|
HC GIARDIA SCREEN
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
30600119
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: Aetna Medicare |
$12.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.59
|
| Rate for Payer: BCBS Complete |
$8.64
|
| Rate for Payer: BCBS MAPPO |
$11.68
|
| Rate for Payer: BCBS Trust/PPO |
$38.39
|
| Rate for Payer: BCN Commercial |
$38.39
|
| Rate for Payer: BCN Medicare Advantage |
$11.68
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.68
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.02
|
| Rate for Payer: Mclaren Medicaid |
$8.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.26
|
| Rate for Payer: Meridian Medicaid |
$8.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PACE Senior Care Partners |
$11.09
|
| Rate for Payer: PACE SWMI |
$11.68
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: PHP Medicare Advantage |
$11.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.63
|
| Rate for Payer: Priority Health Medicare |
$11.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.50
|
| Rate for Payer: Railroad Medicare Medicare |
$11.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.10
|
| Rate for Payer: UHC Core |
$38.99
|
| Rate for Payer: UHC Exchange |
$11.68
|
| Rate for Payer: UHC Medicaid |
$8.23
|
| Rate for Payer: UHC Medicare Advantage |
$11.68
|
| Rate for Payer: UHCCP Medicaid |
$8.23
|
| Rate for Payer: VA VA |
$11.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.02
|
|
|
HC GIARDIA SCREEN
|
Facility
|
IP
|
$46.70
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
30600119
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: BCBS Trust/PPO |
$38.57
|
| Rate for Payer: BCN Commercial |
$38.57
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$38.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.10
|
| Rate for Payer: UHC Core |
$38.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.02
|
|
|
HC GI CONVERT G TO GJ TUBE W
|
Facility
|
IP
|
$1,886.25
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
36100228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,312.83 |
| Max. Negotiated Rate |
$1,697.62 |
| Rate for Payer: Aetna Commercial |
$1,603.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,557.85
|
| Rate for Payer: BCN Commercial |
$1,557.85
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cofinity Commercial |
$1,622.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.00
|
| Rate for Payer: Healthscope Commercial |
$1,697.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,414.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.31
|
| Rate for Payer: Nomi Health Commercial |
$1,546.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,414.69
|
| Rate for Payer: PHP Commercial |
$1,603.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,641.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,312.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,659.90
|
| Rate for Payer: UHC Core |
$1,575.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,414.69
|
|
|
HC GI CONVERT G TO GJ TUBE W
|
Facility
|
OP
|
$1,886.25
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
36100228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$332.55 |
| Max. Negotiated Rate |
$1,697.62 |
| Rate for Payer: Aetna Commercial |
$1,603.31
|
| Rate for Payer: Aetna Medicare |
$490.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$589.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$589.45
|
| Rate for Payer: BCBS Complete |
$349.14
|
| Rate for Payer: BCBS MAPPO |
$471.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,550.69
|
| Rate for Payer: BCN Commercial |
$1,550.69
|
| Rate for Payer: BCN Medicare Advantage |
$471.56
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cofinity Commercial |
$1,622.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,509.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$471.56
|
| Rate for Payer: Healthscope Commercial |
$1,697.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,414.69
|
| Rate for Payer: Mclaren Medicaid |
$332.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$495.14
|
| Rate for Payer: Meridian Medicaid |
$349.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$542.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$518.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.31
|
| Rate for Payer: Nomi Health Commercial |
$1,546.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,414.69
|
| Rate for Payer: PACE Senior Care Partners |
$447.98
|
| Rate for Payer: PACE SWMI |
$471.56
|
| Rate for Payer: PHP Commercial |
$1,603.31
|
| Rate for Payer: PHP Medicare Advantage |
$471.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,641.04
|
| Rate for Payer: Priority Health Medicare |
