|
HC US OB TRANSVAG ONLY
|
Facility
|
OP
|
$398.27
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$358.44 |
| Rate for Payer: Aetna Commercial |
$338.53
|
| Rate for Payer: Aetna Medicare |
$103.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.46
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$99.57
|
| Rate for Payer: BCBS Trust/PPO |
$327.42
|
| Rate for Payer: BCN Commercial |
$309.65
|
| Rate for Payer: BCN Medicare Advantage |
$99.57
|
| Rate for Payer: Cash Price |
$318.62
|
| Rate for Payer: Cash Price |
$318.62
|
| Rate for Payer: Cofinity Commercial |
$342.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.57
|
| Rate for Payer: Healthscope Commercial |
$358.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.70
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.55
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.53
|
| Rate for Payer: Nomi Health Commercial |
$326.58
|
| Rate for Payer: PACE Senior Care Partners |
$94.59
|
| Rate for Payer: PACE SWMI |
$99.57
|
| Rate for Payer: PHP Commercial |
$338.53
|
| Rate for Payer: PHP Medicare Advantage |
$99.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.88
|
| Rate for Payer: Priority Health HMO/PPO |
$346.49
|
| Rate for Payer: Priority Health Medicare |
$100.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.84
|
| Rate for Payer: Railroad Medicare Medicare |
$99.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.48
|
| Rate for Payer: UHC Core |
$332.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.57
|
| Rate for Payer: UHC Exchange |
$99.57
|
| Rate for Payer: UHC Medicare Advantage |
$99.57
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$99.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.70
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
IP
|
$398.27
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$258.88 |
| Max. Negotiated Rate |
$358.44 |
| Rate for Payer: Aetna Commercial |
$338.53
|
| Rate for Payer: BCBS Trust/PPO |
$325.11
|
| Rate for Payer: BCN Commercial |
$307.78
|
| Rate for Payer: Cash Price |
$318.62
|
| Rate for Payer: Cofinity Commercial |
$342.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.62
|
| Rate for Payer: Healthscope Commercial |
$358.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.53
|
| Rate for Payer: Nomi Health Commercial |
$326.58
|
| Rate for Payer: PHP Commercial |
$338.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.88
|
| Rate for Payer: Priority Health HMO/PPO |
$346.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.48
|
| Rate for Payer: UHC Core |
$332.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.70
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$707.85 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: BCBS Trust/PPO |
$888.95
|
| Rate for Payer: BCN Commercial |
$841.58
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$936.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Healthscope Commercial |
$980.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: Nomi Health Commercial |
$892.98
|
| Rate for Payer: PHP Commercial |
$925.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health HMO/PPO |
$947.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$729.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$958.32
|
| Rate for Payer: UHC Core |
$909.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.75
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.45 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: Aetna Medicare |
$283.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$340.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$340.31
|
| Rate for Payer: BCBS Complete |
$152.73
|
| Rate for Payer: BCBS MAPPO |
$272.25
|
| Rate for Payer: BCBS Trust/PPO |
$895.27
|
| Rate for Payer: BCN Commercial |
$846.70
|
| Rate for Payer: BCN Medicare Advantage |
$272.25
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$936.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.25
|
| Rate for Payer: Healthscope Commercial |
$980.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.75
|
| Rate for Payer: Mclaren Medicaid |
$145.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.86
|
| Rate for Payer: Meridian Medicaid |
$152.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: Nomi Health Commercial |
$892.98
|
| Rate for Payer: PACE Senior Care Partners |
$258.64
|
| Rate for Payer: PACE SWMI |
$272.25
|
| Rate for Payer: PHP Commercial |
$925.65
|
| Rate for Payer: PHP Medicare Advantage |
$272.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health HMO/PPO |
$947.43
|
| Rate for Payer: Priority Health Medicare |
$274.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$729.63
|
| Rate for Payer: Railroad Medicare Medicare |
