|
HC US OB GREATER THAN 14 WEEKS
|
Facility
|
IP
|
$581.99
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
40200017
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$256.08 |
| Max. Negotiated Rate |
$523.79 |
| Rate for Payer: Aetna American Axle |
$378.29
|
| Rate for Payer: Aetna Commercial |
$494.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.29
|
| Rate for Payer: Cash Price |
$465.59
|
| Rate for Payer: Cofinity Commercial |
$407.39
|
| Rate for Payer: Cofinity Commercial |
$500.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.59
|
| Rate for Payer: Healthscope Commercial |
$523.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.69
|
| Rate for Payer: PHP Commercial |
$494.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.29
|
| Rate for Payer: Priority Health SBD |
$366.65
|
| Rate for Payer: UMR Bronson Commercial |
$256.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.49
|
|
|
HC US OB LESS THAN 14 WEEKS
|
Facility
|
IP
|
$581.86
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$256.02 |
| Max. Negotiated Rate |
$523.67 |
| Rate for Payer: Aetna American Axle |
$378.21
|
| Rate for Payer: Aetna Commercial |
$494.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.21
|
| Rate for Payer: Cash Price |
$465.49
|
| Rate for Payer: Cofinity Commercial |
$407.30
|
| Rate for Payer: Cofinity Commercial |
$500.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.49
|
| Rate for Payer: Healthscope Commercial |
$523.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.58
|
| Rate for Payer: PHP Commercial |
$494.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.21
|
| Rate for Payer: Priority Health SBD |
$366.57
|
| Rate for Payer: UMR Bronson Commercial |
$256.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.40
|
|
|
HC US OB LESS THAN 14 WEEKS
|
Facility
|
OP
|
$581.86
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$523.67 |
| Rate for Payer: Aetna American Axle |
$378.21
|
| Rate for Payer: Aetna Commercial |
$494.58
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$145.73
|
| Rate for Payer: BCN Commercial |
$145.73
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$465.49
|
| Rate for Payer: Cash Price |
$465.49
|
| Rate for Payer: Cofinity Commercial |
$500.40
|
| Rate for Payer: Cofinity Commercial |
$407.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$523.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$407.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$436.40
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.58
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$494.58
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$366.57
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.15
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$108.32
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$215.29
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$436.40
|
|
|
HC US OB LTD
|
Facility
|
OP
|
$486.11
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna American Axle |
$315.97
|
| Rate for Payer: Aetna Commercial |
$413.19
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$104.00
|
| Rate for Payer: BCN Commercial |
$104.00
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$388.89
|
| Rate for Payer: Cash Price |
$388.89
|
| Rate for Payer: Cofinity Commercial |
$418.05
|
| Rate for Payer: Cofinity Commercial |
$340.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$340.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$437.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.58
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.19
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$413.19
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$306.25
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.19
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$74.72
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$179.86
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.58
|
|
|
HC US OB LTD
|
Facility
|
IP
|
$486.11
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
40200023
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$213.89 |
| Max. Negotiated Rate |
$437.50 |
| Rate for Payer: Aetna American Axle |
$315.97
|
| Rate for Payer: Aetna Commercial |
$413.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.97
|
| Rate for Payer: Cash Price |
$388.89
|
| Rate for Payer: Cofinity Commercial |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$418.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$340.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.89
|
| Rate for Payer: Healthscope Commercial |
$437.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$340.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.19
|
| Rate for Payer: PHP Commercial |
$413.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.97
|
| Rate for Payer: Priority Health SBD |
$306.25
|
| Rate for Payer: UMR Bronson Commercial |
$213.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.58
|
|
|
HC US OB NT EACH ADDL FETUS
|
Facility
|
OP
|
$176.49
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$57.47 |
| Max. Negotiated Rate |
$367.00 |
| Rate for Payer: Aetna American Axle |
$114.72
|
| Rate for Payer: Aetna Commercial |
$150.02
|
| Rate for Payer: Aetna Medicare |
$88.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.72
|
| Rate for Payer: BCBS Complete |
$70.60
|
| Rate for Payer: BCBS Trust/PPO |
$57.47
|
| Rate for Payer: BCN Commercial |
$57.47
|
| Rate for Payer: Cash Price |
$141.19
|
| Rate for Payer: Cash Price |
$141.19
|
| Rate for Payer: Cofinity Commercial |
$123.54
|
| Rate for Payer: Cofinity Commercial |
$151.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.19
|
| Rate for Payer: Healthscope Commercial |
$158.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.02
|
| Rate for Payer: PHP Commercial |
$150.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.72
|
| Rate for Payer: Priority Health SBD |
$111.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.63
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Exchange |
$69.66
|
| Rate for Payer: UMR Bronson Commercial |
$65.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.37
|
|
|
HC US OB NT EACH ADDL FETUS
|
Facility
|
IP
|
$176.49
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
40200022
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$158.84 |
| Rate for Payer: Aetna American Axle |
$114.72
|
| Rate for Payer: Aetna Commercial |
$150.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.72
|
| Rate for Payer: Cash Price |
$141.19
|
| Rate for Payer: Cofinity Commercial |