$476.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,312.83
|
| Rate for Payer: Railroad Medicare Medicare |
$471.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,659.90
|
| Rate for Payer: UHC Core |
$1,575.02
|
| Rate for Payer: UHC Exchange |
$471.56
|
| Rate for Payer: UHC Medicaid |
$332.55
|
| Rate for Payer: UHC Medicare Advantage |
$471.56
|
| Rate for Payer: UHCCP Medicaid |
$332.55
|
| Rate for Payer: VA VA |
$471.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,414.69
|
|
|
HC GI FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$1,847.32
|
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$325.68 |
| Max. Negotiated Rate |
$1,662.59 |
| Rate for Payer: Aetna Commercial |
$1,570.22
|
| Rate for Payer: Aetna Medicare |
$480.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$577.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$577.29
|
| Rate for Payer: BCBS Complete |
$341.94
|
| Rate for Payer: BCBS MAPPO |
$461.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.68
|
| Rate for Payer: BCN Commercial |
$1,518.68
|
| Rate for Payer: BCN Medicare Advantage |
$461.83
|
| Rate for Payer: Cash Price |
$1,477.86
|
| Rate for Payer: Cofinity Commercial |
$1,588.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$461.83
|
| Rate for Payer: Healthscope Commercial |
$1,662.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,385.49
|
| Rate for Payer: Mclaren Medicaid |
$325.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$484.92
|
| Rate for Payer: Meridian Medicaid |
$341.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$531.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$508.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,570.22
|
| Rate for Payer: Nomi Health Commercial |
$1,514.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,385.49
|
| Rate for Payer: PACE Senior Care Partners |
$438.74
|
| Rate for Payer: PACE SWMI |
$461.83
|
| Rate for Payer: PHP Commercial |
$1,570.22
|
| Rate for Payer: PHP Medicare Advantage |
$461.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,607.17
|
| Rate for Payer: Priority Health Medicare |
$466.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,285.73
|
| Rate for Payer: Railroad Medicare Medicare |
$461.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,625.64
|
| Rate for Payer: UHC Core |
$1,542.51
|
| Rate for Payer: UHC Exchange |
$461.83
|
| Rate for Payer: UHC Medicaid |
$325.68
|
| Rate for Payer: UHC Medicare Advantage |
$461.83
|
| Rate for Payer: UHCCP Medicaid |
$325.68
|
| Rate for Payer: VA VA |
$461.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.49
|
|
|
HC GI FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$1,847.32
|
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,285.73 |
| Max. Negotiated Rate |
$1,662.59 |
| Rate for Payer: Aetna Commercial |
$1,570.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,525.70
|
| Rate for Payer: BCN Commercial |
$1,525.70
|
| Rate for Payer: Cash Price |
$1,477.86
|
| Rate for Payer: Cofinity Commercial |
$1,588.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,477.86
|
| Rate for Payer: Healthscope Commercial |
$1,662.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,385.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,570.22
|
| Rate for Payer: Nomi Health Commercial |
$1,514.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,385.49
|
| Rate for Payer: PHP Commercial |
$1,570.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,607.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,285.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,625.64
|
| Rate for Payer: UHC Core |
$1,542.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,385.49
|
|
|
HC GI GASTRIC TUBE REPOSITION
|
Facility
|
IP
|
$1,293.30
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
36100192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$900.14 |
| Max. Negotiated Rate |
$1,163.97 |
| Rate for Payer: Aetna Commercial |
$1,099.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,068.14
|
| Rate for Payer: BCN Commercial |
$1,068.14
|
| Rate for Payer: Cash Price |
$1,034.64
|
| Rate for Payer: Cofinity Commercial |
$1,112.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.64
|
| Rate for Payer: Healthscope Commercial |
$1,163.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$969.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,099.31
|
| Rate for Payer: Nomi Health Commercial |
$1,060.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$969.98
|
| Rate for Payer: PHP Commercial |
$1,099.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,125.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$900.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,138.10
|
