|
HC DILANTIN LEVEL
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
30100039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna American Axle |
$23.67
|
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$12.77
|
| Rate for Payer: BCN Commercial |
$12.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$19.88
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.64
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$10.91
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: UMR Bronson Commercial |
$13.47
|
| Rate for Payer: VA VA |
$13.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
OP
|
$105.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$95.10 |
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna Medicare |
$14.31
|
| Rate for Payer: Aetna American Axle |
$68.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.20
|
| Rate for Payer: BCBS Complete |
$7.74
|
| Rate for Payer: BCBS MAPPO |
$13.76
|
| Rate for Payer: BCBS Trust/PPO |
$13.26
|
| Rate for Payer: BCN Commercial |
$13.26
|
| Rate for Payer: BCN Medicare Advantage |
$13.76
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$90.88
|
| Rate for Payer: Cofinity Commercial |
$73.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$95.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.25
|
| Rate for Payer: Mclaren Medicaid |
$7.38
|
| Rate for Payer: Mclaren Medicare |
$13.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.45
|
| Rate for Payer: Meridian Medicaid |
$7.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: Nomi Health Commercial |
$20.64
|
| Rate for Payer: PACE Medicare |
$13.07
|
| Rate for Payer: PACE SWMI |
$13.76
|
| Rate for Payer: PHP Commercial |
$89.82
|
| Rate for Payer: PHP Medicare Advantage |
$13.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.16
|
| Rate for Payer: Priority Health Medicare |
$13.76
|
| Rate for Payer: Priority Health Narrow Network |
$11.33
|
| Rate for Payer: Priority Health SBD |
$66.57
|
| Rate for Payer: Railroad Medicare Medicare |
$13.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.76
|
| Rate for Payer: UHC Exchange |
$13.76
|
| Rate for Payer: UHC Medicare Advantage |
$13.76
|
| Rate for Payer: UHCCP Medicaid |
$7.38
|
| Rate for Payer: UMR Bronson Commercial |
$39.10
|
| Rate for Payer: VA VA |
$13.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.25
|
|
|
HC DILANTIN/PHENYTOIN FREE LEVEL
|
Facility
|
IP
|
$105.67
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
30100040
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$95.10 |
| Rate for Payer: Aetna American Axle |
$68.69
|
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.69
|
| Rate for Payer: Cash Price |
$84.54
|
| Rate for Payer: Cofinity Commercial |
$73.97
|
| Rate for Payer: Cofinity Commercial |
$90.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.54
|
| Rate for Payer: Healthscope Commercial |
$95.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.82
|
| Rate for Payer: PHP Commercial |
$89.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.69
|
| Rate for Payer: Priority Health SBD |
$66.57
|
| Rate for Payer: UMR Bronson Commercial |
$46.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.25
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
OP
|
$170.11
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.67 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$110.57
|
| Rate for Payer: Aetna Commercial |
$144.59
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$93.42
|
| Rate for Payer: BCN Commercial |
$93.42
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cofinity Commercial |
$119.08
|
| Rate for Payer: Cofinity Commercial |
$146.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Healthscope Commercial |
$153.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.58
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.59
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Commercial |
$144.59
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Priority Health SBD |
$107.17
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.54
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$38.67
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: UMR Bronson Commercial |
$62.94
|
| Rate for Payer: VA VA |
$126.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.58
|
|
|
HC DILAT FEMALE URETHRA,SUBSEQ
|
Facility
|
IP
|
$170.11
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
76100224
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.85 |
| Max. Negotiated Rate |
$153.10 |
| Rate for Payer: Aetna American Axle |
$110.57
|
| Rate for Payer: Aetna Commercial |
$144.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.57
|
| Rate for Payer: Cash Price |
$136.09
|
| Rate for Payer: Cofinity Commercial |
$119.08
|
| Rate for Payer: Cofinity Commercial |
$146.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.09
|
| Rate for Payer: Healthscope Commercial |
$153.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.59
|
| Rate for Payer: PHP Commercial |
$144.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.57
|
| Rate for Payer: Priority Health SBD |
$107.17
|
| Rate for Payer: UMR Bronson Commercial |
$74.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.58
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
OP
|
$662.41
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.11 |
| Max. Negotiated Rate |
$1,895.68 |
| Rate for Payer: Aetna American Axle |
$430.57
|
| Rate for Payer: Aetna Commercial |
$563.05
|
| Rate for Payer: Aetna Medicare |
$331.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.57
|
| Rate for Payer: BCBS Complete |
$264.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,895.68
|
| Rate for Payer: BCN Commercial |
$1,895.68
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cofinity Commercial |
$569.67
|
| Rate for Payer: Cofinity Commercial |
$463.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$463.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.93
|
| Rate for Payer: Healthscope Commercial |
$596.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$463.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.05
|
| Rate for Payer: PHP Commercial |