$123.54
|
| Rate for Payer: Cofinity Commercial |
$151.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.19
|
| Rate for Payer: Healthscope Commercial |
$158.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.02
|
| Rate for Payer: PHP Commercial |
$150.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.72
|
| Rate for Payer: Priority Health SBD |
$111.19
|
| Rate for Payer: UMR Bronson Commercial |
$77.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.37
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
OP
|
$458.39
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$412.55 |
| Rate for Payer: Aetna American Axle |
$297.95
|
| Rate for Payer: Aetna Commercial |
$389.63
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$123.84
|
| Rate for Payer: BCN Commercial |
$123.84
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$366.71
|
| Rate for Payer: Cash Price |
$366.71
|
| Rate for Payer: Cofinity Commercial |
$394.22
|
| Rate for Payer: Cofinity Commercial |
$320.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$412.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.79
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.63
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$389.63
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$288.79
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.02
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$107.29
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$169.60
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.79
|
|
|
HC US OB NUCHAL TRANSLUCENCY
|
Facility
|
IP
|
$458.39
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
40200021
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$201.69 |
| Max. Negotiated Rate |
$412.55 |
| Rate for Payer: Aetna American Axle |
$297.95
|
| Rate for Payer: Aetna Commercial |
$389.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.95
|
| Rate for Payer: Cash Price |
$366.71
|
| Rate for Payer: Cofinity Commercial |
$320.87
|
| Rate for Payer: Cofinity Commercial |
$394.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.71
|
| Rate for Payer: Healthscope Commercial |
$412.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.63
|
| Rate for Payer: PHP Commercial |
$389.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.95
|
| Rate for Payer: Priority Health SBD |
$288.79
|
| Rate for Payer: UMR Bronson Commercial |
$201.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.79
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
IP
|
$398.27
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$175.24 |
| Max. Negotiated Rate |
$358.44 |
| Rate for Payer: Aetna American Axle |
$258.88
|
| Rate for Payer: Aetna Commercial |
$338.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.88
|
| Rate for Payer: Cash Price |
$318.62
|
| Rate for Payer: Cofinity Commercial |
$278.79
|
| Rate for Payer: Cofinity Commercial |
$342.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.62
|
| Rate for Payer: Healthscope Commercial |
$358.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.53
|
| Rate for Payer: PHP Commercial |
$338.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.88
|
| Rate for Payer: Priority Health SBD |
$250.91
|
| Rate for Payer: UMR Bronson Commercial |
$175.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.70
|
|
|
HC US OB TRANSVAG ONLY
|
Facility
|
OP
|
$398.27
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
40200025
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$367.00 |
| Rate for Payer: Aetna American Axle |
$258.88
|
| Rate for Payer: Aetna Commercial |
$338.53
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$117.68
|
| Rate for Payer: BCN Commercial |
$117.68
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$318.62
|
| Rate for Payer: Cash Price |
$318.62
|
| Rate for Payer: Cofinity Commercial |
$342.51
|
| Rate for Payer: Cofinity Commercial |
$278.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$358.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.70
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.53
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$338.53
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$250.91
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.01
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$85.46
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$147.36
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.70
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$479.16 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Aetna American Axle |
$707.85
|
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.85
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$762.30
|
| Rate for Payer: Cofinity Commercial |
$936.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$762.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Healthscope Commercial |
$980.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$762.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: PHP Commercial |
$925.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health SBD |
$686.07
|
| Rate for Payer: UMR Bronson Commercial |
$479.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.75
|
|
|
HC US OB UNLISTED PROCEDURE
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.65 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Aetna American Axle |
$707.85
|
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: Aetna Medicare |
$204.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$142.15
|
| Rate for Payer: BCN Commercial |
$142.15
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$936.54
|
| Rate for Payer: Cofinity Commercial |
$762.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$762.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$980.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$762.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.75
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: Nomi Health Commercial |
$413.91
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Commercial |
$925.65
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.50
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$495.60
|
| Rate for Payer: Priority Health SBD |
$686.07
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.82
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$376.68
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: UMR Bronson Commercial |
$402.93
|
| Rate for Payer: VA VA |
$197.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.75
|
|
|
HC US PARACENTESIS
|
Facility
|
IP
|
$1,369.02