| Rate for Payer: UHC Core |
$1,079.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$969.98
|
|
|
HC GI GASTRIC TUBE REPOSITION
|
Facility
|
OP
|
$1,293.30
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
36100192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.01 |
| Max. Negotiated Rate |
$1,163.97 |
| Rate for Payer: Aetna Commercial |
$1,099.31
|
| Rate for Payer: Aetna Medicare |
$336.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$404.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$404.16
|
| Rate for Payer: BCBS Complete |
$239.39
|
| Rate for Payer: BCBS MAPPO |
$323.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,063.22
|
| Rate for Payer: BCN Commercial |
$1,063.22
|
| Rate for Payer: BCN Medicare Advantage |
$323.32
|
| Rate for Payer: Cash Price |
$1,034.64
|
| Rate for Payer: Cofinity Commercial |
$1,112.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,034.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.32
|
| Rate for Payer: Healthscope Commercial |
$1,163.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$969.98
|
| Rate for Payer: Mclaren Medicaid |
$228.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.49
|
| Rate for Payer: Meridian Medicaid |
$239.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$371.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$355.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,099.31
|
| Rate for Payer: Nomi Health Commercial |
$1,060.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$969.98
|
| Rate for Payer: PACE Senior Care Partners |
$307.16
|
| Rate for Payer: PACE SWMI |
$323.32
|
| Rate for Payer: PHP Commercial |
$1,099.31
|
| Rate for Payer: PHP Medicare Advantage |
$323.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,125.17
|
| Rate for Payer: Priority Health Medicare |
$326.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$900.14
|
| Rate for Payer: Railroad Medicare Medicare |
$323.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,138.10
|
| Rate for Payer: UHC Core |
$1,079.91
|
| Rate for Payer: UHC Exchange |
$323.32
|
| Rate for Payer: UHC Medicaid |
$228.01
|
| Rate for Payer: UHC Medicare Advantage |
$323.32
|
| Rate for Payer: UHCCP Medicaid |
$228.01
|
| Rate for Payer: VA VA |
$323.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$969.98
|
|
|
HC GI INTRALUMINAL IMAGING ESOPHAGUS
|
Facility
|
OP
|
$1,251.04
|
|
|
Service Code
|
CPT 91111
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$220.56 |
| Max. Negotiated Rate |
$1,125.94 |
| Rate for Payer: Aetna Commercial |
$1,063.38
|
| Rate for Payer: Aetna Medicare |
$325.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$390.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$390.95
|
| Rate for Payer: BCBS Complete |
$231.57
|
| Rate for Payer: BCBS MAPPO |
$312.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,028.48
|
| Rate for Payer: BCN Commercial |
$1,028.48
|
| Rate for Payer: BCN Medicare Advantage |
$312.76
|
| Rate for Payer: Cash Price |
$1,000.83
|
| Rate for Payer: Cofinity Commercial |
$1,075.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.76
|
| Rate for Payer: Healthscope Commercial |
$1,125.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$938.28
|
| Rate for Payer: Mclaren Medicaid |
$220.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.40
|
| Rate for Payer: Meridian Medicaid |
$231.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$359.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$344.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,063.38
|
| Rate for Payer: Nomi Health Commercial |
$1,025.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$938.28
|
| Rate for Payer: PACE Senior Care Partners |
$297.12
|
| Rate for Payer: PACE SWMI |
$312.76
|
| Rate for Payer: PHP Commercial |
$1,063.38
|
| Rate for Payer: PHP Medicare Advantage |
$312.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,088.40
|
| Rate for Payer: Priority Health Medicare |
$315.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$870.72
|
| Rate for Payer: Railroad Medicare Medicare |
$312.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,100.92
|
| Rate for Payer: UHC Core |
$1,044.62
|
| Rate for Payer: UHC Exchange |
$312.76
|
| Rate for Payer: UHC Medicaid |
$220.56
|
| Rate for Payer: UHC Medicare Advantage |
$312.76
|
| Rate for Payer: UHCCP Medicaid |
$220.56
|
| Rate for Payer: VA VA |
$312.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$938.28
|
|
|
HC GI INTRALUMINAL IMAGING ESOPHAGUS
|
Facility
|
IP
|
$1,251.04
|
|
|
Service Code
|
CPT 91111
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$870.72 |
| Max. Negotiated Rate |
$1,125.94 |
| Rate for Payer: Aetna Commercial |
$1,063.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,033.23
