|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$0.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.68
|
| Rate for Payer: BCN Medicare Advantage |
$0.54
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.54
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: PACE Senior Care Partners |
$0.51
|
| Rate for Payer: PACE SWMI |
$0.54
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: PHP Medicare Advantage |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1.88
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.45
|
| Rate for Payer: Railroad Medicare Medicare |
$0.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.90
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.54
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHC Medicare Advantage |
$0.54
|
| Rate for Payer: VA VA |
$0.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.76
|
| Rate for Payer: BCN Commercial |
$1.67
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.90
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$53.29
|
| Rate for Payer: BCN Commercial |
$50.45
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health HMO/PPO |
$56.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna Medicare |
$16.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.40
|
| Rate for Payer: BCBS Complete |
$26.11
|
| Rate for Payer: BCBS MAPPO |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$53.67
|
| Rate for Payer: BCN Commercial |
$50.76
|
| Rate for Payer: BCN Medicare Advantage |
$16.32
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: PACE Senior Care Partners |
$15.50
|
| Rate for Payer: PACE SWMI |
$16.32
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: PHP Medicare Advantage |
$16.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health HMO/PPO |
$56.79
|
| Rate for Payer: Priority Health Medicare |
$16.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.74
|
| Rate for Payer: Railroad Medicare Medicare |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.32
|
| Rate for Payer: UHC Exchange |
$16.32
|
| Rate for Payer: UHC Medicare Advantage |
$16.32
|
| Rate for Payer: VA VA |
$16.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.24 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$24.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.26
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS MAPPO |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$76.98
|
| Rate for Payer: BCN Commercial |
$72.81
|
| Rate for Payer: BCN Medicare Advantage |
$23.41
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PACE Senior Care Partners |
$22.24
|
| Rate for Payer: PACE SWMI |
$23.41
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Medicare Advantage |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.74
|
| Rate for Payer: Railroad Medicare Medicare |
$23.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.41
|
| Rate for Payer: UHC Exchange |
$23.41
|
| Rate for Payer: UHC Medicare Advantage |
$23.41
|
| Rate for Payer: VA VA |
$23.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: BCBS Trust/PPO |
$76.44
|
| Rate for Payer: BCN Commercial |
$72.36
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
IP
|
$141.92
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$127.73 |
| Rate for Payer: Aetna Commercial |
$120.63
|
| Rate for Payer: BCBS Trust/PPO |
$115.85
|
| Rate for Payer: BCN Commercial |
$109.68
|
| Rate for Payer: Cash Price |
$113.54
|
| Rate for Payer: Cofinity Commercial |
$122.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.54
|
| Rate for Payer: Healthscope Commercial |
$127.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.63
|
| Rate for Payer: Nomi Health Commercial |
$116.37
|
| Rate for Payer: PHP Commercial |
$120.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.25
|
| Rate for Payer: Priority Health HMO/PPO |
$123.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.89
|
| Rate for Payer: UHC Core |
$118.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.44
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
OP
|
$141.92
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$33.71 |
| Max. Negotiated Rate |
$127.73 |
| Rate for Payer: Aetna Commercial |
$120.63
|
| Rate for Payer: Aetna Medicare |
$36.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.35
|
| Rate for Payer: BCBS Complete |
$56.77
|
| Rate for Payer: BCBS MAPPO |
$35.48
|
| Rate for Payer: BCBS Trust/PPO |
$116.67
|
| Rate for Payer: BCN Commercial |
$110.34
|
| Rate for Payer: BCN Medicare Advantage |
$35.48
|
| Rate for Payer: Cash Price |
$113.54
|
| Rate for Payer: Cofinity Commercial |
$122.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.48
|
| Rate for Payer: Healthscope Commercial |
$127.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.63
|
| Rate for Payer: Nomi Health Commercial |
$116.37
|
| Rate for Payer: PACE Senior Care Partners |
$33.71
|
| Rate for Payer: PACE SWMI |
$35.48
|
| Rate for Payer: PHP Commercial |
$120.63
|
| Rate for Payer: PHP Medicare Advantage |
$35.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.25
|
| Rate for Payer: Priority Health HMO/PPO |
$123.47
|
| Rate for Payer: Priority Health Medicare |
$35.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.09
|
