|
HC CYSTOSCOPY DIL URETHRAL STRICTURE
|
Facility
|
IP
|
$2,769.36
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
76100194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,218.52 |
| Max. Negotiated Rate |
$2,492.42 |
| Rate for Payer: Aetna American Axle |
$1,800.08
|
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,800.08
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Advantage |
$1,938.55
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,938.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,077.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: Priority Health SBD |
$1,744.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,218.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,077.02
|
|
|
HC CYSTOSCOPY DIL URETHRAL STRICTURE
|
Facility
|
OP
|
$2,769.36
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
76100194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,024.66 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna American Axle |
$1,800.08
|
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,800.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,594.22
|
| Rate for Payer: BCN Commercial |
$2,594.22
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Advantage |
$1,938.55
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,938.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,077.02
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,744.70
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,800.08
|
| Rate for Payer: UHC Core |
$1,442.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$1,088.36
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,024.66
|
| Rate for Payer: VA VA |
$2,082.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,077.02
|
|
|
HC CYSTOSCOPY REMV CALCULUS, COMPLICATED
|
Facility
|
OP
|
$2,819.98
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,043.39 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna American Axle |
$1,832.99
|
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,832.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,545.98
|
| Rate for Payer: BCN Commercial |
$2,545.98
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Advantage |
$1,973.99
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,973.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,114.99
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,776.59
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.99
|
| Rate for Payer: UHC Core |
$1,469.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$1,108.25
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,043.39
|
| Rate for Payer: VA VA |
$2,082.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,114.99
|
|
|
HC CYSTOSCOPY REMV CALCULUS, COMPLICATED
|
Facility
|
IP
|
$2,819.98
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,240.79 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna American Axle |
$1,832.99
|
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,832.99
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Advantage |
$1,973.99
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,973.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,114.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: Priority Health SBD |
$1,776.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,240.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,114.99
|
|
|
HC CYSTOSCOPY REMV CALCULUS SIMPLE
|
Facility
|
IP
|
$2,769.36
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
76100195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,218.52 |
| Max. Negotiated Rate |
$2,492.42 |
| Rate for Payer: Aetna American Axle |
$1,800.08
|
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,800.08
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Advantage |
$1,938.55
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,938.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,077.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: Priority Health SBD |
$1,744.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,218.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,077.02
|
|
|
HC CYSTOSCOPY REMV CALCULUS SIMPLE
|
Facility
|
OP
|
$2,769.36
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
76100195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,024.66 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna American Axle |
$1,800.08
|
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,800.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.99
|
| Rate for Payer: BCN Commercial |
$1,661.99
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Advantage |
$1,938.55
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,938.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,077.02
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,744.70
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,800.08
|
| Rate for Payer: UHC Core |
$1,442.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$1,088.36
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,024.66
|
| Rate for Payer: VA VA |
$2,082.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,077.02
|
|
|
HC CYSTO TX FEMALE URETHRAL SYNDROME
|
Facility
|
OP
|
$885.90
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.78 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna American Axle |
$575.84
|
| Rate for Payer: Aetna Commercial |
$753.01
|
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,490.92
|
| Rate for Payer: BCN Commercial |
$1,490.92
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cofinity Advantage |
$620.13
|
| Rate for Payer: Cofinity Commercial |
$761.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$797.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$620.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$664.42