|
| Rate for Payer: BCN Commercial |
$1,033.23
|
| Rate for Payer: Cash Price |
$1,000.83
|
| Rate for Payer: Cofinity Commercial |
$1,075.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.83
|
| Rate for Payer: Healthscope Commercial |
$1,125.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$938.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,063.38
|
| Rate for Payer: Nomi Health Commercial |
$1,025.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$938.28
|
| Rate for Payer: PHP Commercial |
$1,063.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,088.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$870.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,100.92
|
| Rate for Payer: UHC Core |
$1,044.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$938.28
|
|
|
HC GI INTRALUMINAL IMAGING ESOPH THROUGH ILEUM
|
Facility
|
IP
|
$1,376.14
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
75000008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$957.79 |
| Max. Negotiated Rate |
$1,238.53 |
| Rate for Payer: Aetna Commercial |
$1,169.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,136.55
|
| Rate for Payer: BCN Commercial |
$1,136.55
|
| Rate for Payer: Cash Price |
$1,100.91
|
| Rate for Payer: Cofinity Commercial |
$1,183.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,100.91
|
| Rate for Payer: Healthscope Commercial |
$1,238.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.72
|
| Rate for Payer: Nomi Health Commercial |
$1,128.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.11
|
| Rate for Payer: PHP Commercial |
$1,169.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,197.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$957.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.00
|
| Rate for Payer: UHC Core |
$1,149.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.11
|
|
|
HC GI INTRALUMINAL IMAGING ESOPH THROUGH ILEUM
|
Facility
|
OP
|
$1,376.14
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
75000008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$242.61 |
| Max. Negotiated Rate |
$1,238.53 |
| Rate for Payer: Aetna Commercial |
$1,169.72
|
| Rate for Payer: Aetna Medicare |
$357.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$430.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$430.04
|
| Rate for Payer: BCBS Complete |
$254.72
|
| Rate for Payer: BCBS MAPPO |
$344.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.32
|
| Rate for Payer: BCN Commercial |
$1,131.32
|
| Rate for Payer: BCN Medicare Advantage |
$344.04
|
| Rate for Payer: Cash Price |
$1,100.91
|
| Rate for Payer: Cofinity Commercial |
$1,183.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,100.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$1,238.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.11
|
| Rate for Payer: Mclaren Medicaid |
$242.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.24
|
| Rate for Payer: Meridian Medicaid |
$254.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$378.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,169.72
|
| Rate for Payer: Nomi Health Commercial |
$1,128.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.11
|
| Rate for Payer: PACE Senior Care Partners |
$326.83
|
| Rate for Payer: PACE SWMI |
$344.04
|
| Rate for Payer: PHP Commercial |
$1,169.72
|
| Rate for Payer: PHP Medicare Advantage |
$344.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,197.24
|
| Rate for Payer: Priority Health Medicare |
$347.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$957.79
|
| Rate for Payer: Railroad Medicare Medicare |
$344.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.00
|
| Rate for Payer: UHC Core |
$1,149.08
|
| Rate for Payer: UHC Exchange |
$344.04
|
| Rate for Payer: UHC Medicaid |
$242.61
|
| Rate for Payer: UHC Medicare Advantage |
$344.04
|
| Rate for Payer: UHCCP Medicaid |
$242.61
|
| Rate for Payer: VA VA |
$344.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.11
|
|
|
HC GI LONG TUBE PLACEMENT
|
Facility
|
OP
|
$1,302.04
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
36100193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.55 |
| Max. Negotiated Rate |
$1,171.84 |
| Rate for Payer: Aetna Commercial |
$1,106.73
|
| Rate for Payer: Aetna Medicare |
$338.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.89
|
| Rate for Payer: BCBS Complete |
$241.01
|
| Rate for Payer: BCBS MAPPO |
$325.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,070.41
|
| Rate for Payer: BCN Commercial |
$1,070.41
|
| Rate for Payer: BCN Medicare Advantage |
$325.51
|
| Rate for Payer: Cash Price |
$1,041.63
|
| Rate for Payer: Cofinity Commercial |
