|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
IP
|
$0.28
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna American Axle |
$0.18
|
| Rate for Payer: Aetna Commercial |
$0.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.18
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cofinity Commercial |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.22
|
| Rate for Payer: Healthscope Commercial |
$0.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.24
|
| Rate for Payer: PHP Commercial |
$0.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.18
|
| Rate for Payer: Priority Health SBD |
$0.18
|
| Rate for Payer: UMR Bronson Commercial |
$0.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.21
|
|
|
HC CYSTOGRAFIN DILUTE PER ML
|
Facility
|
OP
|
$0.28
|
|
|
Service Code
|
HCPCS Q9958
|
| Hospital Charge Code |
63600008
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna American Axle |
$0.18
|
| Rate for Payer: Aetna Commercial |
$0.24
|
| Rate for Payer: Aetna Medicare |
$0.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.11
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cofinity Commercial |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.22
|
| Rate for Payer: Healthscope Commercial |
$0.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.24
|
| Rate for Payer: PHP Commercial |
$0.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.18
|
| Rate for Payer: Priority Health SBD |
$0.18
|
| Rate for Payer: UMR Bronson Commercial |
$0.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.21
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
OP
|
$6,274.46
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,321.55 |
| Max. Negotiated Rate |
$13,956.13 |
| Rate for Payer: Aetna American Axle |
$4,078.40
|
| Rate for Payer: Aetna Commercial |
$5,333.29
|
| Rate for Payer: Aetna Medicare |
$5,156.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,078.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Cash Price |
$5,019.57
|
| Rate for Payer: Cash Price |
$5,019.57
|
| Rate for Payer: Cofinity Commercial |
$5,396.04
|
| Rate for Payer: Cofinity Commercial |
$4,392.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,392.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,019.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Healthscope Commercial |
$5,647.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,392.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,705.85
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,333.29
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Commercial |
$5,333.29
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,078.40
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Priority Health SBD |
$3,952.91
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,956.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Exchange |
$9,475.14
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,657.46
|
| Rate for Payer: UMR Bronson Commercial |
$2,321.55
|
| Rate for Payer: VA VA |
$4,957.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,705.85
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 1-3 IMPLANTS
|
Facility
|
IP
|
$6,274.46
|
|
|
Service Code
|
HCPCS C9739
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,760.76 |
| Max. Negotiated Rate |
$5,647.01 |
| Rate for Payer: Aetna American Axle |
$4,078.40
|
| Rate for Payer: Aetna Commercial |
$5,333.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,078.40
|
| Rate for Payer: Cash Price |
$5,019.57
|
| Rate for Payer: Cofinity Commercial |
$4,392.12
|
| Rate for Payer: Cofinity Commercial |
$5,396.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,392.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,019.57
|
| Rate for Payer: Healthscope Commercial |
$5,647.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,392.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,705.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,333.29
|
| Rate for Payer: PHP Commercial |
$5,333.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,078.40
|
| Rate for Payer: Priority Health SBD |
$3,952.91
|
| Rate for Payer: UMR Bronson Commercial |
$2,760.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,705.85
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
OP
|
$12,590.82
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,658.60 |
| Max. Negotiated Rate |
$25,386.34 |
| Rate for Payer: Aetna American Axle |
$8,184.03
|
| Rate for Payer: Aetna Commercial |
$10,702.20
|
| Rate for Payer: Aetna Medicare |
$9,379.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,184.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,273.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,273.20
|
| Rate for Payer: BCBS Complete |
$5,075.65
|
| Rate for Payer: BCBS MAPPO |
$9,018.56
|
| Rate for Payer: BCN Medicare Advantage |
$9,018.56
|
| Rate for Payer: Cash Price |
$10,072.66
|
| Rate for Payer: Cash Price |
$10,072.66
|
| Rate for Payer: Cofinity Commercial |
$8,813.57
|
| Rate for Payer: Cofinity Commercial |
$10,828.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,813.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,072.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,018.56
|
| Rate for Payer: Healthscope Commercial |
$11,331.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,813.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,443.11
|
| Rate for Payer: Mclaren Medicaid |
$4,833.95
|
| Rate for Payer: Mclaren Medicare |
$9,018.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,469.49
|
| Rate for Payer: Meridian Medicaid |
$5,075.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,371.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,702.20
|
| Rate for Payer: PACE Medicare |
$8,567.63
|
| Rate for Payer: PACE SWMI |
$9,018.56
|
| Rate for Payer: PHP Commercial |
$10,702.20
|
| Rate for Payer: PHP Medicare Advantage |
$9,018.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,833.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,184.03
|
| Rate for Payer: Priority Health Medicare |