| Rate for Payer: Railroad Medicare Medicare |
$35.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.89
|
| Rate for Payer: UHC Core |
$118.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.48
|
| Rate for Payer: UHC Exchange |
$35.48
|
| Rate for Payer: UHC Medicare Advantage |
$35.48
|
| Rate for Payer: VA VA |
$35.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.44
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
IP
|
$4.16
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.40
|
| Rate for Payer: BCN Commercial |
$3.21
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health HMO/PPO |
$3.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.66
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.12
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.30
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS MAPPO |
$1.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.42
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: BCN Medicare Advantage |
$1.04
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.04
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: PACE Senior Care Partners |
$0.99
|
| Rate for Payer: PACE SWMI |
$1.04
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: PHP Medicare Advantage |
$1.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health HMO/PPO |
$3.62
|
| Rate for Payer: Priority Health Medicare |
$1.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.66
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.04
|
| Rate for Payer: UHC Exchange |
$1.04
|
| Rate for Payer: UHC Medicare Advantage |
$1.04
|
| Rate for Payer: VA VA |
$1.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.12
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
OP
|
$239.75
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$215.78 |
| Rate for Payer: Aetna Commercial |
$203.79
|
| Rate for Payer: Aetna Medicare |
$62.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.92
|
| Rate for Payer: BCBS Complete |
$118.78
|
| Rate for Payer: BCBS MAPPO |
$59.94
|
| Rate for Payer: BCBS Trust/PPO |
$197.10
|
| Rate for Payer: BCN Commercial |
$186.41
|
| Rate for Payer: BCN Medicare Advantage |
$59.94
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$206.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.94
|
| Rate for Payer: Healthscope Commercial |
$215.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.81
|
| Rate for Payer: Mclaren Medicaid |
$113.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.93
|
| Rate for Payer: Meridian Medicaid |
$118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.79
|
| Rate for Payer: Nomi Health Commercial |
$196.59
|
| Rate for Payer: PACE Senior Care Partners |
$56.94
|
| Rate for Payer: PACE SWMI |
$59.94
|
| Rate for Payer: PHP Commercial |
$203.79
|
| Rate for Payer: PHP Medicare Advantage |
$59.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.84
|
| Rate for Payer: Priority Health HMO/PPO |
$208.58
|
| Rate for Payer: Priority Health Medicare |
$60.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.63
|
| Rate for Payer: Railroad Medicare Medicare |
$59.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.98
|
| Rate for Payer: UHC Core |
$200.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.94
|
| Rate for Payer: UHC Exchange |
$59.94
|
| Rate for Payer: UHC Medicare Advantage |
$59.94
|
| Rate for Payer: UHCCP Medicaid |
$113.12
|
| Rate for Payer: VA VA |
$59.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.81
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
IP
|
$239.75
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$155.84 |
| Max. Negotiated Rate |
$215.78 |
| Rate for Payer: Aetna Commercial |
$203.79
|
| Rate for Payer: BCBS Trust/PPO |
$195.71
|
| Rate for Payer: BCN Commercial |
$185.28
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$206.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.80
|
| Rate for Payer: Healthscope Commercial |
$215.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.79
|
| Rate for Payer: Nomi Health Commercial |
$196.59
|
| Rate for Payer: PHP Commercial |
$203.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.84
|
| Rate for Payer: Priority Health HMO/PPO |
$208.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.98
|
| Rate for Payer: UHC Core |
$200.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.81
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
IP
|
$354.02
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$230.11 |
| Max. Negotiated Rate |
$318.62 |
| Rate for Payer: Aetna Commercial |
$300.92
|
| Rate for Payer: BCBS Trust/PPO |
$288.99
|
| Rate for Payer: BCN Commercial |
$273.59
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cofinity Commercial |
$304.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.22
|
| Rate for Payer: Healthscope Commercial |
$318.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.92
|
| Rate for Payer: Nomi Health Commercial |
$290.30
|
| Rate for Payer: PHP Commercial |
$300.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.11
|
| Rate for Payer: Priority Health HMO/PPO |
$308.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.54
|
| Rate for Payer: UHC Core |
$295.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.51
