|
HC GI INTRALUMINAL IMAGING ESOPHAGUS
|
Facility
|
IP
|
$1,226.51
|
|
|
Service Code
|
CPT 91111
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$797.23 |
| Max. Negotiated Rate |
$1,103.86 |
| Rate for Payer: Aetna Commercial |
$1,042.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.20
|
| Rate for Payer: BCN Commercial |
$947.85
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cofinity Commercial |
$1,054.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$981.21
|
| Rate for Payer: Healthscope Commercial |
$1,103.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$919.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.53
|
| Rate for Payer: Nomi Health Commercial |
$1,005.74
|
| Rate for Payer: PHP Commercial |
$1,042.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1,067.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$821.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,079.33
|
| Rate for Payer: UHC Core |
$1,024.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$919.88
|
|
|
HC GI INTRALUMINAL IMAGING ESOPHAGUS
|
Facility
|
OP
|
$1,226.51
|
|
|
Service Code
|
CPT 91111
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$291.30 |
| Max. Negotiated Rate |
$1,103.86 |
| Rate for Payer: Aetna Commercial |
$1,042.53
|
| Rate for Payer: Aetna Medicare |
$318.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$383.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$383.28
|
| Rate for Payer: BCBS Complete |
$711.80
|
| Rate for Payer: BCBS MAPPO |
$306.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.31
|
| Rate for Payer: BCN Commercial |
$953.61
|
| Rate for Payer: BCN Medicare Advantage |
$306.63
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cofinity Commercial |
$1,054.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$981.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.63
|
| Rate for Payer: Healthscope Commercial |
$1,103.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$919.88
|
| Rate for Payer: Mclaren Medicaid |
$677.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.96
|
| Rate for Payer: Meridian Medicaid |
$711.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$352.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.53
|
| Rate for Payer: Nomi Health Commercial |
$1,005.74
|
| Rate for Payer: PACE Senior Care Partners |
$291.30
|
| Rate for Payer: PACE SWMI |
$306.63
|
| Rate for Payer: PHP Commercial |
$1,042.53
|
| Rate for Payer: PHP Medicare Advantage |
$306.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$677.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1,067.06
|
| Rate for Payer: Priority Health Medicare |
$309.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$306.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,079.33
|
| Rate for Payer: UHC Core |
$1,024.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$306.63
|
| Rate for Payer: UHC Exchange |
$306.63
|
| Rate for Payer: UHC Medicare Advantage |
$306.63
|
| Rate for Payer: UHCCP Medicaid |
$677.86
|
| Rate for Payer: VA VA |
$306.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$919.88
|
|
|
HC GI INTRALUMINAL IMAGING ESOPH THROUGH ILEUM
|
Facility
|
IP
|
$1,349.16
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
75000008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$876.95 |
| Max. Negotiated Rate |
$1,214.24 |
| Rate for Payer: Aetna Commercial |
$1,146.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.32
|
| Rate for Payer: BCN Commercial |
$1,042.63
|
| Rate for Payer: Cash Price |
$1,079.33
|
| Rate for Payer: Cofinity Commercial |
$1,160.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.33
|
| Rate for Payer: Healthscope Commercial |
$1,214.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,011.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,146.79
|
| Rate for Payer: Nomi Health Commercial |
$1,106.31
|
| Rate for Payer: PHP Commercial |
$1,146.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,173.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$903.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,187.26
|
| Rate for Payer: UHC Core |
$1,126.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,011.87
|
|
|
HC GI INTRALUMINAL IMAGING ESOPH THROUGH ILEUM
|
Facility
|
OP
|
$1,349.16
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
75000008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$320.43 |
| Max. Negotiated Rate |
$1,214.24 |
| Rate for Payer: Aetna Commercial |
$1,146.79
|
| Rate for Payer: Aetna Medicare |
$350.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$421.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$421.61
|
| Rate for Payer: BCBS Complete |
$711.80
|
| Rate for Payer: BCBS MAPPO |