$9,018.56
|
| Rate for Payer: Priority Health SBD |
$7,932.22
|
| Rate for Payer: Railroad Medicare Medicare |
$9,018.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,386.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,018.56
|
| Rate for Payer: UHC Exchange |
$17,235.37
|
| Rate for Payer: UHC Medicare Advantage |
$9,018.56
|
| Rate for Payer: UHCCP Medicaid |
$4,833.95
|
| Rate for Payer: UMR Bronson Commercial |
$4,658.60
|
| Rate for Payer: VA VA |
$9,018.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,443.11
|
|
|
HC CYSTO INSERTION TRANSPROSTATIC IMPLANT 4 OR MORE IMPLANTS
|
Facility
|
IP
|
$12,590.82
|
|
|
Service Code
|
HCPCS C9740
|
| Hospital Charge Code |
76100197
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,539.96 |
| Max. Negotiated Rate |
$11,331.74 |
| Rate for Payer: Aetna American Axle |
$8,184.03
|
| Rate for Payer: Aetna Commercial |
$10,702.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,184.03
|
| Rate for Payer: Cash Price |
$10,072.66
|
| Rate for Payer: Cofinity Commercial |
$10,828.11
|
| Rate for Payer: Cofinity Commercial |
$8,813.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,813.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,072.66
|
| Rate for Payer: Healthscope Commercial |
$11,331.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,813.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,443.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,702.20
|
| Rate for Payer: PHP Commercial |
$10,702.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,184.03
|
| Rate for Payer: Priority Health SBD |
$7,932.22
|
| Rate for Payer: UMR Bronson Commercial |
$5,539.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,443.11
|
|
|
HC CYSTOMETROGRAM W/VP & UP
|
Facility
|
IP
|
$1,772.55
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$779.92 |
| Max. Negotiated Rate |
$1,595.30 |
| Rate for Payer: Aetna American Axle |
$1,152.16
|
| Rate for Payer: Aetna Commercial |
$1,506.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,152.16
|
| Rate for Payer: Cash Price |
$1,418.04
|
| Rate for Payer: Cofinity Commercial |
$1,240.79
|
| Rate for Payer: Cofinity Commercial |
$1,524.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,240.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,418.04
|
| Rate for Payer: Healthscope Commercial |
$1,595.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,240.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,329.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,506.67
|
| Rate for Payer: PHP Commercial |
$1,506.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.16
|
| Rate for Payer: Priority Health SBD |
$1,116.71
|
| Rate for Payer: UMR Bronson Commercial |
$779.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,329.41
|
|
|
HC CYSTOMETROGRAM W/VP & UP
|
Facility
|
OP
|
$1,772.55
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna American Axle |
$1,152.16
|
| Rate for Payer: Aetna Commercial |
$1,506.67
|
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,152.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$1,418.04
|
| Rate for Payer: Cash Price |
$1,418.04
|
| Rate for Payer: Cofinity Commercial |
$1,524.39
|
| Rate for Payer: Cofinity Commercial |
$1,240.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,240.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,418.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$1,595.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,240.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,329.41
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,506.67
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$1,506.67
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,152.16
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health SBD |
$1,116.71
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Exchange |
$1,244.07
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$348.92
|
| Rate for Payer: UMR Bronson Commercial |
$655.84
|
| Rate for Payer: VA VA |
$650.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,329.41
|
|
|
HC CYSTOSCOPY DIL URETHRAL STRICTURE
|
Facility
|
IP
|
$2,715.06
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
76100194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,194.63 |
| Max. Negotiated Rate |
$2,443.55 |
| Rate for Payer: Aetna American Axle |
$1,764.79
|
| Rate for Payer: Aetna Commercial |
$2,307.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,764.79
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$1,900.54
|
| Rate for Payer: Cofinity Commercial |
$2,334.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,900.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Healthscope Commercial |
$2,443.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,900.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,036.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: PHP Commercial |
$2,307.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health SBD |
$1,710.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,194.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,036.30
|
|
|
HC CYSTOSCOPY DIL URETHRAL STRICTURE
|
Facility
|
OP
|
$2,715.06
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
76100194
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,004.57 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna American Axle |
$1,764.79
|
| Rate for Payer: Aetna Commercial |
$2,307.80
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,764.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$2,334.95
|
| Rate for Payer: Cofinity Commercial |
$1,900.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,900.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$2,443.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,900.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,036.30
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,307.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$1,710.49
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,818.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,004.57