|
| Rate for Payer: Mclaren Medicaid |
$694.79
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.01
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$664.42
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$753.01
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health SBD |
$558.12
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$575.84
|
| Rate for Payer: UHC Core |
$461.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Exchange |
$348.16
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: UMR Bronson Commercial |
$327.78
|
| Rate for Payer: VA VA |
$694.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$664.42
|
|
|
HC CYSTO TX FEMALE URETHRAL SYNDROME
|
Facility
|
IP
|
$885.90
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$389.80 |
| Max. Negotiated Rate |
$797.31 |
| Rate for Payer: Aetna American Axle |
$575.84
|
| Rate for Payer: Aetna Commercial |
$753.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.84
|
| Rate for Payer: Cash Price |
$708.72
|
| Rate for Payer: Cofinity Advantage |
$620.13
|
| Rate for Payer: Cofinity Commercial |
$761.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.72
|
| Rate for Payer: Healthscope Commercial |
$797.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$620.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$664.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$664.42
|
| Rate for Payer: PHP Commercial |
$753.01
|
| Rate for Payer: Priority Health SBD |
$558.12
|
| Rate for Payer: UMR Bronson Commercial |
$389.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$664.42
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
OP
|
$1,017.20
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
45000095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$363.38 |
| Max. Negotiated Rate |
$2,246.88 |
| Rate for Payer: Aetna American Axle |
$661.18
|
| Rate for Payer: Aetna Commercial |
$864.62
|
| Rate for Payer: Aetna Medicare |
$722.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$868.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$868.49
|
| Rate for Payer: BCBS Complete |
$381.58
|
| Rate for Payer: BCBS MAPPO |
$694.79
|
| Rate for Payer: BCBS Trust/PPO |
$923.28
|
| Rate for Payer: BCN Commercial |
$923.28
|
| Rate for Payer: BCN Medicare Advantage |
$694.79
|
| Rate for Payer: Cash Price |
$813.76
|
| Rate for Payer: Cash Price |
$813.76
|
| Rate for Payer: Cash Price |
$813.76
|
| Rate for Payer: Cofinity Advantage |
$712.04
|
| Rate for Payer: Cofinity Commercial |
$874.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.79
|
| Rate for Payer: Healthscope Commercial |
$915.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$712.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.90
|
| Rate for Payer: Mclaren Medicaid |
$694.79
|
| Rate for Payer: Mclaren Medicare |
$694.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.53
|
| Rate for Payer: Meridian Medicaid |
$729.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$799.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$764.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$864.62
|
| Rate for Payer: Nomi Health Commercial |
$2,084.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.90
|
| Rate for Payer: PACE Medicare |
$660.05
|
| Rate for Payer: PACE SWMI |
$694.79
|
| Rate for Payer: PHP Commercial |
$864.62
|
| Rate for Payer: PHP Medicare Advantage |
$694.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,246.88
|
| Rate for Payer: Priority Health Medicare |
$694.79
|
| Rate for Payer: Priority Health SBD |
$640.84
|
| Rate for Payer: Priority Health Tiered Network |
$1,797.50
|
| Rate for Payer: Railroad Medicare Medicare |
$694.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.18
|
| Rate for Payer: UHC Core |
$529.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$694.79
|
| Rate for Payer: UHC Exchange |
$399.76
|
| Rate for Payer: UHC Medicaid |
$363.38
|
| Rate for Payer: UHCCP Medicaid |
$363.38
|
| Rate for Payer: UMR Bronson Commercial |
$376.36
|
| Rate for Payer: VA VA |
$694.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.90
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
IP
|
$1,017.20
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
45000095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.57 |
| Max. Negotiated Rate |
$915.48 |
| Rate for Payer: Aetna American Axle |
$661.18
|
| Rate for Payer: Aetna Commercial |
$864.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.18
|
| Rate for Payer: Cash Price |
$813.76
|
| Rate for Payer: Cofinity Advantage |
$712.04
|
| Rate for Payer: Cofinity Commercial |
$874.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$813.76
|
| Rate for Payer: Healthscope Commercial |
$915.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$712.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$762.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$864.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.90
|
| Rate for Payer: PHP Commercial |
$864.62
|
| Rate for Payer: Priority Health SBD |
$640.84
|
| Rate for Payer: UMR Bronson Commercial |
$447.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$762.90
|
|
|
HC CYSTOURETHROSCOPY BIOPSY
|
Facility
|
OP
|
$3,101.59
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna American Axle |
$2,016.03
|
| Rate for Payer: Aetna Commercial |
$2,636.35
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,016.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,983.64
|
| Rate for Payer: BCN Commercial |
$2,983.64
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,481.27
|
| Rate for Payer: Cash Price |
$2,481.27
|
| Rate for Payer: Cash Price |
$2,481.27
|
| Rate for Payer: Cofinity Advantage |