$337.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,109.14
|
| Rate for Payer: BCN Commercial |
$1,048.97
|
| Rate for Payer: BCN Medicare Advantage |
$337.29
|
| Rate for Payer: Cash Price |
$1,079.33
|
| Rate for Payer: Cash Price |
$1,079.33
|
| Rate for Payer: Cofinity Commercial |
$1,160.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,079.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.29
|
| Rate for Payer: Healthscope Commercial |
$1,214.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,011.87
|
| Rate for Payer: Mclaren Medicaid |
$677.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.15
|
| Rate for Payer: Meridian Medicaid |
$711.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$387.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,146.79
|
| Rate for Payer: Nomi Health Commercial |
$1,106.31
|
| Rate for Payer: PACE Senior Care Partners |
$320.43
|
| Rate for Payer: PACE SWMI |
$337.29
|
| Rate for Payer: PHP Commercial |
$1,146.79
|
| Rate for Payer: PHP Medicare Advantage |
$337.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$677.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,173.77
|
| Rate for Payer: Priority Health Medicare |
$340.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$903.94
|
| Rate for Payer: Railroad Medicare Medicare |
$337.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,187.26
|
| Rate for Payer: UHC Core |
$1,126.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.29
|
| Rate for Payer: UHC Exchange |
$337.29
|
| Rate for Payer: UHC Medicare Advantage |
$337.29
|
| Rate for Payer: UHCCP Medicaid |
$677.86
|
| Rate for Payer: VA VA |
$337.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,011.87
|
|
|
HC GI LONG TUBE PLACEMENT
|
Facility
|
IP
|
$1,276.51
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
36100193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$829.73 |
| Max. Negotiated Rate |
$1,148.86 |
| Rate for Payer: Aetna Commercial |
$1,085.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.02
|
| Rate for Payer: BCN Commercial |
$986.49
|
| Rate for Payer: Cash Price |
$1,021.21
|
| Rate for Payer: Cofinity Commercial |
$1,097.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.21
|
| Rate for Payer: Healthscope Commercial |
$1,148.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.03
|
| Rate for Payer: Nomi Health Commercial |
$1,046.74
|
| Rate for Payer: PHP Commercial |
$1,085.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.73
|
| Rate for Payer: Priority Health HMO/PPO |
$1,110.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.33
|
| Rate for Payer: UHC Core |
$1,065.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.38
|
|
|
HC GI LONG TUBE PLACEMENT
|
Facility
|
OP
|
$1,276.51
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
36100193
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$303.17 |
| Max. Negotiated Rate |
$1,148.86 |
| Rate for Payer: Aetna Commercial |
$1,085.03
|
| Rate for Payer: Aetna Medicare |
$331.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$398.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$398.91
|
| Rate for Payer: BCBS Complete |
$711.80
|
| Rate for Payer: BCBS MAPPO |
$319.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.42
|
| Rate for Payer: BCN Commercial |
$992.49
|
| Rate for Payer: BCN Medicare Advantage |
$319.13
|
| Rate for Payer: Cash Price |
$1,021.21
|
| Rate for Payer: Cash Price |
$1,021.21
|
| Rate for Payer: Cofinity Commercial |
$1,097.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,021.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.13
|
| Rate for Payer: Healthscope Commercial |
$1,148.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$957.38
|
| Rate for Payer: Mclaren Medicaid |
$677.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.08
|
| Rate for Payer: Meridian Medicaid |
$711.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,085.03
|
| Rate for Payer: Nomi Health Commercial |
$1,046.74
|
| Rate for Payer: PACE Senior Care Partners |
$303.17
|
| Rate for Payer: PACE SWMI |
$319.13
|
| Rate for Payer: PHP Commercial |
$1,085.03
|
| Rate for Payer: PHP Medicare Advantage |
$319.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$677.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.73
|
| Rate for Payer: Priority Health HMO/PPO |
$1,110.56
|
| Rate for Payer: Priority Health Medicare |
$322.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.26
|
| Rate for Payer: Railroad Medicare Medicare |
$319.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.33
|
| Rate for Payer: UHC Core |
$1,065.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.13
|
| Rate for Payer: UHC Exchange |
$319.13
|
| Rate for Payer: UHC Medicare Advantage |