|
| Rate for Payer: VA VA |
$1,997.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,036.30
|
|
|
HC CYSTOSCOPY REMV CALCULUS, COMPLICATED
|
Facility
|
OP
|
$2,764.69
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,022.94 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna American Axle |
$1,797.05
|
| Rate for Payer: Aetna Commercial |
$2,349.99
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,797.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cofinity Commercial |
$2,377.63
|
| Rate for Payer: Cofinity Commercial |
$1,935.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,935.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$2,488.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,935.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,073.52
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,349.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$1,741.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,818.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,022.94
|
| Rate for Payer: VA VA |
$1,997.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,073.52
|
|
|
HC CYSTOSCOPY REMV CALCULUS, COMPLICATED
|
Facility
|
IP
|
$2,764.69
|
|
|
Service Code
|
CPT 52315
|
| Hospital Charge Code |
76100253
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,216.46 |
| Max. Negotiated Rate |
$2,488.22 |
| Rate for Payer: Aetna American Axle |
$1,797.05
|
| Rate for Payer: Aetna Commercial |
$2,349.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,797.05
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cofinity Commercial |
$1,935.28
|
| Rate for Payer: Cofinity Commercial |
$2,377.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,935.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Healthscope Commercial |
$2,488.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,935.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,073.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: PHP Commercial |
$2,349.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: Priority Health SBD |
$1,741.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,216.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,073.52
|
|
|
HC CYSTOSCOPY REMV CALCULUS SIMPLE
|
Facility
|
IP
|
$2,715.06
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
76100195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,194.63 |
| Max. Negotiated Rate |
$2,443.55 |
| Rate for Payer: Aetna American Axle |
$1,764.79
|
| Rate for Payer: Aetna Commercial |
$2,307.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,764.79
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$1,900.54
|
| Rate for Payer: Cofinity Commercial |
$2,334.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,900.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Healthscope Commercial |
$2,443.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,900.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,036.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: PHP Commercial |
$2,307.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health SBD |
$1,710.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,194.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,036.30
|
|
|
HC CYSTOSCOPY REMV CALCULUS SIMPLE
|
Facility
|
OP
|
$2,715.06
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
76100195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,004.57 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna American Axle |
$1,764.79
|
| Rate for Payer: Aetna Commercial |
$2,307.80
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,764.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cash Price |
$2,172.05
|
| Rate for Payer: Cofinity Commercial |
$2,334.95
|
| Rate for Payer: Cofinity Commercial |
$1,900.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,900.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,172.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$2,443.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,900.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,036.30
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.80
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,307.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.79
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$1,710.49
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,818.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,004.57
|
| Rate for Payer: VA VA |
$1,997.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,036.30
|
|
|
HC CYSTO TX FEMALE URETHRAL SYNDROME
|
Facility
|
IP
|
$868.53
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.15 |
| Max. Negotiated Rate |
$781.68 |
| Rate for Payer: Aetna American Axle |
$564.54
|
| Rate for Payer: Aetna Commercial |
$738.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.54
|
| Rate for Payer: Cash Price |
$694.82
|
| Rate for Payer: Cofinity Commercial |
$607.97
|
| Rate for Payer: Cofinity Commercial |
$746.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$607.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.82
|
| Rate for Payer: Healthscope Commercial |
$781.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$607.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.25
|
| Rate for Payer: PHP Commercial |
$738.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.54
|
| Rate for Payer: Priority Health SBD |
$547.17
|
| Rate for Payer: UMR Bronson Commercial |
$382.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.40
|
|
|
HC CYSTO TX FEMALE URETHRAL SYNDROME
|
Facility
|
OP
|
$868.53
|
|
|
Service Code
|
CPT 52285
|
| Hospital Charge Code |
76100272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.36 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna American Axle |
$564.54
|
| Rate for Payer: Aetna Commercial |
$738.25
|
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$694.82
|
| Rate for Payer: Cash Price |
$694.82
|
| Rate for Payer: Cofinity Commercial |
$746.94
|
| Rate for Payer: Cofinity Commercial |
