252.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.43
|
| Rate for Payer: Priority Health HMO/PPO |
$879.94
|
| Rate for Payer: Priority Health Medicare |
$255.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$677.66
|
| Rate for Payer: Railroad Medicare Medicare |
$252.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$890.06
|
| Rate for Payer: UHC Core |
$844.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$252.86
|
| Rate for Payer: UHC Exchange |
$252.86
|
| Rate for Payer: UHC Medicare Advantage |
$252.86
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$252.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.57
|
|
|
HC US DUPLX DOP ABD PELV SCROTUM
|
Facility
|
OP
|
$1,742.46
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$1,568.21 |
| Rate for Payer: Aetna Commercial |
$1,481.09
|
| Rate for Payer: Aetna Medicare |
$453.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$544.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$544.52
|
| Rate for Payer: BCBS Complete |
$183.51
|
| Rate for Payer: BCBS MAPPO |
$435.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.48
|
| Rate for Payer: BCN Commercial |
$1,354.76
|
| Rate for Payer: BCN Medicare Advantage |
$435.62
|
| Rate for Payer: Cash Price |
$1,393.97
|
| Rate for Payer: Cash Price |
$1,393.97
|
| Rate for Payer: Cofinity Commercial |
$1,498.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$435.62
|
| Rate for Payer: Healthscope Commercial |
$1,568.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,306.85
|
| Rate for Payer: Mclaren Medicaid |
$174.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$457.40
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$500.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,481.09
|
| Rate for Payer: Nomi Health Commercial |
$1,428.82
|
| Rate for Payer: PACE Senior Care Partners |
$413.83
|
| Rate for Payer: PACE SWMI |
$435.62
|
| Rate for Payer: PHP Commercial |
$1,481.09
|
| Rate for Payer: PHP Medicare Advantage |
$435.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,132.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,515.94
|
| Rate for Payer: Priority Health Medicare |
$439.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,167.45
|
| Rate for Payer: Railroad Medicare Medicare |
$435.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,533.36
|
| Rate for Payer: UHC Core |
$1,454.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$435.62
|
| Rate for Payer: UHC Exchange |
$435.62
|
| Rate for Payer: UHC Medicare Advantage |
$435.62
|
| Rate for Payer: UHCCP Medicaid |
$174.76
|
| Rate for Payer: VA VA |
$435.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,306.85
|
|
|
HC US DUPLX DOP ABD PELV SCROTUM
|
Facility
|
IP
|
$1,742.46
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
92100013
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,132.60 |
| Max. Negotiated Rate |
$1,568.21 |
| Rate for Payer: Aetna Commercial |
$1,481.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.37
|
| Rate for Payer: BCN Commercial |
$1,346.57
|
| Rate for Payer: Cash Price |
$1,393.97
|
| Rate for Payer: Cofinity Commercial |
$1,498.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,393.97
|
| Rate for Payer: Healthscope Commercial |
$1,568.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,306.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,481.09
|
| Rate for Payer: Nomi Health Commercial |
$1,428.82
|
| Rate for Payer: PHP Commercial |
$1,481.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,132.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,515.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,167.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,533.36
|
| Rate for Payer: UHC Core |
$1,454.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,306.85
|
|
|
HC US EACH ADDL FETUS BPP
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: Aetna Medicare |
$126.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.88
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$121.50
|
| Rate for Payer: BCBS Trust/PPO |
$399.54
|
| Rate for Payer: BCN Commercial |
$377.87
|
| Rate for Payer: BCN Medicare Advantage |
$121.50
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cofinity Commercial |
$417.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.50
|
| Rate for Payer: Healthscope Commercial |
$437.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.50
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.58
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.10
|
| Rate for Payer: Nomi Health Commercial |
$398.52
|
| Rate for Payer: PACE Senior Care Partners |
$115.42
|
| Rate for Payer: PACE SWMI |
$121.50
|
| Rate for Payer: PHP Commercial |
$413.10
|
| Rate for Payer: PHP Medicare Advantage |
$121.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.90
|
| Rate for Payer: Priority Health HMO/PPO |
$422.82
|
| Rate for Payer: Priority Health Medicare |
$122.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.62
|
| Rate for Payer: Railroad Medicare Medicare |
$121.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.68
|
| Rate for Payer: UHC Core |
$405.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.50
|
| Rate for Payer: UHC Exchange |
$121.50
|
| Rate for Payer: UHC Medicare Advantage |
$121.50