$319.13
|
| Rate for Payer: UHCCP Medicaid |
$677.86
|
| Rate for Payer: VA VA |
$319.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$957.38
|
|
|
HC GI OSTOMY OBSTRUCT REMOVL
|
Facility
|
OP
|
$887.36
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
36100232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$798.62 |
| Rate for Payer: Aetna Commercial |
$754.26
|
| Rate for Payer: Aetna Medicare |
$230.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$277.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$277.30
|
| Rate for Payer: BCBS Complete |
$711.80
|
| Rate for Payer: BCBS MAPPO |
$221.84
|
| Rate for Payer: BCBS Trust/PPO |
$729.50
|
| Rate for Payer: BCN Commercial |
$689.92
|
| Rate for Payer: BCN Medicare Advantage |
$221.84
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$763.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$798.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.52
|
| Rate for Payer: Mclaren Medicaid |
$677.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.93
|
| Rate for Payer: Meridian Medicaid |
$711.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$255.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: Nomi Health Commercial |
$727.64
|
| Rate for Payer: PACE Senior Care Partners |
$210.75
|
| Rate for Payer: PACE SWMI |
$221.84
|
| Rate for Payer: PHP Commercial |
$754.26
|
| Rate for Payer: PHP Medicare Advantage |
$221.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$677.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health HMO/PPO |
$772.00
|
| Rate for Payer: Priority Health Medicare |
$224.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.53
|
| Rate for Payer: Railroad Medicare Medicare |
$221.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.88
|
| Rate for Payer: UHC Core |
$740.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.84
|
| Rate for Payer: UHC Exchange |
$221.84
|
| Rate for Payer: UHC Medicare Advantage |
$221.84
|
| Rate for Payer: UHCCP Medicaid |
$677.86
|
| Rate for Payer: VA VA |
$221.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.52
|
|
|
HC GI OSTOMY OBSTRUCT REMOVL
|
Facility
|
IP
|
$887.36
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
36100232
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.78 |
| Max. Negotiated Rate |
$798.62 |
| Rate for Payer: Aetna Commercial |
$754.26
|
| Rate for Payer: BCBS Trust/PPO |
$724.35
|
| Rate for Payer: BCN Commercial |
$685.75
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$763.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Healthscope Commercial |
$798.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: Nomi Health Commercial |
$727.64
|
| Rate for Payer: PHP Commercial |
$754.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health HMO/PPO |
$772.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.88
|
| Rate for Payer: UHC Core |
$740.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.52
|
|
|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
OP
|
$718.71
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$170.69 |
| Max. Negotiated Rate |
$646.84 |
| Rate for Payer: Aetna Commercial |
$610.90
|
| Rate for Payer: Aetna Medicare |
$186.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$224.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$224.60
|
| Rate for Payer: BCBS Complete |
$316.42
|
| Rate for Payer: BCBS MAPPO |
$179.68
|
| Rate for Payer: BCBS Trust/PPO |
$590.85
|
| Rate for Payer: BCN Commercial |
$558.80
|
| Rate for Payer: BCN Medicare Advantage |
$179.68
|
| Rate for Payer: Cash Price |
$574.97
|
| Rate for Payer: Cash Price |
$574.97
|
| Rate for Payer: Cofinity Commercial |
$618.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.68
|
| Rate for Payer: Healthscope Commercial |
$646.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$539.03
|
| Rate for Payer: Mclaren Medicaid |
$301.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.66
|
| Rate for Payer: Meridian Medicaid |
$316.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.90
|
| Rate for Payer: Nomi Health Commercial |
$589.34
|
| Rate for Payer: PACE Senior Care Partners |
$170.69
|
| Rate for Payer: PACE SWMI |
$179.68
|
| Rate for Payer: PHP Commercial |
$610.90
|
| Rate for Payer: PHP Medicare Advantage |
$179.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$301.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.16
|
| Rate for Payer: Priority Health HMO/PPO |
$625.28
|
| Rate for Payer: Priority Health Medicare |
$181.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$481.54
|
| Rate for Payer: Railroad Medicare Medicare |
$179.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$632.46
|
| Rate for Payer: UHC Core |