$272.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$958.32
|
| Rate for Payer: UHC Core |
$909.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.25
|
| Rate for Payer: UHC Exchange |
$272.25
|
| Rate for Payer: UHC Medicare Advantage |
$272.25
|
| Rate for Payer: UHCCP Medicaid |
$145.45
|
| Rate for Payer: VA VA |
$272.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.75
|
|
|
HC US PARACENTESIS
|
Facility
|
IP
|
$1,369.02
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$889.86 |
| Max. Negotiated Rate |
$1,232.12 |
| Rate for Payer: Aetna Commercial |
$1,163.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.53
|
| Rate for Payer: BCN Commercial |
$1,057.98
|
| Rate for Payer: Cash Price |
$1,095.22
|
| Rate for Payer: Cofinity Commercial |
$1,177.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.22
|
| Rate for Payer: Healthscope Commercial |
$1,232.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,026.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.67
|
| Rate for Payer: Nomi Health Commercial |
$1,122.60
|
| Rate for Payer: PHP Commercial |
$1,163.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.86
|
| Rate for Payer: Priority Health HMO/PPO |
$1,191.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$917.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,204.74
|
| Rate for Payer: UHC Core |
$1,143.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,026.77
|
|
|
HC US PARACENTESIS
|
Facility
|
OP
|
$1,369.02
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$325.14 |
| Max. Negotiated Rate |
$1,232.12 |
| Rate for Payer: Aetna Commercial |
$1,163.67
|
| Rate for Payer: Aetna Medicare |
$355.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$427.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$427.82
|
| Rate for Payer: BCBS Complete |
$711.80
|
| Rate for Payer: BCBS MAPPO |
$342.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,125.47
|
| Rate for Payer: BCN Commercial |
$1,064.41
|
| Rate for Payer: BCN Medicare Advantage |
$342.25
|
| Rate for Payer: Cash Price |
$1,095.22
|
| Rate for Payer: Cash Price |
$1,095.22
|
| Rate for Payer: Cofinity Commercial |
$1,177.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$342.25
|
| Rate for Payer: Healthscope Commercial |
$1,232.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,026.77
|
| Rate for Payer: Mclaren Medicaid |
$677.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$359.37
|
| Rate for Payer: Meridian Medicaid |
$711.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$393.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.67
|
| Rate for Payer: Nomi Health Commercial |
$1,122.60
|
| Rate for Payer: PACE Senior Care Partners |
$325.14
|
| Rate for Payer: PACE SWMI |
$342.25
|
| Rate for Payer: PHP Commercial |
$1,163.67
|
| Rate for Payer: PHP Medicare Advantage |
$342.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$677.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.86
|
| Rate for Payer: Priority Health HMO/PPO |
$1,191.05
|
| Rate for Payer: Priority Health Medicare |
$345.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$917.24
|
| Rate for Payer: Railroad Medicare Medicare |
$342.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,204.74
|
| Rate for Payer: UHC Core |
$1,143.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$342.25
|
| Rate for Payer: UHC Exchange |
$342.25
|
| Rate for Payer: UHC Medicare Advantage |
$342.25
|
| Rate for Payer: UHCCP Medicaid |
$677.86
|
| Rate for Payer: VA VA |
$342.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,026.77
|
|
|
HC US PELVIS LTD
|
Facility
|
OP
|
$510.39
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$459.35 |
| Rate for Payer: Aetna Commercial |
$433.83
|
| Rate for Payer: Aetna Medicare |
$132.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.50
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$127.60
|
| Rate for Payer: BCBS Trust/PPO |
$419.59
|
| Rate for Payer: BCN Commercial |
$396.83
|
| Rate for Payer: BCN Medicare Advantage |
$127.60
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$438.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.60
|
| Rate for Payer: Healthscope Commercial |
$459.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.79
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.98
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: Nomi Health Commercial |
$418.52
|
| Rate for Payer: PACE Senior Care Partners |
$121.22
|
| Rate for Payer: PACE SWMI |
$127.60
|
| Rate for Payer: PHP Commercial |
$433.83
|
| Rate for Payer: PHP Medicare Advantage |
$127.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: Priority Health HMO/PPO |
$444.04
|
| Rate for Payer: Priority Health Medicare |
$128.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.96