$563.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health SBD |
$417.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.92
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$128.11
|
| Rate for Payer: UMR Bronson Commercial |
$245.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.81
|
|
|
HC DILATION BILE DUCT OR AMPULLA EACH DUCT
|
Facility
|
IP
|
$662.41
|
|
|
Service Code
|
CPT 47542
|
| Hospital Charge Code |
36100499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$291.46 |
| Max. Negotiated Rate |
$596.17 |
| Rate for Payer: Aetna American Axle |
$430.57
|
| Rate for Payer: Aetna Commercial |
$563.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.57
|
| Rate for Payer: Cash Price |
$529.93
|
| Rate for Payer: Cofinity Commercial |
$463.69
|
| Rate for Payer: Cofinity Commercial |
$569.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$463.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.93
|
| Rate for Payer: Healthscope Commercial |
$596.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$463.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$496.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.05
|
| Rate for Payer: PHP Commercial |
$563.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.57
|
| Rate for Payer: Priority Health SBD |
$417.32
|
| Rate for Payer: UMR Bronson Commercial |
$291.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$496.81
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
OP
|
$3,663.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$362.23 |
| Max. Negotiated Rate |
$32,060.66 |
| Rate for Payer: Aetna American Axle |
$2,380.95
|
| Rate for Payer: Aetna Commercial |
$3,113.55
|
| Rate for Payer: Aetna Medicare |
$10,608.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,380.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,750.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,750.89
|
| Rate for Payer: BCBS Complete |
$5,740.96
|
| Rate for Payer: BCBS MAPPO |
$10,200.71
|
| Rate for Payer: BCBS Trust/PPO |
$4,670.11
|
| Rate for Payer: BCN Commercial |
$4,670.11
|
| Rate for Payer: BCN Medicare Advantage |
$10,200.71
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cofinity Commercial |
$3,150.18
|
| Rate for Payer: Cofinity Commercial |
$2,564.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,564.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,930.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,200.71
|
| Rate for Payer: Healthscope Commercial |
$3,296.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,564.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,747.25
|
| Rate for Payer: Mclaren Medicaid |
$5,467.58
|
| Rate for Payer: Mclaren Medicare |
$10,200.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,710.75
|
| Rate for Payer: Meridian Medicaid |
$5,740.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,730.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,113.55
|
| Rate for Payer: Nomi Health Commercial |
$21,421.49
|
| Rate for Payer: PACE Medicare |
$9,690.67
|
| Rate for Payer: PACE SWMI |
$10,200.71
|
| Rate for Payer: PHP Commercial |
$3,113.55
|
| Rate for Payer: PHP Medicare Advantage |
$10,200.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,467.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,380.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,060.66
|
| Rate for Payer: Priority Health Medicare |
$10,200.71
|
| Rate for Payer: Priority Health Narrow Network |
$25,648.53
|
| Rate for Payer: Priority Health SBD |
$2,307.69
|
| Rate for Payer: Railroad Medicare Medicare |
$10,200.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$398.45
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,200.71
|
| Rate for Payer: UHC Exchange |
$362.23
|
| Rate for Payer: UHC Medicare Advantage |
$10,200.71
|
| Rate for Payer: UHCCP Medicaid |
$5,467.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,355.31
|
| Rate for Payer: VA VA |
$10,200.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,747.25
|
|
|
HC DILATION BILIARY DUCT WITH STENT
|
Facility
|
IP
|
$3,663.00
|
|
|
Service Code
|
CPT 47556
|
| Hospital Charge Code |
36100209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,611.72 |
| Max. Negotiated Rate |
$3,296.70 |
| Rate for Payer: Aetna American Axle |
$2,380.95
|
| Rate for Payer: Aetna Commercial |
$3,113.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,380.95
|
| Rate for Payer: Cash Price |
$2,930.40
|
| Rate for Payer: Cofinity Commercial |
$2,564.10
|
| Rate for Payer: Cofinity Commercial |
$3,150.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,564.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,930.40
|
| Rate for Payer: Healthscope Commercial |
$3,296.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,564.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,747.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,113.55
|
| Rate for Payer: PHP Commercial |
$3,113.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,380.95
|
| Rate for Payer: Priority Health SBD |
$2,307.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,611.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,747.25
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
IP
|
$1,944.12
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$855.41 |
| Max. Negotiated Rate |
$1,749.71 |
| Rate for Payer: Aetna American Axle |
$1,263.68
|
| Rate for Payer: Aetna Commercial |
$1,652.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,263.68
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cofinity Commercial |
$1,360.88
|
| Rate for Payer: Cofinity Commercial |
$1,671.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,360.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.30
|
| Rate for Payer: Healthscope Commercial |
$1,749.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,360.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,458.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.50
|
| Rate for Payer: PHP Commercial |
$1,652.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.68
|
| Rate for Payer: Priority Health SBD |
$1,224.80
|
| Rate for Payer: UMR Bronson Commercial |
$855.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,458.09