$600.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.68
|
| Rate for Payer: UHC Exchange |
$179.68
|
| Rate for Payer: UHC Medicare Advantage |
$179.68
|
| Rate for Payer: UHCCP Medicaid |
$301.33
|
| Rate for Payer: VA VA |
$179.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$539.03
|
|
|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
IP
|
$718.71
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$467.16 |
| Max. Negotiated Rate |
$646.84 |
| Rate for Payer: Aetna Commercial |
$610.90
|
| Rate for Payer: BCBS Trust/PPO |
$586.68
|
| Rate for Payer: BCN Commercial |
$555.42
|
| Rate for Payer: Cash Price |
$574.97
|
| Rate for Payer: Cofinity Commercial |
$618.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.97
|
| Rate for Payer: Healthscope Commercial |
$646.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$539.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.90
|
| Rate for Payer: Nomi Health Commercial |
$589.34
|
| Rate for Payer: PHP Commercial |
$610.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.16
|
| Rate for Payer: Priority Health HMO/PPO |
$625.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$481.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$632.46
|
| Rate for Payer: UHC Core |
$600.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$539.03
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
IP
|
$887.36
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.78 |
| Max. Negotiated Rate |
$798.62 |
| Rate for Payer: Aetna Commercial |
$754.26
|
| Rate for Payer: BCBS Trust/PPO |
$724.35
|
| Rate for Payer: BCN Commercial |
$685.75
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$763.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Healthscope Commercial |
$798.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: Nomi Health Commercial |
$727.64
|
| Rate for Payer: PHP Commercial |
$754.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health HMO/PPO |
$772.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.88
|
| Rate for Payer: UHC Core |
$740.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.52
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
OP
|
$887.36
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$798.62 |
| Rate for Payer: Aetna Commercial |
$754.26
|
| Rate for Payer: Aetna Medicare |
$230.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$277.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$277.30
|
| Rate for Payer: BCBS Complete |
$711.80
|
| Rate for Payer: BCBS MAPPO |
$221.84
|
| Rate for Payer: BCBS Trust/PPO |
$729.50
|
| Rate for Payer: BCN Commercial |
$689.92
|
| Rate for Payer: BCN Medicare Advantage |
$221.84
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$763.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$798.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.52
|
| Rate for Payer: Mclaren Medicaid |
$677.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.93
|
| Rate for Payer: Meridian Medicaid |
$711.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$255.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: Nomi Health Commercial |
$727.64
|
| Rate for Payer: PACE Senior Care Partners |
$210.75
|
| Rate for Payer: PACE SWMI |
$221.84
|
| Rate for Payer: PHP Commercial |
$754.26
|
| Rate for Payer: PHP Medicare Advantage |
$221.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$677.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health HMO/PPO |
$772.00
|
| Rate for Payer: Priority Health Medicare |
$224.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.53
|
| Rate for Payer: Railroad Medicare Medicare |
$221.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.88
|
| Rate for Payer: UHC Core |
$740.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.84
|
| Rate for Payer: UHC Exchange |
$221.84
|
| Rate for Payer: UHC Medicare Advantage |
$221.84
|
| Rate for Payer: UHCCP Medicaid |
$677.86
|
| Rate for Payer: VA VA |
$221.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.52
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
IP
|
$887.36
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.78 |
| Max. Negotiated Rate |
$798.62 |
| Rate for Payer: Aetna Commercial |
$754.26
|
| Rate for Payer: BCBS Trust/PPO |
$724.35
|
| Rate for Payer: BCN Commercial |
$685.75
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$763.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Healthscope Commercial |
$798.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: Nomi Health Commercial |
$727.64
|
| Rate for Payer: PHP Commercial |
$754.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health HMO/PPO |
$772.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.88
|
| Rate for Payer: UHC Core |