$607.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$607.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$781.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$607.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.40
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.25
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$738.25
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.54
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health SBD |
$547.17
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Exchange |
$1,244.07
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$348.92
|
| Rate for Payer: UMR Bronson Commercial |
$321.36
|
| Rate for Payer: VA VA |
$650.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.40
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
OP
|
$997.25
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
45000095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.92 |
| Max. Negotiated Rate |
$1,832.42 |
| Rate for Payer: Aetna American Axle |
$648.21
|
| Rate for Payer: Aetna Commercial |
$847.66
|
| Rate for Payer: Aetna Medicare |
$677.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$813.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$813.71
|
| Rate for Payer: BCBS Complete |
$366.37
|
| Rate for Payer: BCBS MAPPO |
$650.97
|
| Rate for Payer: BCN Medicare Advantage |
$650.97
|
| Rate for Payer: Cash Price |
$797.80
|
| Rate for Payer: Cash Price |
$797.80
|
| Rate for Payer: Cofinity Commercial |
$857.63
|
| Rate for Payer: Cofinity Commercial |
$698.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$698.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$797.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.97
|
| Rate for Payer: Healthscope Commercial |
$897.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$698.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$747.94
|
| Rate for Payer: Mclaren Medicaid |
$348.92
|
| Rate for Payer: Mclaren Medicare |
$650.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.52
|
| Rate for Payer: Meridian Medicaid |
$366.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$748.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$847.66
|
| Rate for Payer: PACE Medicare |
$618.42
|
| Rate for Payer: PACE SWMI |
$650.97
|
| Rate for Payer: PHP Commercial |
$847.66
|
| Rate for Payer: PHP Medicare Advantage |
$650.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.21
|
| Rate for Payer: Priority Health Medicare |
$650.97
|
| Rate for Payer: Priority Health SBD |
$628.27
|
| Rate for Payer: Railroad Medicare Medicare |
$650.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,832.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.97
|
| Rate for Payer: UHC Exchange |
$1,244.07
|
| Rate for Payer: UHC Medicare Advantage |
$650.97
|
| Rate for Payer: UHCCP Medicaid |
$348.92
|
| Rate for Payer: UMR Bronson Commercial |
$368.98
|
| Rate for Payer: VA VA |
$650.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$747.94
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
IP
|
$997.25
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
45000095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.79 |
| Max. Negotiated Rate |
$897.52 |
| Rate for Payer: Aetna American Axle |
$648.21
|
| Rate for Payer: Aetna Commercial |
$847.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.21
|
| Rate for Payer: Cash Price |
$797.80
|
| Rate for Payer: Cofinity Commercial |
$698.08
|
| Rate for Payer: Cofinity Commercial |
$857.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$698.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$797.80
|
| Rate for Payer: Healthscope Commercial |
$897.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$698.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$747.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$847.66
|
| Rate for Payer: PHP Commercial |
$847.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.21
|
| Rate for Payer: Priority Health SBD |
$628.27
|
| Rate for Payer: UMR Bronson Commercial |
$438.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$747.94
|
|
|
HC CYSTOURETHROSCOPY BIOPSY
|
Facility
|
IP
|
$3,040.77
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,337.94 |
| Max. Negotiated Rate |
$2,736.69 |
| Rate for Payer: Aetna American Axle |
$1,976.50
|
| Rate for Payer: Aetna Commercial |
$2,584.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.50
|
| Rate for Payer: Cash Price |
$2,432.62
|
| Rate for Payer: Cofinity Commercial |
$2,128.54
|
| Rate for Payer: Cofinity Commercial |
$2,615.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,128.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,432.62
|
| Rate for Payer: Healthscope Commercial |
$2,736.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,128.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,280.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,584.65
|
| Rate for Payer: PHP Commercial |
$2,584.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.50
|
| Rate for Payer: Priority Health SBD |
$1,915.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,337.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,280.58
|
|
|
HC CYSTOURETHROSCOPY BIOPSY
|
Facility
|
OP
|
$3,040.77
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
76100221
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna American Axle |
$1,976.50
|
| Rate for Payer: Aetna Commercial |
$2,584.65
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$2,432.62
|
| Rate for Payer: Cash Price |
$2,432.62
|
| Rate for Payer: Cofinity Commercial |
$2,615.06
|
| Rate for Payer: Cofinity Commercial |
$2,128.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,128.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,432.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$2,736.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,128.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,280.58
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,584.65
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,584.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.50