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$602.37 |
| Max. Negotiated Rate |
$1,232.12 |
| Rate for Payer: Aetna American Axle |
$889.86
|
| Rate for Payer: Aetna Commercial |
$1,163.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.86
|
| Rate for Payer: Cash Price |
$1,095.22
|
| Rate for Payer: Cofinity Commercial |
$1,177.36
|
| Rate for Payer: Cofinity Commercial |
$958.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$958.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.22
|
| Rate for Payer: Healthscope Commercial |
$1,232.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$958.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,026.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.67
|
| Rate for Payer: PHP Commercial |
$1,163.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.86
|
| Rate for Payer: Priority Health SBD |
$862.48
|
| Rate for Payer: UMR Bronson Commercial |
$602.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,026.76
|
|
|
HC US PARACENTESIS
|
Facility
|
OP
|
$1,369.02
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
36100346
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.61 |
| Max. Negotiated Rate |
$2,887.15 |
| Rate for Payer: Aetna American Axle |
$889.86
|
| Rate for Payer: Aetna Commercial |
$1,163.67
|
| Rate for Payer: Aetna Medicare |
$955.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$748.47
|
| Rate for Payer: BCN Commercial |
$748.47
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Cash Price |
$1,095.22
|
| Rate for Payer: Cash Price |
$1,095.22
|
| Rate for Payer: Cash Price |
$1,095.22
|
| Rate for Payer: Cofinity Commercial |
$958.31
|
| Rate for Payer: Cofinity Commercial |
$1,177.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$958.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,095.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Healthscope Commercial |
$1,232.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$958.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,026.76
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.67
|
| Rate for Payer: Nomi Health Commercial |
$1,929.06
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Commercial |
$1,163.67
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,887.15
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.72
|
| Rate for Payer: Priority Health SBD |
$862.48
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.67
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$100.61
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: UMR Bronson Commercial |
$506.54
|
| Rate for Payer: VA VA |
$918.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,026.76
|
|
|
HC US PELVIS LTD
|
Facility
|
OP
|
$510.39
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$459.35 |
| Rate for Payer: Aetna American Axle |
$331.75
|
| Rate for Payer: Aetna Commercial |
$433.83
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$54.06
|
| Rate for Payer: BCN Commercial |
$54.06
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$438.94
|
| Rate for Payer: Cofinity Commercial |
$357.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$459.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.79
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$433.83
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$321.55
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.45
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$45.86
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$188.84
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.79
|
|
|
HC US PELVIS LTD
|
Facility
|
IP
|
$510.39
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
40200034
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$224.57 |
| Max. Negotiated Rate |
$459.35 |
| Rate for Payer: Aetna American Axle |
$331.75
|
| Rate for Payer: Aetna Commercial |
$433.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.75
|
| Rate for Payer: Cash Price |
$408.31
|
| Rate for Payer: Cofinity Commercial |
$357.27
|
| Rate for Payer: Cofinity Commercial |
$438.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.31
|
| Rate for Payer: Healthscope Commercial |
$459.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.83
|
| Rate for Payer: PHP Commercial |
$433.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.75
|
| Rate for Payer: Priority Health SBD |
$321.55
|
| Rate for Payer: UMR Bronson Commercial |
$224.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.79
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
OP
|
$918.71
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$826.84 |
| Rate for Payer: Aetna American Axle |
$597.16
|
| Rate for Payer: Aetna Commercial |
$780.90
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$150.52
|
| Rate for Payer: BCN Commercial |
$150.52
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cofinity Commercial |
$790.09
|
| Rate for Payer: Cofinity Commercial |
$643.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$643.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$826.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$643.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.03
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.90
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$780.90
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$578.79
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.28
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$96.62
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$339.92
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.03
|
|
|
HC US PELVIS TRANSABDOMINAL ONLY
|
Facility
|
IP
|
$918.71
|
|
|
Service Code
|
CPT 76856
|
| Hospital Charge Code |
40200033
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$404.23 |
| Max. Negotiated Rate |
$826.84 |
| Rate for Payer: Aetna American Axle |
$597.16
|
| Rate for Payer: Aetna Commercial |
$780.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.16
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cofinity Commercial |
$643.10
|
| Rate for Payer: Cofinity Commercial |
$790.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$643.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.97
|
| Rate for Payer: Healthscope Commercial |
$826.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$643.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.90
|
| Rate for Payer: PHP Commercial |
$780.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.16
|
| Rate for Payer: Priority Health SBD |
$578.79
|
| Rate for Payer: UMR Bronson Commercial |
$404.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.03