|
| Rate for Payer: Railroad Medicare Medicare |
$127.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.14
|
| Rate for Payer: UHC Core |
$426.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.60
|
| Rate for Payer: UHC Exchange |
$127.60
|
| Rate for Payer: UHC Medicare Advantage |
$127.60
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$127.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.79
|
|
|
HC US PELVIS LTD
|
Facility
|
IP
|
$510.39
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$331.75 |
| Max. Negotiated Rate |
$459.35 |
| Rate for Payer: Aetna Commercial |
$433.83
|
| Rate for Payer: BCBS Trust/PPO |
$416.63
|
| Rate for Payer: BCN Commercial |
$394.43
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$438.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Healthscope Commercial |
$459.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: Nomi Health Commercial |
$418.52
|
| Rate for Payer: PHP Commercial |
$433.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: Priority Health HMO/PPO |
$444.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.14
|
| Rate for Payer: UHC Core |
$426.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.79
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
OP
|
$918.71
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$826.84 |
| Rate for Payer: Aetna Commercial |
$780.90
|
| Rate for Payer: Aetna Medicare |
$238.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$287.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$287.10
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$229.68
|
| Rate for Payer: BCBS Trust/PPO |
$755.27
|
| Rate for Payer: BCN Commercial |
$714.30
|
| Rate for Payer: BCN Medicare Advantage |
$229.68
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cofinity Commercial |
$790.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.68
|
| Rate for Payer: Healthscope Commercial |
$826.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.03
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.16
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$264.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.90
|
| Rate for Payer: Nomi Health Commercial |
$753.34
|
| Rate for Payer: PACE Senior Care Partners |
$218.19
|
| Rate for Payer: PACE SWMI |
$229.68
|
| Rate for Payer: PHP Commercial |
$780.90
|
| Rate for Payer: PHP Medicare Advantage |
$229.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.16
|
| Rate for Payer: Priority Health HMO/PPO |
$799.28
|
| Rate for Payer: Priority Health Medicare |
$231.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$615.54
|
| Rate for Payer: Railroad Medicare Medicare |
$229.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.46
|
| Rate for Payer: UHC Core |
$767.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.68
|
| Rate for Payer: UHC Exchange |
$229.68
|
| Rate for Payer: UHC Medicare Advantage |
$229.68
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$229.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.03
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
IP
|
$918.71
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$597.16 |
| Max. Negotiated Rate |
$826.84 |
| Rate for Payer: Aetna Commercial |
$780.90
|
| Rate for Payer: BCBS Trust/PPO |
$749.94
|
| Rate for Payer: BCN Commercial |
$709.98
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cofinity Commercial |
$790.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.97
|
| Rate for Payer: Healthscope Commercial |
$826.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.90
|
| Rate for Payer: Nomi Health Commercial |
$753.34
|
| Rate for Payer: PHP Commercial |
$780.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.16
|
| Rate for Payer: Priority Health HMO/PPO |
$799.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$615.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.46
|
| Rate for Payer: UHC Core |
$767.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.03
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
OP
|
$377.89
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna Commercial |
$321.21
|
| Rate for Payer: Aetna Medicare |
$98.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.09
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$94.47
|
| Rate for Payer: BCBS Trust/PPO |
$310.66
|
| Rate for Payer: BCN Commercial |
$293.81
|
| Rate for Payer: BCN Medicare Advantage |
$94.47
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cofinity Commercial |
$324.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.47
|
| Rate for Payer: Healthscope Commercial |
$340.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.42
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.20