$1,119.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,041.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.51
|
| Rate for Payer: Healthscope Commercial |
$1,171.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.53
|
| Rate for Payer: Mclaren Medicaid |
$229.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.79
|
| Rate for Payer: Meridian Medicaid |
$241.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$358.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.73
|
| Rate for Payer: Nomi Health Commercial |
$1,067.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$976.53
|
| Rate for Payer: PACE Senior Care Partners |
$309.23
|
| Rate for Payer: PACE SWMI |
$325.51
|
| Rate for Payer: PHP Commercial |
$1,106.73
|
| Rate for Payer: PHP Medicare Advantage |
$325.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,132.77
|
| Rate for Payer: Priority Health Medicare |
$328.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$906.22
|
| Rate for Payer: Railroad Medicare Medicare |
$325.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,145.80
|
| Rate for Payer: UHC Core |
$1,087.20
|
| Rate for Payer: UHC Exchange |
$325.51
|
| Rate for Payer: UHC Medicaid |
$229.55
|
| Rate for Payer: UHC Medicare Advantage |
$325.51
|
| Rate for Payer: UHCCP Medicaid |
$229.55
|
| Rate for Payer: VA VA |
$325.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.53
|
|
|
HC GI LONG TUBE PLACEMENT
|
Facility
|
IP
|
$1,302.04
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
36100193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$906.22 |
| Max. Negotiated Rate |
$1,171.84 |
| Rate for Payer: Aetna Commercial |
$1,106.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,075.35
|
| Rate for Payer: BCN Commercial |
$1,075.35
|
| Rate for Payer: Cash Price |
$1,041.63
|
| Rate for Payer: Cofinity Commercial |
$1,119.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,041.63
|
| Rate for Payer: Healthscope Commercial |
$1,171.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.73
|
| Rate for Payer: Nomi Health Commercial |
$1,067.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$976.53
|
| Rate for Payer: PHP Commercial |
$1,106.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,132.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$906.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,145.80
|
| Rate for Payer: UHC Core |
$1,087.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.53
|
|
|
HC GI OSTOMY OBSTRUCT REMOVL
|
Facility
|
IP
|
$905.11
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
36100232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$629.96 |
| Max. Negotiated Rate |
$814.60 |
| Rate for Payer: Aetna Commercial |
$769.34
|
| Rate for Payer: BCBS Trust/PPO |
$747.53
|
| Rate for Payer: BCN Commercial |
$747.53
|
| Rate for Payer: Cash Price |
$724.09
|
| Rate for Payer: Cofinity Commercial |
$778.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.09
|
| Rate for Payer: Healthscope Commercial |
$814.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$678.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$769.34
|
| Rate for Payer: Nomi Health Commercial |
$742.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$678.83
|
| Rate for Payer: PHP Commercial |
$769.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$787.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$629.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.50
|
| Rate for Payer: UHC Core |
$755.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$678.83
|
|
|
HC GI OSTOMY OBSTRUCT REMOVL
|
Facility
|
OP
|
$905.11
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
36100232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.57 |
| Max. Negotiated Rate |
$814.60 |
| Rate for Payer: Aetna Commercial |
$769.34
|
| Rate for Payer: Aetna Medicare |
$235.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$282.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$282.85
|
| Rate for Payer: BCBS Complete |
$167.54
|
| Rate for Payer: BCBS MAPPO |
$226.28
|
| Rate for Payer: BCBS Trust/PPO |
$744.09
|
| Rate for Payer: BCN Commercial |
$744.09
|
| Rate for Payer: BCN Medicare Advantage |
$226.28
|
| Rate for Payer: Cash Price |
$724.09
|
| Rate for Payer: Cofinity Commercial |
$778.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.28
|
| Rate for Payer: Healthscope Commercial |
$814.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$678.83
|
| Rate for Payer: Mclaren Medicaid |
$159.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.59
|
| Rate for Payer: Meridian Medicaid |
$167.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$248.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$769.34
|
| Rate for Payer: Nomi Health Commercial |