$740.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.52
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
OP
|
$887.36
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$798.62 |
| Rate for Payer: Aetna Commercial |
$754.26
|
| Rate for Payer: Aetna Medicare |
$230.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$277.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$277.30
|
| Rate for Payer: BCBS Complete |
$711.80
|
| Rate for Payer: BCBS MAPPO |
$221.84
|
| Rate for Payer: BCBS Trust/PPO |
$729.50
|
| Rate for Payer: BCN Commercial |
$689.92
|
| Rate for Payer: BCN Medicare Advantage |
$221.84
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$763.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$798.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.52
|
| Rate for Payer: Mclaren Medicaid |
$677.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.93
|
| Rate for Payer: Meridian Medicaid |
$711.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$255.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: Nomi Health Commercial |
$727.64
|
| Rate for Payer: PACE Senior Care Partners |
$210.75
|
| Rate for Payer: PACE SWMI |
$221.84
|
| Rate for Payer: PHP Commercial |
$754.26
|
| Rate for Payer: PHP Medicare Advantage |
$221.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$677.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health HMO/PPO |
$772.00
|
| Rate for Payer: Priority Health Medicare |
$224.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.53
|
| Rate for Payer: Railroad Medicare Medicare |
$221.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.88
|
| Rate for Payer: UHC Core |
$740.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.84
|
| Rate for Payer: UHC Exchange |
$221.84
|
| Rate for Payer: UHC Medicare Advantage |
$221.84
|
| Rate for Payer: UHCCP Medicaid |
$677.86
|
| Rate for Payer: VA VA |
$221.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.52
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
OP
|
$913.46
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.95 |
| Max. Negotiated Rate |
$822.11 |
| Rate for Payer: Aetna Commercial |
$776.44
|
| Rate for Payer: Aetna Medicare |
$237.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$285.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$285.46
|
| Rate for Payer: BCBS Complete |
$711.80
|
| Rate for Payer: BCBS MAPPO |
$228.37
|
| Rate for Payer: BCBS Trust/PPO |
$750.96
|
| Rate for Payer: BCN Commercial |
$710.22
|
| Rate for Payer: BCN Medicare Advantage |
$228.37
|
| Rate for Payer: Cash Price |
$730.77
|
| Rate for Payer: Cash Price |
$730.77
|
| Rate for Payer: Cofinity Commercial |
$785.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.37
|
| Rate for Payer: Healthscope Commercial |
$822.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.10
|
| Rate for Payer: Mclaren Medicaid |
$677.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$239.78
|
| Rate for Payer: Meridian Medicaid |
$711.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$262.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.44
|
| Rate for Payer: Nomi Health Commercial |
$749.04
|
| Rate for Payer: PACE Senior Care Partners |
$216.95
|
| Rate for Payer: PACE SWMI |
$228.37
|
| Rate for Payer: PHP Commercial |
$776.44
|
| Rate for Payer: PHP Medicare Advantage |
$228.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$677.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.75
|
| Rate for Payer: Priority Health HMO/PPO |
$794.71
|
| Rate for Payer: Priority Health Medicare |
$230.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$612.02
|
| Rate for Payer: Railroad Medicare Medicare |
$228.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$803.84
|
| Rate for Payer: UHC Core |
$762.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$228.37
|
| Rate for Payer: UHC Exchange |
$228.37
|
| Rate for Payer: UHC Medicare Advantage |
$228.37
|
| Rate for Payer: UHCCP Medicaid |
$677.86
|
| Rate for Payer: VA VA |
$228.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.10
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
IP
|
$913.46
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$593.75 |
| Max. Negotiated Rate |
$822.11 |
| Rate for Payer: Aetna Commercial |
$776.44
|
| Rate for Payer: BCBS Trust/PPO |
$745.66
|
| Rate for Payer: BCN Commercial |
$705.92
|
| Rate for Payer: Cash Price |
$730.77
|
| Rate for Payer: Cofinity Commercial |
$785.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.77
|
| Rate for Payer: Healthscope Commercial |
$822.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.44
|
| Rate for Payer: Nomi Health Commercial |
$749.04
|
| Rate for Payer: PHP Commercial |