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.21
|
| Rate for Payer: Nomi Health Commercial |
$309.87
|
| Rate for Payer: PACE Senior Care Partners |
$89.75
|
| Rate for Payer: PACE SWMI |
$94.47
|
| Rate for Payer: PHP Commercial |
$321.21
|
| Rate for Payer: PHP Medicare Advantage |
$94.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.63
|
| Rate for Payer: Priority Health HMO/PPO |
$328.76
|
| Rate for Payer: Priority Health Medicare |
$95.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.19
|
| Rate for Payer: Railroad Medicare Medicare |
$94.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.54
|
| Rate for Payer: UHC Core |
$315.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.47
|
| Rate for Payer: UHC Exchange |
$94.47
|
| Rate for Payer: UHC Medicare Advantage |
$94.47
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$94.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.42
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
IP
|
$377.89
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$245.63 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna Commercial |
$321.21
|
| Rate for Payer: BCBS Trust/PPO |
$308.47
|
| Rate for Payer: BCN Commercial |
$292.03
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cofinity Commercial |
$324.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.31
|
| Rate for Payer: Healthscope Commercial |
$340.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.21
|
| Rate for Payer: Nomi Health Commercial |
$309.87
|
| Rate for Payer: PHP Commercial |
$321.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.63
|
| Rate for Payer: Priority Health HMO/PPO |
$328.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.54
|
| Rate for Payer: UHC Core |
$315.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.42
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$1,086.05
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$977.45 |
| Rate for Payer: Aetna Commercial |
$923.14
|
| Rate for Payer: Aetna Medicare |
$282.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$339.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$339.39
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$271.51
|
| Rate for Payer: BCBS Trust/PPO |
$892.84
|
| Rate for Payer: BCN Commercial |
$844.40
|
| Rate for Payer: BCN Medicare Advantage |
$271.51
|
| Rate for Payer: Cash Price |
$868.84
|
| Rate for Payer: Cash Price |
$868.84
|
| Rate for Payer: Cofinity Commercial |
$934.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.51
|
| Rate for Payer: Healthscope Commercial |
$977.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$814.54
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.09
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$923.14
|
| Rate for Payer: Nomi Health Commercial |
$890.56
|
| Rate for Payer: PACE Senior Care Partners |
$257.94
|
| Rate for Payer: PACE SWMI |
$271.51
|
| Rate for Payer: PHP Commercial |
$923.14
|
| Rate for Payer: PHP Medicare Advantage |
$271.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.93
|
| Rate for Payer: Priority Health HMO/PPO |
$944.86
|
| Rate for Payer: Priority Health Medicare |
$274.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$727.65
|
| Rate for Payer: Railroad Medicare Medicare |
$271.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$955.72
|
| Rate for Payer: UHC Core |
$906.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.51
|
| Rate for Payer: UHC Exchange |
$271.51
|
| Rate for Payer: UHC Medicare Advantage |
$271.51
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$271.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$814.54
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$1,086.05
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$705.93 |
| Max. Negotiated Rate |
$977.45 |
| Rate for Payer: Aetna Commercial |
$923.14
|
| Rate for Payer: BCBS Trust/PPO |
$886.54
|
| Rate for Payer: BCN Commercial |
$839.30
|
| Rate for Payer: Cash Price |
$868.84
|
| Rate for Payer: Cofinity Commercial |
$934.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.84
|
| Rate for Payer: Healthscope Commercial |
$977.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$814.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$923.14
|
| Rate for Payer: Nomi Health Commercial |
$890.56
|
| Rate for Payer: PHP Commercial |
$923.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.93
|
| Rate for Payer: Priority Health HMO/PPO |
$944.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$727.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$955.72
|
| Rate for Payer: UHC Core |
$906.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$814.54
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
OP
|
$291.31