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$121.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.50
|
|
|
HC US EACH ADDL FETUS BPP
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
40200026
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$315.90 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: BCBS Trust/PPO |
$396.72
|
| Rate for Payer: BCN Commercial |
$375.58
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cofinity Commercial |
$417.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.80
|
| Rate for Payer: Healthscope Commercial |
$437.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.10
|
| Rate for Payer: Nomi Health Commercial |
$398.52
|
| Rate for Payer: PHP Commercial |
$413.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.90
|
| Rate for Payer: Priority Health HMO/PPO |
$422.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.68
|
| Rate for Payer: UHC Core |
$405.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.50
|
|
|
HC US EACH ADDL FETUS GT 14 WKS
|
Facility
|
IP
|
$431.77
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$280.65 |
| Max. Negotiated Rate |
$388.59 |
| Rate for Payer: Aetna Commercial |
$367.00
|
| Rate for Payer: BCBS Trust/PPO |
$352.45
|
| Rate for Payer: BCN Commercial |
$333.67
|
| Rate for Payer: Cash Price |
$345.42
|
| Rate for Payer: Cofinity Commercial |
$371.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.42
|
| Rate for Payer: Healthscope Commercial |
$388.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.00
|
| Rate for Payer: Nomi Health Commercial |
$354.05
|
| Rate for Payer: PHP Commercial |
$367.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.65
|
| Rate for Payer: Priority Health HMO/PPO |
$375.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.96
|
| Rate for Payer: UHC Core |
$360.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.83
|
|
|
HC US EACH ADDL FETUS GT 14 WKS
|
Facility
|
OP
|
$431.77
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
40200018
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.55 |
| Max. Negotiated Rate |
$388.59 |
| Rate for Payer: Aetna Commercial |
$367.00
|
| Rate for Payer: Aetna Medicare |
$112.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.93
|
| Rate for Payer: BCBS Complete |
$172.71
|
| Rate for Payer: BCBS MAPPO |
$107.94
|
| Rate for Payer: BCBS Trust/PPO |
$354.96
|
| Rate for Payer: BCN Commercial |
$335.70
|
| Rate for Payer: BCN Medicare Advantage |
$107.94
|
| Rate for Payer: Cash Price |
$345.42
|
| Rate for Payer: Cofinity Commercial |
$371.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.94
|
| Rate for Payer: Healthscope Commercial |
$388.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.00
|
| Rate for Payer: Nomi Health Commercial |
$354.05
|
| Rate for Payer: PACE Senior Care Partners |
$102.55
|
| Rate for Payer: PACE SWMI |
$107.94
|
| Rate for Payer: PHP Commercial |
$367.00
|
| Rate for Payer: PHP Medicare Advantage |
$107.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.65
|
| Rate for Payer: Priority Health HMO/PPO |
$375.64
|
| Rate for Payer: Priority Health Medicare |
$109.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.29
|
| Rate for Payer: Railroad Medicare Medicare |
$107.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.96
|
| Rate for Payer: UHC Core |
$360.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.94
|
| Rate for Payer: UHC Exchange |
$107.94
|
| Rate for Payer: UHC Medicare Advantage |
$107.94
|
| Rate for Payer: VA VA |
$107.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.83
|
|
|
HC US EACH ADDL FETUS LESS THAN 14 WKS
|
Facility
|
IP
|
$355.44
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$231.04 |
| Max. Negotiated Rate |
$319.90 |
| Rate for Payer: Aetna Commercial |
$302.12
|
| Rate for Payer: BCBS Trust/PPO |
$290.15
|
| Rate for Payer: BCN Commercial |
$274.68
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cofinity Commercial |
$305.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.35
|
| Rate for Payer: Healthscope Commercial |
$319.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.12
|
| Rate for Payer: Nomi Health Commercial |
$291.46
|
| Rate for Payer: PHP Commercial |
$302.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.04
|
| Rate for Payer: Priority Health HMO/PPO |
$309.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.79
|
| Rate for Payer: UHC Core |
$296.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.58
|
|
|
HC US EACH ADDL FETUS LESS THAN 14 WKS
|
Facility
|
OP
|
$355.44
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.42 |
| Max. Negotiated Rate |
$319.90 |
| Rate for Payer: Aetna Commercial |
$302.12
|
| Rate for Payer: Aetna Medicare |
$92.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.08
|
| Rate for Payer: BCBS Complete |
$142.18
|
| Rate for Payer: BCBS MAPPO |
$88.86
|
| Rate for Payer: BCBS Trust/PPO |
$292.21
|
| Rate for Payer: BCN Commercial |
$276.35
|
| Rate for Payer: BCN Medicare Advantage |
$88.86
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cofinity Commercial |
$305.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.86
|
| Rate for Payer: Healthscope Commercial |
$319.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.12
|
| Rate for Payer: Nomi Health Commercial |
$291.46
|
| Rate for Payer: PACE Senior Care Partners |