$742.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$678.83
|
| Rate for Payer: PACE Senior Care Partners |
$214.96
|
| Rate for Payer: PACE SWMI |
$226.28
|
| Rate for Payer: PHP Commercial |
$769.34
|
| Rate for Payer: PHP Medicare Advantage |
$226.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$787.45
|
| Rate for Payer: Priority Health Medicare |
$228.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$629.96
|
| Rate for Payer: Railroad Medicare Medicare |
$226.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.50
|
| Rate for Payer: UHC Core |
$755.77
|
| Rate for Payer: UHC Exchange |
$226.28
|
| Rate for Payer: UHC Medicaid |
$159.57
|
| Rate for Payer: UHC Medicare Advantage |
$226.28
|
| Rate for Payer: UHCCP Medicaid |
$159.57
|
| Rate for Payer: VA VA |
$226.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$678.83
|
|
|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
OP
|
$733.08
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$129.24 |
| Max. Negotiated Rate |
$659.77 |
| Rate for Payer: Aetna Commercial |
$623.12
|
| Rate for Payer: Aetna Medicare |
$190.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$229.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$229.09
|
| Rate for Payer: BCBS Complete |
$135.69
|
| Rate for Payer: BCBS MAPPO |
$183.27
|
| Rate for Payer: BCBS Trust/PPO |
$602.67
|
| Rate for Payer: BCN Commercial |
$602.67
|
| Rate for Payer: BCN Medicare Advantage |
$183.27
|
| Rate for Payer: Cash Price |
$586.46
|
| Rate for Payer: Cofinity Commercial |
$630.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.27
|
| Rate for Payer: Healthscope Commercial |
$659.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$549.81
|
| Rate for Payer: Mclaren Medicaid |
$129.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.43
|
| Rate for Payer: Meridian Medicaid |
$135.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$201.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.12
|
| Rate for Payer: Nomi Health Commercial |
$601.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$549.81
|
| Rate for Payer: PACE Senior Care Partners |
$174.11
|
| Rate for Payer: PACE SWMI |
$183.27
|
| Rate for Payer: PHP Commercial |
$623.12
|
| Rate for Payer: PHP Medicare Advantage |
$183.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$637.78
|
| Rate for Payer: Priority Health Medicare |
$185.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$510.22
|
| Rate for Payer: Railroad Medicare Medicare |
$183.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.11
|
| Rate for Payer: UHC Core |
$612.12
|
| Rate for Payer: UHC Exchange |
$183.27
|
| Rate for Payer: UHC Medicaid |
$129.24
|
| Rate for Payer: UHC Medicare Advantage |
$183.27
|
| Rate for Payer: UHCCP Medicaid |
$129.24
|
| Rate for Payer: VA VA |
$183.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$549.81
|
|
|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
IP
|
$733.08
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$510.22 |
| Max. Negotiated Rate |
$659.77 |
| Rate for Payer: Aetna Commercial |
$623.12
|
| Rate for Payer: BCBS Trust/PPO |
$605.45
|
| Rate for Payer: BCN Commercial |
$605.45
|
| Rate for Payer: Cash Price |
$586.46
|
| Rate for Payer: Cofinity Commercial |
$630.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.46
|
| Rate for Payer: Healthscope Commercial |
$659.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$549.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.12
|
| Rate for Payer: Nomi Health Commercial |
$601.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$549.81
|
| Rate for Payer: PHP Commercial |
$623.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$637.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$510.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.11
|
| Rate for Payer: UHC Core |
$612.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$549.81
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
IP
|
$905.11
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$629.96 |
| Max. Negotiated Rate |
$814.60 |
| Rate for Payer: Aetna Commercial |
$769.34
|
| Rate for Payer: BCBS Trust/PPO |
$747.53
|
| Rate for Payer: BCN Commercial |
$747.53
|
| Rate for Payer: Cash Price |
$724.09
|
| Rate for Payer: Cofinity Commercial |
$778.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.09
|
| Rate for Payer: Healthscope Commercial |
$814.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$678.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$769.34
|
| Rate for Payer: Nomi Health Commercial |
$742.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$678.83
|
| Rate for Payer: PHP Commercial |
$769.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$787.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$629.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.50