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.19 |
| Max. Negotiated Rate |
$262.18 |
| Rate for Payer: Aetna Commercial |
$247.61
|
| Rate for Payer: Aetna Medicare |
$75.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.03
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$72.83
|
| Rate for Payer: BCBS Trust/PPO |
$239.49
|
| Rate for Payer: BCN Commercial |
$226.49
|
| Rate for Payer: BCN Medicare Advantage |
$72.83
|
| Rate for Payer: Cash Price |
$233.05
|
| Rate for Payer: Cash Price |
$233.05
|
| Rate for Payer: Cofinity Commercial |
$250.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.83
|
| Rate for Payer: Healthscope Commercial |
$262.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.48
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.47
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.61
|
| Rate for Payer: Nomi Health Commercial |
$238.87
|
| Rate for Payer: PACE Senior Care Partners |
$69.19
|
| Rate for Payer: PACE SWMI |
$72.83
|
| Rate for Payer: PHP Commercial |
$247.61
|
| Rate for Payer: PHP Medicare Advantage |
$72.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.35
|
| Rate for Payer: Priority Health HMO/PPO |
$253.44
|
| Rate for Payer: Priority Health Medicare |
$73.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.18
|
| Rate for Payer: Railroad Medicare Medicare |
$72.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.35
|
| Rate for Payer: UHC Core |
$243.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.83
|
| Rate for Payer: UHC Exchange |
$72.83
|
| Rate for Payer: UHC Medicare Advantage |
$72.83
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$72.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.48
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
IP
|
$291.31
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$189.35 |
| Max. Negotiated Rate |
$262.18 |
| Rate for Payer: Aetna Commercial |
$247.61
|
| Rate for Payer: BCBS Trust/PPO |
$237.80
|
| Rate for Payer: BCN Commercial |
$225.12
|
| Rate for Payer: Cash Price |
$233.05
|
| Rate for Payer: Cofinity Commercial |
$250.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.05
|
| Rate for Payer: Healthscope Commercial |
$262.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.61
|
| Rate for Payer: Nomi Health Commercial |
$238.87
|
| Rate for Payer: PHP Commercial |
$247.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.35
|
| Rate for Payer: Priority Health HMO/PPO |
$253.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.35
|
| Rate for Payer: UHC Core |
$243.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.48
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$765.71
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$497.71 |
| Max. Negotiated Rate |
$689.14 |
| Rate for Payer: Aetna Commercial |
$650.85
|
| Rate for Payer: BCBS Trust/PPO |
$625.05
|
| Rate for Payer: BCN Commercial |
$591.74
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cofinity Commercial |
$658.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.57
|
| Rate for Payer: Healthscope Commercial |
$689.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.85
|
| Rate for Payer: Nomi Health Commercial |
$627.88
|
| Rate for Payer: PHP Commercial |
$650.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.71
|
| Rate for Payer: Priority Health HMO/PPO |
$666.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$673.82
|
| Rate for Payer: UHC Core |
$639.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.28
|
|
|
HC US RETROPERITONEAL COMPLETE
|
Facility
|
OP
|
$765.71
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
40200011
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$689.14 |
| Rate for Payer: Aetna Commercial |
$650.85
|
| Rate for Payer: Aetna Medicare |
$199.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$239.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$239.28
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$191.43
|
| Rate for Payer: BCBS Trust/PPO |
$629.49
|
| Rate for Payer: BCN Commercial |
$595.34
|
| Rate for Payer: BCN Medicare Advantage |
$191.43
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cofinity Commercial |
$658.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.43
|
| Rate for Payer: Healthscope Commercial |
$689.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.28
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.00
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.85
|
| Rate for Payer: Nomi Health Commercial |
$627.88
|
| Rate for Payer: PACE Senior Care Partners |
$181.86
|
| Rate for Payer: PACE SWMI |
$191.43
|
| Rate for Payer: PHP Commercial |
$650.85
|
| Rate for Payer: PHP Medicare Advantage |
$191.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.71
|