$776.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.75
|
| Rate for Payer: Priority Health HMO/PPO |
$794.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$612.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$803.84
|
| Rate for Payer: UHC Core |
$762.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.10
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
OP
|
$1,226.51
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$291.30 |
| Max. Negotiated Rate |
$1,103.86 |
| Rate for Payer: Aetna Commercial |
$1,042.53
|
| Rate for Payer: Aetna Medicare |
$318.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$383.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$383.28
|
| Rate for Payer: BCBS Complete |
$711.80
|
| Rate for Payer: BCBS MAPPO |
$306.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.31
|
| Rate for Payer: BCN Commercial |
$953.61
|
| Rate for Payer: BCN Medicare Advantage |
$306.63
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cofinity Commercial |
$1,054.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$981.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.63
|
| Rate for Payer: Healthscope Commercial |
$1,103.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$919.88
|
| Rate for Payer: Mclaren Medicaid |
$677.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.96
|
| Rate for Payer: Meridian Medicaid |
$711.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$352.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.53
|
| Rate for Payer: Nomi Health Commercial |
$1,005.74
|
| Rate for Payer: PACE Senior Care Partners |
$291.30
|
| Rate for Payer: PACE SWMI |
$306.63
|
| Rate for Payer: PHP Commercial |
$1,042.53
|
| Rate for Payer: PHP Medicare Advantage |
$306.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$677.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1,067.06
|
| Rate for Payer: Priority Health Medicare |
$309.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$306.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,079.33
|
| Rate for Payer: UHC Core |
$1,024.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$306.63
|
| Rate for Payer: UHC Exchange |
$306.63
|
| Rate for Payer: UHC Medicare Advantage |
$306.63
|
| Rate for Payer: UHCCP Medicaid |
$677.86
|
| Rate for Payer: VA VA |
$306.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$919.88
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
IP
|
$1,226.51
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$797.23 |
| Max. Negotiated Rate |
$1,103.86 |
| Rate for Payer: Aetna Commercial |
$1,042.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.20
|
| Rate for Payer: BCN Commercial |
$947.85
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cofinity Commercial |
$1,054.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$981.21
|
| Rate for Payer: Healthscope Commercial |
$1,103.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$919.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.53
|
| Rate for Payer: Nomi Health Commercial |
$1,005.74
|
| Rate for Payer: PHP Commercial |
$1,042.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.23
|
| Rate for Payer: Priority Health HMO/PPO |
$1,067.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$821.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,079.33
|
| Rate for Payer: UHC Core |
$1,024.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$919.88
|
|
|
HC GLIADIN AB DEAMINATED IGA
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$9.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.38
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS MAPPO |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.93
|
| Rate for Payer: BCN Commercial |
$28.31
|
| Rate for Payer: BCN Medicare Advantage |
$9.10
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.10
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Mclaren Medicaid |
$8.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.56
|
| Rate for Payer: Meridian Medicaid |
$8.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.65
|
| Rate for Payer: PACE SWMI |
$9.10
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Medicare |
$9.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: Railroad Medicare Medicare |
$9.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.10
|
| Rate for Payer: UHC Exchange |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$9.10
|
| Rate for Payer: UHCCP Medicaid |
$8.34
|
| Rate for Payer: VA VA |
$9.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC GLIADIN AB DEAMINATED IGA
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$28.14
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC GLIADIN AB DEAMINATED IGG