$84.42
|
| Rate for Payer: PACE SWMI |
$88.86
|
| Rate for Payer: PHP Commercial |
$302.12
|
| Rate for Payer: PHP Medicare Advantage |
$88.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.04
|
| Rate for Payer: Priority Health HMO/PPO |
$309.23
|
| Rate for Payer: Priority Health Medicare |
$89.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.14
|
| Rate for Payer: Railroad Medicare Medicare |
$88.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.79
|
| Rate for Payer: UHC Core |
$296.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.86
|
| Rate for Payer: UHC Exchange |
$88.86
|
| Rate for Payer: UHC Medicare Advantage |
$88.86
|
| Rate for Payer: VA VA |
$88.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.58
|
|
|
HC US ELASTOGRAPHY 1ST LESION
|
Facility
|
IP
|
$208.08
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.25 |
| Max. Negotiated Rate |
$187.27 |
| Rate for Payer: Aetna Commercial |
$176.87
|
| Rate for Payer: BCBS Trust/PPO |
$169.86
|
| Rate for Payer: BCN Commercial |
$160.80
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$178.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Healthscope Commercial |
$187.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Nomi Health Commercial |
$170.63
|
| Rate for Payer: PHP Commercial |
$176.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.25
|
| Rate for Payer: Priority Health HMO/PPO |
$181.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.11
|
| Rate for Payer: UHC Core |
$173.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.06
|
|
|
HC US ELASTOGRAPHY 1ST LESION
|
Facility
|
OP
|
$208.08
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200075
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$187.27 |
| Rate for Payer: Aetna Commercial |
$176.87
|
| Rate for Payer: Aetna Medicare |
$54.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.03
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$171.06
|
| Rate for Payer: BCN Commercial |
$161.78
|
| Rate for Payer: BCN Medicare Advantage |
$52.02
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cash Price |
$166.46
|
| Rate for Payer: Cofinity Commercial |
$178.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.02
|
| Rate for Payer: Healthscope Commercial |
$187.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.06
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.62
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.87
|
| Rate for Payer: Nomi Health Commercial |
$170.63
|
| Rate for Payer: PACE Senior Care Partners |
$49.42
|
| Rate for Payer: PACE SWMI |
$52.02
|
| Rate for Payer: PHP Commercial |
$176.87
|
| Rate for Payer: PHP Medicare Advantage |
$52.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.25
|
| Rate for Payer: Priority Health HMO/PPO |
$181.03
|
| Rate for Payer: Priority Health Medicare |
$52.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.41
|
| Rate for Payer: Railroad Medicare Medicare |
$52.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.11
|
| Rate for Payer: UHC Core |
$173.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.02
|
| Rate for Payer: UHC Exchange |
$52.02
|
| Rate for Payer: UHC Medicare Advantage |
$52.02
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$52.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.06
|
|
|
HC US ELASTOGRAPHY 1ST TARGET LESION
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$73.62 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna Commercial |
$263.50
|
| Rate for Payer: Aetna Medicare |
$80.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.88
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$77.50
|
| Rate for Payer: BCBS Trust/PPO |
$254.85
|
| Rate for Payer: BCN Commercial |
$241.03
|
| Rate for Payer: BCN Medicare Advantage |
$77.50
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$266.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.50
|
| Rate for Payer: Healthscope Commercial |
$279.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.50
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.38
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.50
|
| Rate for Payer: Nomi Health Commercial |
$254.20
|
| Rate for Payer: PACE Senior Care Partners |
$73.62
|
| Rate for Payer: PACE SWMI |
$77.50
|
| Rate for Payer: PHP Commercial |
$263.50
|
| Rate for Payer: PHP Medicare Advantage |
$77.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health HMO/PPO |
$269.70
|
| Rate for Payer: Priority Health Medicare |
$78.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.70
|
| Rate for Payer: Railroad Medicare Medicare |
$77.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.80
|
| Rate for Payer: UHC Core |
$258.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.50
|
| Rate for Payer: UHC Exchange |
$77.50
|
| Rate for Payer: UHC Medicare Advantage |
$77.50
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$77.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.50
|
|
|
HC US ELASTOGRAPHY 1ST TARGET LESION
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 76982
|
| Hospital Charge Code |
40200082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna Commercial |
$263.50
|
| Rate for Payer: BCBS Trust/PPO |
$253.05
|
| Rate for Payer: BCN Commercial |
$239.57