$2,171.11
|
| Rate for Payer: Cofinity Commercial |
$2,667.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,791.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,171.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,326.19
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,636.35
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,326.19
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,636.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,954.00
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,016.03
|
| Rate for Payer: UHC Core |
$1,615.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$1,218.92
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,147.59
|
| Rate for Payer: VA VA |
$2,082.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,326.19
|
|
|
HC CYSTOURETHROSCOPY BIOPSY
|
Facility
|
IP
|
$3,101.59
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,364.70 |
| Max. Negotiated Rate |
$2,791.43 |
| Rate for Payer: Aetna American Axle |
$2,016.03
|
| Rate for Payer: Aetna Commercial |
$2,636.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,016.03
|
| Rate for Payer: Cash Price |
$2,481.27
|
| Rate for Payer: Cofinity Advantage |
$2,171.11
|
| Rate for Payer: Cofinity Commercial |
$2,667.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.27
|
| Rate for Payer: Healthscope Commercial |
$2,791.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,171.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,326.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,636.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,326.19
|
| Rate for Payer: PHP Commercial |
$2,636.35
|
| Rate for Payer: Priority Health SBD |
$1,954.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,364.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,326.19
|
|
|
HC CYSTOURETHROSCOPY W/INJ FOR CHEMODENERV BLADDER
|
Facility
|
OP
|
$2,819.98
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
76100238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,043.39 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna American Axle |
$1,832.99
|
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,832.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$3,443.05
|
| Rate for Payer: BCN Commercial |
$3,443.05
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Advantage |
$1,973.99
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,973.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,114.99
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$1,776.59
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.99
|
| Rate for Payer: UHC Core |
$1,469.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$1,108.25
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,043.39
|
| Rate for Payer: VA VA |
$2,082.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,114.99
|
|
|
HC CYSTOURETHROSCOPY W/INJ FOR CHEMODENERV BLADDER
|
Facility
|
IP
|
$2,819.98
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
76100238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,240.79 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna American Axle |
$1,832.99
|
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,832.99
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Advantage |
$1,973.99
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,973.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,114.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: Priority Health SBD |
$1,776.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,240.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,114.99
|
|
|
HC CYSTO W/IRRIG & EVAC CLOTS
|
Facility
|
OP
|
$4,804.41
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
76100226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,716.16 |
| Max. Negotiated Rate |
$11,358.48 |
| Rate for Payer: Aetna American Axle |
$3,122.87
|
| Rate for Payer: Aetna Commercial |
$4,083.75
|
| Rate for Payer: Aetna Medicare |
$3,652.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,122.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,390.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,390.39
|
| Rate for Payer: BCBS Complete |
$1,928.96
|
| Rate for Payer: BCBS MAPPO |
$3,512.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.16
|
| Rate for Payer: BCN Commercial |
$1,716.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,512.31
|
| Rate for Payer: Cash Price |
$3,843.53
|
| Rate for Payer: Cash Price |
$3,843.53
|
| Rate for Payer: Cash Price |
$3,843.53
|
| Rate for Payer: Cofinity Advantage |
$3,363.09
|
| Rate for Payer: Cofinity Commercial |
$4,131.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,843.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,512.31
|
| Rate for Payer: Healthscope Commercial |
$4,323.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,363.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,603.31
|
| Rate for Payer: Mclaren Medicaid |
$3,512.31
|
| Rate for Payer: Mclaren Medicare |
$3,512.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,687.93
|
| Rate for Payer: Meridian Medicaid |
$3,687.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,039.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,863.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,083.75
|
| Rate for Payer: Nomi Health Commercial |
$10,536.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,603.31
|
| Rate for Payer: PACE Medicare |
$3,336.69
|
| Rate for Payer: PACE SWMI |
$3,512.31
|
| Rate for Payer: PHP Commercial |
$4,083.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,512.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,836.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,358.48
|
| Rate for Payer: Priority Health Medicare |