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
OP
|
$354.02
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.08 |
| Max. Negotiated Rate |
$318.62 |
| Rate for Payer: Aetna Commercial |
$300.92
|
| Rate for Payer: Aetna Medicare |
$92.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.63
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$88.50
|
| Rate for Payer: BCBS Trust/PPO |
$291.04
|
| Rate for Payer: BCN Commercial |
$275.25
|
| Rate for Payer: BCN Medicare Advantage |
$88.50
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cofinity Commercial |
$304.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.50
|
| Rate for Payer: Healthscope Commercial |
$318.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.51
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.93
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.92
|
| Rate for Payer: Nomi Health Commercial |
$290.30
|
| Rate for Payer: PACE Senior Care Partners |
$84.08
|
| Rate for Payer: PACE SWMI |
$88.50
|
| Rate for Payer: PHP Commercial |
$300.92
|
| Rate for Payer: PHP Medicare Advantage |
$88.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.11
|
| Rate for Payer: Priority Health HMO/PPO |
$308.00
|
| Rate for Payer: Priority Health Medicare |
$89.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.19
|
| Rate for Payer: Railroad Medicare Medicare |
$88.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.54
|
| Rate for Payer: UHC Core |
$295.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.50
|
| Rate for Payer: UHC Exchange |
$88.50
|
| Rate for Payer: UHC Medicare Advantage |
$88.50
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$88.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.51
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
OP
|
$390.42
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.72 |
| Max. Negotiated Rate |
$351.38 |
| Rate for Payer: Aetna Commercial |
$331.86
|
| Rate for Payer: Aetna Medicare |
$101.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.01
|
| Rate for Payer: BCBS Complete |
$156.17
|
| Rate for Payer: BCBS MAPPO |
$97.61
|
| Rate for Payer: BCBS Trust/PPO |
$320.96
|
| Rate for Payer: BCN Commercial |
$303.55
|
| Rate for Payer: BCN Medicare Advantage |
$97.61
|
| Rate for Payer: Cash Price |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$335.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.61
|
| Rate for Payer: Healthscope Commercial |
$351.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.86
|
| Rate for Payer: Nomi Health Commercial |
$320.14
|
| Rate for Payer: PACE Senior Care Partners |
$92.72
|
| Rate for Payer: PACE SWMI |
$97.61
|
| Rate for Payer: PHP Commercial |
$331.86
|
| Rate for Payer: PHP Medicare Advantage |
$97.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.77
|
| Rate for Payer: Priority Health HMO/PPO |
$339.67
|
| Rate for Payer: Priority Health Medicare |
$98.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.58
|
| Rate for Payer: Railroad Medicare Medicare |
$97.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.57
|
| Rate for Payer: UHC Core |
$326.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.61
|
| Rate for Payer: UHC Exchange |
$97.61
|
| Rate for Payer: UHC Medicare Advantage |
$97.61
|
| Rate for Payer: VA VA |
$97.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.81
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
IP
|
$390.42
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.77 |
| Max. Negotiated Rate |
$351.38 |
| Rate for Payer: Aetna Commercial |
$331.86
|
| Rate for Payer: BCBS Trust/PPO |
$318.70
|
| Rate for Payer: BCN Commercial |
$301.72
|
| Rate for Payer: Cash Price |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$335.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.34
|
| Rate for Payer: Healthscope Commercial |
$351.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.86
|
| Rate for Payer: Nomi Health Commercial |
$320.14
|
| Rate for Payer: PHP Commercial |
$331.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.77
|
| Rate for Payer: Priority Health HMO/PPO |
$339.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.57
|
| Rate for Payer: UHC Core |
$326.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.81
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
OP
|
$1,445.27
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$343.25 |
| Max. Negotiated Rate |
$1,300.74 |
| Rate for Payer: Aetna Commercial |
$1,228.48
|
| Rate for Payer: Aetna Medicare |
$375.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$451.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$451.65
|
| Rate for Payer: BCBS Complete |
$408.65
|
| Rate for Payer: BCBS MAPPO |
$361.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.16
|
| Rate for Payer: BCN Commercial |
$1,123.70
|
| Rate for Payer: BCN Medicare Advantage |
$361.32
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cofinity Commercial |
$1,242.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.32
|
| Rate for Payer: Healthscope Commercial |
$1,300.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,083.95
|
| Rate for Payer: Mclaren Medicaid |
$389.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$379.38
|
| Rate for Payer: Meridian Medicaid |