|
| Rate for Payer: UHC Core |
$755.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$678.83
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
OP
|
$905.11
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.57 |
| Max. Negotiated Rate |
$814.60 |
| Rate for Payer: Aetna Commercial |
$769.34
|
| Rate for Payer: Aetna Medicare |
$235.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$282.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$282.85
|
| Rate for Payer: BCBS Complete |
$167.54
|
| Rate for Payer: BCBS MAPPO |
$226.28
|
| Rate for Payer: BCBS Trust/PPO |
$744.09
|
| Rate for Payer: BCN Commercial |
$744.09
|
| Rate for Payer: BCN Medicare Advantage |
$226.28
|
| Rate for Payer: Cash Price |
$724.09
|
| Rate for Payer: Cofinity Commercial |
$778.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.28
|
| Rate for Payer: Healthscope Commercial |
$814.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$678.83
|
| Rate for Payer: Mclaren Medicaid |
$159.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.59
|
| Rate for Payer: Meridian Medicaid |
$167.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$248.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$769.34
|
| Rate for Payer: Nomi Health Commercial |
$742.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$678.83
|
| Rate for Payer: PACE Senior Care Partners |
$214.96
|
| Rate for Payer: PACE SWMI |
$226.28
|
| Rate for Payer: PHP Commercial |
$769.34
|
| Rate for Payer: PHP Medicare Advantage |
$226.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$787.45
|
| Rate for Payer: Priority Health Medicare |
$228.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$629.96
|
| Rate for Payer: Railroad Medicare Medicare |
$226.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.50
|
| Rate for Payer: UHC Core |
$755.77
|
| Rate for Payer: UHC Exchange |
$226.28
|
| Rate for Payer: UHC Medicaid |
$159.57
|
| Rate for Payer: UHC Medicare Advantage |
$226.28
|
| Rate for Payer: UHCCP Medicaid |
$159.57
|
| Rate for Payer: VA VA |
$226.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$678.83
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
IP
|
$931.73
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$648.48 |
| Max. Negotiated Rate |
$838.56 |
| Rate for Payer: Aetna Commercial |
$791.97
|
| Rate for Payer: BCBS Trust/PPO |
$769.52
|
| Rate for Payer: BCN Commercial |
$769.52
|
| Rate for Payer: Cash Price |
$745.38
|
| Rate for Payer: Cofinity Commercial |
$801.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.38
|
| Rate for Payer: Healthscope Commercial |
$838.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$698.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.97
|
| Rate for Payer: Nomi Health Commercial |
$764.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$698.80
|
| Rate for Payer: PHP Commercial |
$791.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$810.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$648.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$819.92
|
| Rate for Payer: UHC Core |
$777.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$698.80
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
OP
|
$931.73
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.26 |
| Max. Negotiated Rate |
$838.56 |
| Rate for Payer: Aetna Commercial |
$791.97
|
| Rate for Payer: Aetna Medicare |
$242.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$291.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$291.17
|
| Rate for Payer: BCBS Complete |
$172.46
|
| Rate for Payer: BCBS MAPPO |
$232.93
|
| Rate for Payer: BCBS Trust/PPO |
$765.98
|
| Rate for Payer: BCN Commercial |
$765.98
|
| Rate for Payer: BCN Medicare Advantage |
$232.93
|
| Rate for Payer: Cash Price |
$745.38
|
| Rate for Payer: Cofinity Commercial |
$801.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$745.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.93
|
| Rate for Payer: Healthscope Commercial |
$838.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$698.80
|
| Rate for Payer: Mclaren Medicaid |
$164.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.58
|
| Rate for Payer: Meridian Medicaid |
$172.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$256.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.97
|
| Rate for Payer: Nomi Health Commercial |
$764.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$698.80
|
| Rate for Payer: PACE Senior Care Partners |
$221.29
|
| Rate for Payer: PACE SWMI |
$232.93
|
| Rate for Payer: PHP Commercial |
$791.97
|
| Rate for Payer: PHP Medicare Advantage |
$232.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$810.61