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
OP
|
$377.89
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$367.00 |
| Rate for Payer: Aetna American Axle |
$245.63
|
| Rate for Payer: Aetna Commercial |
$321.21
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$178.57
|
| Rate for Payer: BCN Commercial |
$178.57
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cofinity Commercial |
$324.99
|
| Rate for Payer: Cofinity Commercial |
$264.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$264.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$340.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.42
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.21
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$321.21
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$238.07
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.15
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$109.23
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$139.82
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.42
|
|
|
HC US PELVIS TRANSVAG ONLY
|
Facility
|
IP
|
$377.89
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
40200031
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$166.27 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna American Axle |
$245.63
|
| Rate for Payer: Aetna Commercial |
$321.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.63
|
| Rate for Payer: Cash Price |
$302.31
|
| Rate for Payer: Cofinity Commercial |
$264.52
|
| Rate for Payer: Cofinity Commercial |
$324.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$264.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.31
|
| Rate for Payer: Healthscope Commercial |
$340.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$264.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.21
|
| Rate for Payer: PHP Commercial |
$321.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.63
|
| Rate for Payer: Priority Health SBD |
$238.07
|
| Rate for Payer: UMR Bronson Commercial |
$166.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.42
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
IP
|
$1,086.05
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$477.86 |
| Max. Negotiated Rate |
$977.44 |
| Rate for Payer: Cofinity Commercial |
$934.00
|
| Rate for Payer: Aetna American Axle |
$705.93
|
| Rate for Payer: Aetna Commercial |
$923.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$705.93
|
| Rate for Payer: Cash Price |
$868.84
|
| Rate for Payer: Cofinity Commercial |
$760.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$760.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.84
|
| Rate for Payer: Healthscope Commercial |
$977.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$760.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$814.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$923.14
|
| Rate for Payer: PHP Commercial |
$923.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.93
|
| Rate for Payer: Priority Health SBD |
$684.21
|
| Rate for Payer: UMR Bronson Commercial |
$477.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$814.54
|
|
|
HC US PROSTATE TRANSRECTAL
|
Facility
|
OP
|
$1,086.05
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
40200036
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$977.44 |
| Rate for Payer: Aetna American Axle |
$705.93
|
| Rate for Payer: Aetna Commercial |
$923.14
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$705.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$347.56
|
| Rate for Payer: BCN Commercial |
$347.56
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$868.84
|
| Rate for Payer: Cash Price |
$868.84
|
| Rate for Payer: Cofinity Commercial |
$934.00
|
| Rate for Payer: Cofinity Commercial |
$760.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$760.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$977.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$760.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$814.54
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$923.14
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$923.14
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$684.21
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.78
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$182.53
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$401.84
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$814.54
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
IP
|
$291.31
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$128.18 |
| Max. Negotiated Rate |
$262.18 |
| Rate for Payer: Aetna American Axle |
$189.35
|
| Rate for Payer: Aetna Commercial |
$247.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.35
|
| Rate for Payer: Cash Price |
$233.05
|
| Rate for Payer: Cofinity Commercial |
$203.92
|
| Rate for Payer: Cofinity Commercial |
$250.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.05
|
| Rate for Payer: Healthscope Commercial |
$262.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.61
|
| Rate for Payer: PHP Commercial |
$247.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.35
|
| Rate for Payer: Priority Health SBD |
$183.53
|
| Rate for Payer: UMR Bronson Commercial |
$128.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.48
|
|
|
HC US PROSTATE TRANSRECT TX PLAN SEP PROC
|
Facility
|
OP
|
$291.31
|
|
|
Service Code
|
CPT 76873
|
| Hospital Charge Code |
40200081
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.85 |
| Max. Negotiated Rate |
$367.00 |
| Rate for Payer: Aetna American Axle |
$189.35
|
| Rate for Payer: Aetna Commercial |
$247.61
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$205.93
|
| Rate for Payer: BCN Commercial |
$205.93
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$233.05
|
| Rate for Payer: Cash Price |
$233.05
|
| Rate for Payer: Cofinity Commercial |
$250.53
|
| Rate for Payer: Cofinity Commercial |
$203.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$262.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.48
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.61
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$247.61
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$183.53
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.65
|
| Rate for Payer: UHC Core |
$367.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$162.41
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$55.85
|
| Rate for Payer: UMR Bronson Commercial |
$107.78
|
| Rate for Payer: VA VA |
$104.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.48
|
|