$3,512.31
|
| Rate for Payer: Priority Health SBD |
$3,026.78
|
| Rate for Payer: Priority Health Tiered Network |
$9,086.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3,512.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,122.87
|
| Rate for Payer: UHC Core |
$2,503.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,512.31
|
| Rate for Payer: UHC Exchange |
$1,888.13
|
| Rate for Payer: UHC Medicaid |
$1,836.94
|
| Rate for Payer: UHCCP Medicaid |
$1,836.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,777.63
|
| Rate for Payer: VA VA |
$3,512.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,603.31
|
|
|
HC CYSTO W/IRRIG & EVAC CLOTS
|
Facility
|
IP
|
$4,804.41
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
76100226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,113.94 |
| Max. Negotiated Rate |
$4,323.97 |
| Rate for Payer: Aetna American Axle |
$3,122.87
|
| Rate for Payer: Aetna Commercial |
$4,083.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,122.87
|
| Rate for Payer: Cash Price |
$3,843.53
|
| Rate for Payer: Cofinity Advantage |
$3,363.09
|
| Rate for Payer: Cofinity Commercial |
$4,131.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,843.53
|
| Rate for Payer: Healthscope Commercial |
$4,323.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,363.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,603.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,083.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,603.31
|
| Rate for Payer: PHP Commercial |
$4,083.75
|
| Rate for Payer: Priority Health SBD |
$3,026.78
|
| Rate for Payer: UMR Bronson Commercial |
$2,113.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,603.31
|
|
|
HC CYTO DNA PROBE
|
Facility
|
OP
|
$135.83
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Aetna American Axle |
$88.29
|
| Rate for Payer: Aetna Commercial |
$115.46
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.77
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$24.77
|
| Rate for Payer: BCN Commercial |
$24.77
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$108.66
|
| Rate for Payer: Cash Price |
$108.66
|
| Rate for Payer: Cofinity Advantage |
$95.08
|
| Rate for Payer: Cofinity Commercial |
$116.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$122.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.87
|
| Rate for Payer: Mclaren Medicaid |
$21.42
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.46
|
| Rate for Payer: Nomi Health Commercial |
$32.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.87
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$115.46
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.42
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health SBD |
$85.57
|
| Rate for Payer: Priority Health Tiered Network |
$17.14
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.13
|
| Rate for Payer: UHC Core |
$32.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.42
|
| Rate for Payer: UHC Exchange |
$32.13
|
| Rate for Payer: UHC Medicaid |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: UMR Bronson Commercial |
$50.26
|
| Rate for Payer: VA VA |
$21.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.87
|
|
|
HC CYTO DNA PROBE
|
Facility
|
IP
|
$135.83
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.77 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Aetna American Axle |
$88.29
|
| Rate for Payer: Aetna Commercial |
$115.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.29
|
| Rate for Payer: Cash Price |
$108.66
|
| Rate for Payer: Cofinity Advantage |
$95.08
|
| Rate for Payer: Cofinity Commercial |
$116.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.66
|
| Rate for Payer: Healthscope Commercial |
$122.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.87
|
| Rate for Payer: PHP Commercial |
$115.46
|
| Rate for Payer: Priority Health SBD |
$85.57
|
| Rate for Payer: UMR Bronson Commercial |
$59.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.87
|
|
|
HC CYTO DNA PROBE CMPT
|
Facility
|
IP
|
$108.24
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000032
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$97.42 |
| Rate for Payer: Aetna American Axle |
$70.36
|
| Rate for Payer: Aetna Commercial |
$92.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.36
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Advantage |
$75.77
|
| Rate for Payer: Cofinity Commercial |
$93.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Healthscope Commercial |
$97.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: PHP Commercial |
$92.00
|
| Rate for Payer: Priority Health SBD |
$68.19
|
| Rate for Payer: UMR Bronson Commercial |
$47.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.18
|
|
|
HC CYTO DNA PROBE CMPT
|
Facility
|
OP
|
$108.24
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000032
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$97.42 |
| Rate for Payer: Aetna American Axle |
$70.36
|
| Rate for Payer: Aetna Commercial |
$92.00
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.77
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$24.77
|
| Rate for Payer: BCN Commercial |
$24.77
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cash Price |
$86.59
|
| Rate for Payer: Cofinity Advantage |
$75.77
|
| Rate for Payer: Cofinity Commercial |
$93.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$97.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.18
|
| Rate for Payer: Mclaren Medicaid |
$21.42
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.00
|
| Rate for Payer: Nomi Health Commercial |
$32.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.18
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$92.00