$408.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$415.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,228.48
|
| Rate for Payer: Nomi Health Commercial |
$1,185.12
|
| Rate for Payer: PACE Senior Care Partners |
$343.25
|
| Rate for Payer: PACE SWMI |
$361.32
|
| Rate for Payer: PHP Commercial |
$1,228.48
|
| Rate for Payer: PHP Medicare Advantage |
$361.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.43
|
| Rate for Payer: Priority Health HMO/PPO |
$1,257.38
|
| Rate for Payer: Priority Health Medicare |
$364.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$968.33
|
| Rate for Payer: Railroad Medicare Medicare |
$361.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,271.84
|
| Rate for Payer: UHC Core |
$1,206.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$361.32
|
| Rate for Payer: UHC Exchange |
$361.32
|
| Rate for Payer: UHC Medicare Advantage |
$361.32
|
| Rate for Payer: UHCCP Medicaid |
$389.17
|
| Rate for Payer: VA VA |
$361.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,083.95
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
IP
|
$1,445.27
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$939.43 |
| Max. Negotiated Rate |
$1,300.74 |
| Rate for Payer: Aetna Commercial |
$1,228.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.77
|
| Rate for Payer: BCN Commercial |
$1,116.90
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cofinity Commercial |
$1,242.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.22
|
| Rate for Payer: Healthscope Commercial |
$1,300.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,083.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,228.48
|
| Rate for Payer: Nomi Health Commercial |
$1,185.12
|
| Rate for Payer: PHP Commercial |
$1,228.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.43
|
| Rate for Payer: Priority Health HMO/PPO |
$1,257.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$968.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,271.84
|
| Rate for Payer: UHC Core |
$1,206.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,083.95
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
IP
|
$1,505.50
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$978.58 |
| Max. Negotiated Rate |
$1,354.95 |
| Rate for Payer: Aetna Commercial |
$1,279.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.94
|
| Rate for Payer: BCN Commercial |
$1,163.45
|
| Rate for Payer: Cash Price |
$1,204.40
|
| Rate for Payer: Cofinity Commercial |
$1,294.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.40
|
| Rate for Payer: Healthscope Commercial |
$1,354.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,129.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,279.67
|
| Rate for Payer: Nomi Health Commercial |
$1,234.51
|
| Rate for Payer: PHP Commercial |
$1,279.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.58
|
| Rate for Payer: Priority Health HMO/PPO |
$1,309.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,008.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,324.84
|
| Rate for Payer: UHC Core |
$1,257.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,129.12
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
OP
|
$1,505.50
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$290.52 |
| Max. Negotiated Rate |
$1,354.95 |
| Rate for Payer: Aetna Commercial |
$1,279.67
|
| Rate for Payer: Aetna Medicare |
$391.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$470.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$470.47
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$376.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,237.67
|
| Rate for Payer: BCN Commercial |
$1,170.53
|
| Rate for Payer: BCN Medicare Advantage |
$376.38
|
| Rate for Payer: Cash Price |
$1,204.40
|
| Rate for Payer: Cash Price |
$1,204.40
|
| Rate for Payer: Cofinity Commercial |
$1,294.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$376.38
|
| Rate for Payer: Healthscope Commercial |
$1,354.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,129.12
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$395.19
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$432.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,279.67
|
| Rate for Payer: Nomi Health Commercial |
$1,234.51
|
| Rate for Payer: PACE Senior Care Partners |
$357.56
|
| Rate for Payer: PACE SWMI |
$376.38
|
| Rate for Payer: PHP Commercial |
$1,279.67
|
| Rate for Payer: PHP Medicare Advantage |
$376.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.58
|
| Rate for Payer: Priority Health HMO/PPO |
$1,309.79
|
| Rate for Payer: Priority Health Medicare |
$380.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,008.68
|
| Rate for Payer: Railroad Medicare Medicare |
$376.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,324.84
|
| Rate for Payer: UHC Core |
$1,257.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$376.38
|
| Rate for Payer: UHC Exchange |
$376.38
|
| Rate for Payer: UHC Medicare Advantage |
$376.38
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$376.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,129.12
|
|
|
HC GASTRIN LEVEL
|
Facility
|
OP
|
$42.66
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$38.39 |