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
OP
|
$1,944.12
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$319.72 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna American Axle |
$1,263.68
|
| Rate for Payer: Aetna Commercial |
$1,652.50
|
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,263.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,737.15
|
| Rate for Payer: BCN Commercial |
$1,737.15
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cofinity Commercial |
$1,671.94
|
| Rate for Payer: Cofinity Commercial |
$1,360.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,360.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Healthscope Commercial |
$1,749.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,360.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,458.09
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.50
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Commercial |
$1,652.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Priority Health SBD |
$1,224.80
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.69
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Exchange |
$319.72
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,853.33
|
| Rate for Payer: UMR Bronson Commercial |
$719.32
|
| Rate for Payer: VA VA |
$3,457.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,458.09
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
OP
|
$7,943.45
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.37 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna American Axle |
$5,163.24
|
| Rate for Payer: Aetna Commercial |
$6,751.93
|
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,163.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$40.37
|
| Rate for Payer: BCN Commercial |
$40.37
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cofinity Commercial |
$6,831.37
|
| Rate for Payer: Cofinity Commercial |
$5,560.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,560.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,354.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$7,149.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,560.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,957.59
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,751.93
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$6,751.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Priority Health SBD |
$5,004.37
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.27
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$46.61
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: UMR Bronson Commercial |
$2,939.08
|
| Rate for Payer: VA VA |
$3,115.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,957.59
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
IP
|
$7,943.45
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,495.12 |
| Max. Negotiated Rate |
$7,149.10 |
| Rate for Payer: Aetna American Axle |
$5,163.24
|
| Rate for Payer: Aetna Commercial |
$6,751.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,163.24
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cofinity Commercial |
$5,560.42
|
| Rate for Payer: Cofinity Commercial |
$6,831.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,560.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,354.76
|
| Rate for Payer: Healthscope Commercial |
$7,149.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,560.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,957.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,751.93
|
| Rate for Payer: PHP Commercial |
$6,751.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.24
|
| Rate for Payer: Priority Health SBD |
$5,004.37
|
| Rate for Payer: UMR Bronson Commercial |
$3,495.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,957.59
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
IP
|
$215.91
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$194.32 |
| Rate for Payer: Aetna American Axle |
$140.34
|
| Rate for Payer: Aetna Commercial |
$183.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.34
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cofinity Commercial |
$151.14
|
| Rate for Payer: Cofinity Commercial |
$185.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.73
|
| Rate for Payer: Healthscope Commercial |
$194.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.52
|
| Rate for Payer: PHP Commercial |
$183.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.34
|
| Rate for Payer: Priority Health SBD |
$136.02
|
| Rate for Payer: UMR Bronson Commercial |
$95.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.93
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
OP
|
$215.91
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.83 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$140.34
|
| Rate for Payer: Aetna Commercial |
$183.52
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$57.94
|
| Rate for Payer: BCN Commercial |
$57.94
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cofinity Commercial |
$151.14
|
| Rate for Payer: Cofinity Commercial |
$185.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$194.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.93
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.52
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$183.52
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$136.02
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.81
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$39.83
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$82.17
|
| Rate for Payer: UMR Bronson Commercial |
$79.89
|
| Rate for Payer: VA VA |
$153.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.93
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
OP
|
$366.59
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.38 |
| Max. Negotiated Rate |
$748.94 |
| Rate for Payer: Aetna American Axle |
$238.28
|
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$49.38
|
| Rate for Payer: BCN Commercial |
$49.38
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cofinity Commercial |
$315.27
|
| Rate for Payer: Cofinity Commercial |