| Rate for Payer: Priority Health HMO/PPO |
$666.17
|
| Rate for Payer: Priority Health Medicare |
$193.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.03
|
| Rate for Payer: Railroad Medicare Medicare |
$191.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$673.82
|
| Rate for Payer: UHC Core |
$639.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.43
|
| Rate for Payer: UHC Exchange |
$191.43
|
| Rate for Payer: UHC Medicare Advantage |
$191.43
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$191.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.28
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
OP
|
$765.71
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$689.14 |
| Rate for Payer: Aetna Commercial |
$650.85
|
| Rate for Payer: Aetna Medicare |
$199.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$239.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$239.28
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$191.43
|
| Rate for Payer: BCBS Trust/PPO |
$629.49
|
| Rate for Payer: BCN Commercial |
$595.34
|
| Rate for Payer: BCN Medicare Advantage |
$191.43
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cofinity Commercial |
$658.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.43
|
| Rate for Payer: Healthscope Commercial |
$689.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.28
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.00
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.85
|
| Rate for Payer: Nomi Health Commercial |
$627.88
|
| Rate for Payer: PACE Senior Care Partners |
$181.86
|
| Rate for Payer: PACE SWMI |
$191.43
|
| Rate for Payer: PHP Commercial |
$650.85
|
| Rate for Payer: PHP Medicare Advantage |
$191.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.71
|
| Rate for Payer: Priority Health HMO/PPO |
$666.17
|
| Rate for Payer: Priority Health Medicare |
$193.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.03
|
| Rate for Payer: Railroad Medicare Medicare |
$191.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$673.82
|
| Rate for Payer: UHC Core |
$639.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.43
|
| Rate for Payer: UHC Exchange |
$191.43
|
| Rate for Payer: UHC Medicare Advantage |
$191.43
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$191.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.28
|
|
|
HC US RETROPERITONEAL LTD
|
Facility
|
IP
|
$765.71
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
40200012
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$497.71 |
| Max. Negotiated Rate |
$689.14 |
| Rate for Payer: Aetna Commercial |
$650.85
|
| Rate for Payer: BCBS Trust/PPO |
$625.05
|
| Rate for Payer: BCN Commercial |
$591.74
|
| Rate for Payer: Cash Price |
$612.57
|
| Rate for Payer: Cofinity Commercial |
$658.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$612.57
|
| Rate for Payer: Healthscope Commercial |
$689.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$574.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.85
|
| Rate for Payer: Nomi Health Commercial |
$627.88
|
| Rate for Payer: PHP Commercial |
$650.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.71
|
| Rate for Payer: Priority Health HMO/PPO |
$666.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$673.82
|
| Rate for Payer: UHC Core |
$639.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$574.28
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
OP
|
$714.62
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$643.16 |
| Rate for Payer: Aetna Commercial |
$607.43
|
| Rate for Payer: Aetna Medicare |
$185.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$223.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$223.32
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$178.66
|
| Rate for Payer: BCBS Trust/PPO |
$587.49
|
| Rate for Payer: BCN Commercial |
$555.62
|
| Rate for Payer: BCN Medicare Advantage |
$178.66
|
| Rate for Payer: Cash Price |
$571.70
|
| Rate for Payer: Cash Price |
$571.70
|
| Rate for Payer: Cofinity Commercial |
$614.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.66
|
| Rate for Payer: Healthscope Commercial |
$643.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.97
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.59
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.43
|
| Rate for Payer: Nomi Health Commercial |
$585.99
|
| Rate for Payer: PACE Senior Care Partners |
$169.72
|
| Rate for Payer: PACE SWMI |
$178.66
|
| Rate for Payer: PHP Commercial |
$607.43
|
| Rate for Payer: PHP Medicare Advantage |
$178.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.50
|
| Rate for Payer: Priority Health HMO/PPO |
$621.72
|
| Rate for Payer: Priority Health Medicare |
$180.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$478.80