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.42
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health SBD |
$68.19
|
| Rate for Payer: Priority Health Tiered Network |
$17.14
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.13
|
| Rate for Payer: UHC Core |
$32.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.42
|
| Rate for Payer: UHC Exchange |
$32.13
|
| Rate for Payer: UHC Medicaid |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: UMR Bronson Commercial |
$40.05
|
| Rate for Payer: VA VA |
$21.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.18
|
|
|
HC CYTOGENETICS DNA PROBE
|
Facility
|
IP
|
$273.63
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000128
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$246.27 |
| Rate for Payer: Aetna American Axle |
$177.86
|
| Rate for Payer: Aetna Commercial |
$232.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.86
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cofinity Advantage |
$191.54
|
| Rate for Payer: Cofinity Commercial |
$235.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.90
|
| Rate for Payer: Healthscope Commercial |
$246.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.22
|
| Rate for Payer: PHP Commercial |
$232.59
|
| Rate for Payer: Priority Health SBD |
$172.39
|
| Rate for Payer: UMR Bronson Commercial |
$120.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.22
|
|
|
HC CYTOGENETICS DNA PROBE
|
Facility
|
OP
|
$273.63
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000128
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$246.27 |
| Rate for Payer: Aetna American Axle |
$177.86
|
| Rate for Payer: Aetna Commercial |
$232.59
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.77
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$24.77
|
| Rate for Payer: BCN Commercial |
$24.77
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cash Price |
$218.90
|
| Rate for Payer: Cofinity Advantage |
$191.54
|
| Rate for Payer: Cofinity Commercial |
$235.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$246.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.22
|
| Rate for Payer: Mclaren Medicaid |
$21.42
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.59
|
| Rate for Payer: Nomi Health Commercial |
$32.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.22
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$232.59
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.42
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health SBD |
$172.39
|
| Rate for Payer: Priority Health Tiered Network |
$17.14
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.13
|
| Rate for Payer: UHC Core |
$32.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.42
|
| Rate for Payer: UHC Exchange |
$32.13
|
| Rate for Payer: UHC Medicaid |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: UMR Bronson Commercial |
$101.24
|
| Rate for Payer: VA VA |
$21.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.22
|
|
|
HC CYTOGENETICS DNA PROBE CMPT
|
Facility
|
OP
|
$247.62
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000129
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$222.86 |
| Rate for Payer: Aetna American Axle |
$160.95
|
| Rate for Payer: Aetna Commercial |
$210.48
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.77
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$24.77
|
| Rate for Payer: BCN Commercial |
$24.77
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: Cofinity Advantage |
$173.33
|
| Rate for Payer: Cofinity Commercial |
$212.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$222.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.72
|
| Rate for Payer: Mclaren Medicaid |
$21.42
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.48
|
| Rate for Payer: Nomi Health Commercial |
$32.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.72
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$210.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.42
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health SBD |
$156.00
|
| Rate for Payer: Priority Health Tiered Network |
$17.14
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.13
|
| Rate for Payer: UHC Core |
$32.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.42
|
| Rate for Payer: UHC Exchange |
$32.13
|
| Rate for Payer: UHC Medicaid |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
| Rate for Payer: UMR Bronson Commercial |
$91.62
|
| Rate for Payer: VA VA |
$21.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.72
|
|
|
HC CYTOGENETICS DNA PROBE CMPT
|
Facility
|
IP
|
$247.62
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000129
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$108.95 |
| Max. Negotiated Rate |
$222.86 |
| Rate for Payer: Aetna American Axle |
$160.95
|
| Rate for Payer: Aetna Commercial |
$210.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.95
|
| Rate for Payer: Cash Price |
$198.10
|
| Rate for Payer: Cofinity Advantage |
$173.33
|
| Rate for Payer: Cofinity Commercial |
$212.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.10
|
| Rate for Payer: Healthscope Commercial |
$222.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.72
|
| Rate for Payer: PHP Commercial |
$210.48
|
| Rate for Payer: Priority Health SBD |
$156.00
|
| Rate for Payer: UMR Bronson Commercial |
$108.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.72
|
|
|
HC CYTOMEGALOVIRUS (CMV)
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
30600266
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna American Axle |
$34.49
|
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: UMR Bronson Commercial |
$23.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