|
| Rate for Payer: Priority Health Medicare |
$235.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$648.48
|
| Rate for Payer: Railroad Medicare Medicare |
$232.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$819.92
|
| Rate for Payer: UHC Core |
$777.99
|
| Rate for Payer: UHC Exchange |
$232.93
|
| Rate for Payer: UHC Medicaid |
$164.26
|
| Rate for Payer: UHC Medicare Advantage |
$232.93
|
| Rate for Payer: UHCCP Medicaid |
$164.26
|
| Rate for Payer: VA VA |
$232.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$698.80
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
OP
|
$959.13
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.09 |
| Max. Negotiated Rate |
$863.22 |
| Rate for Payer: Aetna Commercial |
$815.26
|
| Rate for Payer: Aetna Medicare |
$249.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$299.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$299.73
|
| Rate for Payer: BCBS Complete |
$177.53
|
| Rate for Payer: BCBS MAPPO |
$239.78
|
| Rate for Payer: BCBS Trust/PPO |
$788.50
|
| Rate for Payer: BCN Commercial |
$788.50
|
| Rate for Payer: BCN Medicare Advantage |
$239.78
|
| Rate for Payer: Cash Price |
$767.30
|
| Rate for Payer: Cofinity Commercial |
$824.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$767.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.78
|
| Rate for Payer: Healthscope Commercial |
$863.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$719.35
|
| Rate for Payer: Mclaren Medicaid |
$169.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.77
|
| Rate for Payer: Meridian Medicaid |
$177.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$263.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$815.26
|
| Rate for Payer: Nomi Health Commercial |
$786.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$719.35
|
| Rate for Payer: PACE Senior Care Partners |
$227.79
|
| Rate for Payer: PACE SWMI |
$239.78
|
| Rate for Payer: PHP Commercial |
$815.26
|
| Rate for Payer: PHP Medicare Advantage |
$239.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$834.44
|
| Rate for Payer: Priority Health Medicare |
$242.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$667.55
|
| Rate for Payer: Railroad Medicare Medicare |
$239.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$844.03
|
| Rate for Payer: UHC Core |
$800.87
|
| Rate for Payer: UHC Exchange |
$239.78
|
| Rate for Payer: UHC Medicaid |
$169.09
|
| Rate for Payer: UHC Medicare Advantage |
$239.78
|
| Rate for Payer: UHCCP Medicaid |
$169.09
|
| Rate for Payer: VA VA |
$239.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$719.35
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
IP
|
$959.13
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$667.55 |
| Max. Negotiated Rate |
$863.22 |
| Rate for Payer: Aetna Commercial |
$815.26
|
| Rate for Payer: BCBS Trust/PPO |
$792.15
|
| Rate for Payer: BCN Commercial |
$792.15
|
| Rate for Payer: Cash Price |
$767.30
|
| Rate for Payer: Cofinity Commercial |
$824.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$767.30
|
| Rate for Payer: Healthscope Commercial |
$863.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$719.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$815.26
|
| Rate for Payer: Nomi Health Commercial |
$786.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$719.35
|
| Rate for Payer: PHP Commercial |
$815.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$834.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$667.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$844.03
|
| Rate for Payer: UHC Core |
$800.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$719.35
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
IP
|
$1,251.04
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$870.72 |
| Max. Negotiated Rate |
$1,125.94 |
| Rate for Payer: Aetna Commercial |
$1,063.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,033.23
|
| Rate for Payer: BCN Commercial |
$1,033.23
|
| Rate for Payer: Cash Price |
$1,000.83
|
| Rate for Payer: Cofinity Commercial |
$1,075.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,000.83
|
| Rate for Payer: Healthscope Commercial |
$1,125.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$938.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,063.38
|
| Rate for Payer: Nomi Health Commercial |
$1,025.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$938.28
|
| Rate for Payer: PHP Commercial |
$1,063.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,088.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$870.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,100.92
|
| Rate for Payer: UHC Core |
$1,044.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$938.28
|
|