|
| Rate for Payer: Railroad Medicare Medicare |
$178.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.87
|
| Rate for Payer: UHC Core |
$596.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.66
|
| Rate for Payer: UHC Exchange |
$178.66
|
| Rate for Payer: UHC Medicare Advantage |
$178.66
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$178.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.97
|
|
|
HC US SCROTUM AND CONTENTS
|
Facility
|
IP
|
$714.62
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
40200035
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$464.50 |
| Max. Negotiated Rate |
$643.16 |
| Rate for Payer: Aetna Commercial |
$607.43
|
| Rate for Payer: BCBS Trust/PPO |
$583.34
|
| Rate for Payer: BCN Commercial |
$552.26
|
| Rate for Payer: Cash Price |
$571.70
|
| Rate for Payer: Cofinity Commercial |
$614.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.70
|
| Rate for Payer: Healthscope Commercial |
$643.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$535.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.43
|
| Rate for Payer: Nomi Health Commercial |
$585.99
|
| Rate for Payer: PHP Commercial |
$607.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.50
|
| Rate for Payer: Priority Health HMO/PPO |
$621.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$478.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.87
|
| Rate for Payer: UHC Core |
$596.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$535.97
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
OP
|
$16.89
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna Commercial |
$14.36
|
| Rate for Payer: Aetna Medicare |
$4.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.28
|
| Rate for Payer: BCBS Complete |
$6.76
|
| Rate for Payer: BCBS MAPPO |
$4.22
|
| Rate for Payer: BCBS Trust/PPO |
$13.89
|
| Rate for Payer: BCN Commercial |
$13.13
|
| Rate for Payer: BCN Medicare Advantage |
$4.22
|
| Rate for Payer: Cash Price |
$13.51
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.22
|
| Rate for Payer: Healthscope Commercial |
$15.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.36
|
| Rate for Payer: Nomi Health Commercial |
$13.85
|
| Rate for Payer: PACE Senior Care Partners |
$4.01
|
| Rate for Payer: PACE SWMI |
$4.22
|
| Rate for Payer: PHP Commercial |
$14.36
|
| Rate for Payer: PHP Medicare Advantage |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.98
|
| Rate for Payer: Priority Health HMO/PPO |
$14.69
|
| Rate for Payer: Priority Health Medicare |
$4.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.32
|
| Rate for Payer: Railroad Medicare Medicare |
$4.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.86
|
| Rate for Payer: UHC Core |
$14.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.22
|
| Rate for Payer: UHC Exchange |
$4.22
|
| Rate for Payer: UHC Medicare Advantage |
$4.22
|
| Rate for Payer: VA VA |
$4.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.67
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
IP
|
$16.89
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna Commercial |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$13.79
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: Cash Price |
$13.51
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.51
|
| Rate for Payer: Healthscope Commercial |
$15.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.36
|
| Rate for Payer: Nomi Health Commercial |
$13.85
|
| Rate for Payer: PHP Commercial |
$14.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.98
|
| Rate for Payer: Priority Health HMO/PPO |
$14.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.86
|
| Rate for Payer: UHC Core |
$14.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.67
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
IP
|
$785.96
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$510.87 |
| Max. Negotiated Rate |
$707.36 |
| Rate for Payer: Aetna Commercial |
$668.07
|
| Rate for Payer: BCBS Trust/PPO |
$641.58
|
| Rate for Payer: BCN Commercial |
$607.39
|
| Rate for Payer: Cash Price |
$628.77
|
| Rate for Payer: Cofinity Commercial |
$675.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.77
|
| Rate for Payer: Healthscope Commercial |
$707.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.07
|
| Rate for Payer: Nomi Health Commercial |
$644.49
|
| Rate for Payer: PHP Commercial |
$668.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.87
|
| Rate for Payer: Priority Health HMO/PPO |
$683.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$526.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$691.64
|
| Rate for Payer: UHC Core |
$656.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.47
|
|