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200009
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: BCBS Trust/PPO |
$23.19
|
| Rate for Payer: BCN Commercial |
$21.96
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO |
$24.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.00
|
| Rate for Payer: UHC Core |
$23.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.31
|
|
|
HC GLIADIN AB DEAMINATED IGG
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200009
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$7.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.88
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS MAPPO |
$7.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.36
|
| Rate for Payer: BCN Commercial |
$22.09
|
| Rate for Payer: BCN Medicare Advantage |
$7.10
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.31
|
| Rate for Payer: Mclaren Medicaid |
$8.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.46
|
| Rate for Payer: Meridian Medicaid |
$8.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: PACE Senior Care Partners |
$6.75
|
| Rate for Payer: PACE SWMI |
$7.10
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: PHP Medicare Advantage |
$7.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO |
$24.72
|
| Rate for Payer: Priority Health Medicare |
$7.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.03
|
| Rate for Payer: Railroad Medicare Medicare |
$7.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.00
|
| Rate for Payer: UHC Core |
$23.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.10
|
| Rate for Payer: UHC Exchange |
$7.10
|
| Rate for Payer: UHC Medicare Advantage |
$7.10
|
| Rate for Payer: UHCCP Medicaid |
$8.34
|
| Rate for Payer: VA VA |
$7.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.31
|
|
|
HC GLIADIN (DEAMIDATED) AB, IGA OR IGG, S
|
Facility
|
IP
|
$49.98
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
30200509
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: BCBS Trust/PPO |
$40.80
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.48
|
| Rate for Payer: Nomi Health Commercial |
$40.98
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.49
|
| Rate for Payer: Priority Health HMO/PPO |
$43.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.98
|
| Rate for Payer: UHC Core |
$41.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.48
|
|
|
HC GLIADIN (DEAMIDATED) AB, IGA OR IGG, S
|
Facility
|
OP
|
$49.98
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
30200509
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna Medicare |
$12.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.62
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$12.49
|
| Rate for Payer: BCBS Trust/PPO |
$41.09
|
| Rate for Payer: BCN Commercial |
$38.86
|
| Rate for Payer: BCN Medicare Advantage |
$12.49
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.48
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.12
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.48
|
| Rate for Payer: Nomi Health Commercial |
$40.98
|
| Rate for Payer: PACE Senior Care Partners |
$11.87
|
| Rate for Payer: PACE SWMI |
$12.49
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: PHP Medicare Advantage |
$12.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.49
|
| Rate for Payer: Priority Health HMO/PPO |
$43.48
|
| Rate for Payer: Priority Health Medicare |
$12.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.49
|
| Rate for Payer: Railroad Medicare Medicare |
$12.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.98
|
| Rate for Payer: UHC Core |
$41.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.49
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicare Advantage |
$12.49
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$12.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.48
|
|
|
HC GLIDEWIRE EXCHANGE
|
Facility
|
IP
|
$309.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.01 |
| Max. Negotiated Rate |
$278.32 |
| Rate for Payer: Aetna Commercial |
$262.85
|
| Rate for Payer: BCBS Trust/PPO |
$252.43
|
| Rate for Payer: BCN Commercial |
$238.98
|
| Rate for Payer: Cash Price |
$247.39
|
| Rate for Payer: Cofinity Commercial |
$265.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.39
|
| Rate for Payer: Healthscope Commercial |
$278.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.85
|
| Rate for Payer: Nomi Health Commercial |
$253.58
|
| Rate for Payer: PHP Commercial |
$262.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.01
|
| Rate for Payer: Priority Health HMO/PPO |
$269.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.13
|
| Rate for Payer: UHC Core |
$258.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.93
|
|