| Rate for Payer: Aetna Commercial |
$36.26
|
| Rate for Payer: Aetna Medicare |
$11.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.33
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$10.66
|
| Rate for Payer: BCBS Trust/PPO |
$35.07
|
| Rate for Payer: BCN Commercial |
$33.17
|
| Rate for Payer: BCN Medicare Advantage |
$10.66
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$36.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.66
|
| Rate for Payer: Healthscope Commercial |
$38.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.00
|
| Rate for Payer: Mclaren Medicaid |
$12.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.20
|
| Rate for Payer: Meridian Medicaid |
$13.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: Nomi Health Commercial |
$34.98
|
| Rate for Payer: PACE Senior Care Partners |
$10.13
|
| Rate for Payer: PACE SWMI |
$10.66
|
| Rate for Payer: PHP Commercial |
$36.26
|
| Rate for Payer: PHP Medicare Advantage |
$10.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health HMO/PPO |
$37.11
|
| Rate for Payer: Priority Health Medicare |
$10.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.58
|
| Rate for Payer: Railroad Medicare Medicare |
$10.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.54
|
| Rate for Payer: UHC Core |
$35.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.66
|
| Rate for Payer: UHC Exchange |
$10.66
|
| Rate for Payer: UHC Medicare Advantage |
$10.66
|
| Rate for Payer: UHCCP Medicaid |
$12.75
|
| Rate for Payer: VA VA |
$10.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.00
|
|
|
HC GASTRIN LEVEL
|
Facility
|
IP
|
$42.66
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.73 |
| Max. Negotiated Rate |
$38.39 |
| Rate for Payer: Aetna Commercial |
$36.26
|
| Rate for Payer: BCBS Trust/PPO |
$34.82
|
| Rate for Payer: BCN Commercial |
$32.97
|
| Rate for Payer: Cash Price |
$34.13
|
| Rate for Payer: Cofinity Commercial |
$36.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.13
|
| Rate for Payer: Healthscope Commercial |
$38.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.26
|
| Rate for Payer: Nomi Health Commercial |
$34.98
|
| Rate for Payer: PHP Commercial |
$36.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.73
|
| Rate for Payer: Priority Health HMO/PPO |
$37.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.54
|
| Rate for Payer: UHC Core |
$35.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.00
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
IP
|
$3.48
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: BCBS Trust/PPO |
$2.84
|
| Rate for Payer: BCN Commercial |
$2.69
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: Nomi Health Commercial |
$2.85
|
| Rate for Payer: PHP Commercial |
$2.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: Priority Health HMO/PPO |
$3.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.06
|
| Rate for Payer: UHC Core |
$2.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.61
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
OP
|
$3.48
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Medicare |
$0.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.09
|
| Rate for Payer: BCBS Complete |
$1.39
|
| Rate for Payer: BCBS MAPPO |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.86
|
| Rate for Payer: BCN Commercial |
$2.71
|
| Rate for Payer: BCN Medicare Advantage |
$0.87
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.87
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.96
|
| Rate for Payer: Nomi Health Commercial |
$2.85
|
| Rate for Payer: PACE Senior Care Partners |
$0.83
|
| Rate for Payer: PACE SWMI |
$0.87
|
| Rate for Payer: PHP Commercial |
$2.96
|
| Rate for Payer: PHP Medicare Advantage |
$0.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: Priority Health HMO/PPO |
$3.03
|
| Rate for Payer: Priority Health Medicare |
$0.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.33
|
| Rate for Payer: Railroad Medicare Medicare |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.06
|
| Rate for Payer: UHC Core |
$2.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Medicare Advantage |
$0.87
|
| Rate for Payer: VA VA |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.61
|
|
|
HC GASTROSCOPY
|
Facility
|
IP
|
$1,962.15
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,275.40 |
| Max. Negotiated Rate |
$1,765.93 |
| Rate for Payer: Aetna Commercial |
$1,667.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,601.70
|
| Rate for Payer: BCN Commercial |
$1,516.35
|
| Rate for Payer: Cash Price |
$1,569.72
|
| Rate for Payer: Cofinity Commercial |
$1,687.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,569.72
|
| Rate for Payer: Healthscope Commercial |
$1,765.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,471.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,667.83
|
| Rate for Payer: Nomi Health Commercial |
$1,608.96
|
| Rate for Payer: PHP Commercial |
$1,667.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,707.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,314.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,726.69
|
| Rate for Payer: UHC Core |
$1,638.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,471.61
|
|