$256.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Healthscope Commercial |
$329.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.94
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.60
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Commercial |
$311.60
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Priority Health SBD |
$230.95
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.98
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$60.89
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$127.72
|
| Rate for Payer: UMR Bronson Commercial |
$135.64
|
| Rate for Payer: VA VA |
$238.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.94
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
IP
|
$366.59
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.30 |
| Max. Negotiated Rate |
$329.93 |
| Rate for Payer: Aetna American Axle |
$238.28
|
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.28
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cofinity Commercial |
$256.61
|
| Rate for Payer: Cofinity Commercial |
$315.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.27
|
| Rate for Payer: Healthscope Commercial |
$329.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.60
|
| Rate for Payer: PHP Commercial |
$311.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.28
|
| Rate for Payer: Priority Health SBD |
$230.95
|
| Rate for Payer: UMR Bronson Commercial |
$161.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.94
|
|
|
HC DILATOR SIZE 12
|
Facility
|
IP
|
$34.57
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Aetna American Axle |
$22.47
|
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.47
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.47
|
| Rate for Payer: Priority Health SBD |
$21.78
|
| Rate for Payer: UMR Bronson Commercial |
$15.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.93
|
|
|
HC DILATOR SIZE 12
|
Facility
|
OP
|
$34.57
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Aetna American Axle |
$22.47
|
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Medicare |
$17.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.47
|
| Rate for Payer: BCBS Complete |
$13.83
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.47
|
| Rate for Payer: Priority Health SBD |
$21.78
|
| Rate for Payer: UMR Bronson Commercial |
$12.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.93
|
|
|
HC DILATOR SIZE 7
|
Facility
|
IP
|
$25.30
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna American Axle |
$16.44
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.44
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health SBD |
$15.94
|
| Rate for Payer: UMR Bronson Commercial |
$11.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
HC DILATOR SIZE 7
|
Facility
|
OP
|
$25.30
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna American Axle |
$16.44
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.44
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health SBD |
$15.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
HC DILATOR SIZE 9
|
Facility
|
IP
|
$25.30
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna American Axle |
$16.44
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.44
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health SBD |
$15.94
|
| Rate for Payer: UMR Bronson Commercial |
$11.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
HC DILATOR SIZE 9
|
Facility
|
OP
|
$25.30
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna American Axle |
$16.44
|
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.44
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health SBD |
$15.94
|
| Rate for Payer: UMR Bronson Commercial |
$9.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
IP
|
$4,567.36
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,009.64 |
| Max. Negotiated Rate |
$4,110.62 |
| Rate for Payer: Aetna American Axle |
$2,968.78
|
| Rate for Payer: Aetna Commercial |
$3,882.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,968.78
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cofinity Commercial |
$3,197.15
|
| Rate for Payer: Cofinity Commercial |
$3,927.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,197.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,653.89
|
| Rate for Payer: Healthscope Commercial |
$4,110.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,197.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,425.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,882.26
|
| Rate for Payer: PHP Commercial |
$3,882.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,968.78
|
| Rate for Payer: Priority Health SBD |
$2,877.44
|
| Rate for Payer: UMR Bronson Commercial |
$2,009.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,425.52
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
OP
|
$4,567.36
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.43 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna American Axle |
$2,968.78
|
| Rate for Payer: Aetna Commercial |
$3,882.26
|
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,968.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,434.68
|
| Rate for Payer: BCN Commercial |
$2,434.68
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cofinity Commercial |
$3,927.93
|
| Rate for Payer: Cofinity Commercial |
$3,197.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,197.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,653.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Healthscope Commercial |
$4,110.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,197.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,425.52
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,882.26
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Commercial |
$3,882.26
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,968.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Priority Health SBD |
$2,877.44
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.87
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$234.43
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,689.92
|
| Rate for Payer: VA VA |
$3,379.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,425.52
|
|