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$1,915.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,818.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,125.08
|
| Rate for Payer: VA VA |
$1,997.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,280.58
|
|
|
HC CYSTOURETHROSCOPY W/INJ FOR CHEMODENERV BLADDER
|
Facility
|
IP
|
$2,764.69
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
76100238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,216.46 |
| Max. Negotiated Rate |
$2,488.22 |
| Rate for Payer: Aetna American Axle |
$1,797.05
|
| Rate for Payer: Aetna Commercial |
$2,349.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,797.05
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cofinity Commercial |
$1,935.28
|
| Rate for Payer: Cofinity Commercial |
$2,377.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,935.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Healthscope Commercial |
$2,488.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,935.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,073.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: PHP Commercial |
$2,349.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: Priority Health SBD |
$1,741.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,216.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,073.52
|
|
|
HC CYSTOURETHROSCOPY W/INJ FOR CHEMODENERV BLADDER
|
Facility
|
OP
|
$2,764.69
|
|
|
Service Code
|
CPT 52287
|
| Hospital Charge Code |
76100238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,022.94 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna American Axle |
$1,797.05
|
| Rate for Payer: Aetna Commercial |
$2,349.99
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,797.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cash Price |
$2,211.75
|
| Rate for Payer: Cofinity Commercial |
$2,377.63
|
| Rate for Payer: Cofinity Commercial |
$1,935.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,935.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,211.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$2,488.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,935.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,073.52
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,349.99
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,349.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,797.05
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$1,741.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,818.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,022.94
|
| Rate for Payer: VA VA |
$1,997.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,073.52
|
|
|
HC CYSTO W/IRRIG & EVAC CLOTS
|
Facility
|
IP
|
$4,710.21
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
76100226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,072.49 |
| Max. Negotiated Rate |
$4,239.19 |
| Rate for Payer: Aetna American Axle |
$3,061.64
|
| Rate for Payer: Aetna Commercial |
$4,003.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,061.64
|
| Rate for Payer: Cash Price |
$3,768.17
|
| Rate for Payer: Cofinity Commercial |
$3,297.15
|
| Rate for Payer: Cofinity Commercial |
$4,050.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,297.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,768.17
|
| Rate for Payer: Healthscope Commercial |
$4,239.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,297.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,532.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,003.68
|
| Rate for Payer: PHP Commercial |
$4,003.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,061.64
|
| Rate for Payer: Priority Health SBD |
$2,967.43
|
| Rate for Payer: UMR Bronson Commercial |
$2,072.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,532.66
|
|
|
HC CYSTO W/IRRIG & EVAC CLOTS
|
Facility
|
OP
|
$4,710.21
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
76100226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,742.78 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna American Axle |
$3,061.64
|
| Rate for Payer: Aetna Commercial |
$4,003.68
|
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,061.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Cash Price |
$3,768.17
|
| Rate for Payer: Cash Price |
$3,768.17
|
| Rate for Payer: Cofinity Commercial |
$4,050.78
|
| Rate for Payer: Cofinity Commercial |
$3,297.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,297.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,768.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Healthscope Commercial |
$4,239.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,297.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,532.66
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,003.68
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Commercial |
$4,003.68
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,061.64
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Priority Health SBD |
$2,967.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$6,428.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,742.78
|
| Rate for Payer: VA VA |
$3,363.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,532.66
|
|
|
HC CYTO DNA PROBE
|
Facility
|
IP
|
$133.17
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000031
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.59 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Aetna American Axle |
$86.56
|
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.56
|
| Rate for Payer: Cash Price |
$106.54
|
| Rate for Payer: Cofinity Commercial |
$114.53
|
| Rate for Payer: Cofinity Commercial |
$93.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.54
|
| Rate for Payer: Healthscope Commercial |
$119.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.19
|
| Rate for Payer: PHP Commercial |
$113.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.56
|
| Rate for Payer: Priority Health SBD |
$83.90
|
| Rate for Payer: UMR Bronson Commercial |
$58.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.88
|
|