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$266.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.00
|
| Rate for Payer: Healthscope Commercial |
$279.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.50
|
| Rate for Payer: Nomi Health Commercial |
$254.20
|
| Rate for Payer: PHP Commercial |
$263.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health HMO/PPO |
$269.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.80
|
| Rate for Payer: UHC Core |
$258.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.50
|
|
|
HC US ELASTOGRAPHY EA ADDL LESION
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.75
|
| Rate for Payer: BCBS Complete |
$12.48
|
| Rate for Payer: BCBS MAPPO |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$24.27
|
| Rate for Payer: BCN Medicare Advantage |
$7.80
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.80
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PACE Senior Care Partners |
$7.41
|
| Rate for Payer: PACE SWMI |
$7.80
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: Railroad Medicare Medicare |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.80
|
| Rate for Payer: UHC Exchange |
$7.80
|
| Rate for Payer: UHC Medicare Advantage |
$7.80
|
| Rate for Payer: VA VA |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC US ELASTOGRAPHY EA ADDL LESION
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.48
|
| Rate for Payer: BCN Commercial |
$24.12
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC US ELASTOGRAPHY EA ADDL TARGET LESION
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna Medicare |
$54.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.62
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS MAPPO |
$52.50
|
| Rate for Payer: BCBS Trust/PPO |
$172.64
|
| Rate for Payer: BCN Commercial |
$163.28
|
| Rate for Payer: BCN Medicare Advantage |
$52.50
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.50
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Nomi Health Commercial |
$172.20
|
| Rate for Payer: PACE Senior Care Partners |
$49.88
|
| Rate for Payer: PACE SWMI |
$52.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: PHP Medicare Advantage |
$52.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health HMO/PPO |
$182.70
|
| Rate for Payer: Priority Health Medicare |
$53.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.70
|
| Rate for Payer: Railroad Medicare Medicare |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.80
|
| Rate for Payer: UHC Core |
$175.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.50
|
| Rate for Payer: UHC Exchange |
$52.50
|
| Rate for Payer: UHC Medicare Advantage |
$52.50
|
| Rate for Payer: VA VA |
$52.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
HC US ELASTOGRAPHY EA ADDL TARGET LESION
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 76983
|
| Hospital Charge Code |
40200083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: BCBS Trust/PPO |
$171.42
|
| Rate for Payer: BCN Commercial |
$162.29
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Nomi Health Commercial |
$172.20
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health HMO/PPO |
$182.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.80
|
| Rate for Payer: UHC Core |
$175.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
IP
|
$244.80
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: BCBS Trust/PPO |
$199.83
|
| Rate for Payer: BCN Commercial |
$189.18
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$210.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: Nomi Health Commercial |
$200.74
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.12
|
| Rate for Payer: Priority Health HMO/PPO |
$212.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.42
|
| Rate for Payer: UHC Core |
$204.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.60
|
|
|
HC US ELASTOGRAPHY ORGAN
|
Facility
|
OP
|
$244.80
|
|
|
Service Code
|
CPT 76981
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.14 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: Aetna Medicare |
$63.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.50
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$201.25
|
| Rate for Payer: BCN Commercial |
$190.33
|
| Rate for Payer: BCN Medicare Advantage |
$61.20
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$210.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.60
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.26
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: Nomi Health Commercial |
$200.74
|
| Rate for Payer: PACE Senior Care Partners |
$58.14
|
| Rate for Payer: PACE SWMI |
$61.20
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: PHP Medicare Advantage |
$61.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.12
|
| Rate for Payer: Priority Health HMO/PPO |
$212.98
|
| Rate for Payer: Priority Health Medicare |
$61.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.02
|
| Rate for Payer: Railroad Medicare Medicare |
$61.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.42
|
| Rate for Payer: UHC Core |
$204.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.20
|
| Rate for Payer: UHC Exchange |
$61.20
|
| Rate for Payer: UHC Medicare Advantage |
$61.20
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$61.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.60
|
|
