|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
OP
|
$2,620.38
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$622.34 |
| Max. Negotiated Rate |
$2,358.34 |
| Rate for Payer: Aetna Commercial |
$2,227.32
|
| Rate for Payer: Aetna Medicare |
$681.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$818.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$818.87
|
| Rate for Payer: BCBS Complete |
$1,048.15
|
| Rate for Payer: BCBS MAPPO |
$655.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,037.35
|
| Rate for Payer: BCN Commercial |
$2,037.35
|
| Rate for Payer: BCN Medicare Advantage |
$655.10
|
| Rate for Payer: Cash Price |
$2,096.30
|
| Rate for Payer: Cofinity Commercial |
$2,253.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,096.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.10
|
| Rate for Payer: Healthscope Commercial |
$2,358.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,965.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$687.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$753.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,227.32
|
| Rate for Payer: PACE Senior Care Partners |
$622.34
|
| Rate for Payer: PACE SWMI |
$655.10
|
| Rate for Payer: PHP Commercial |
$2,227.32
|
| Rate for Payer: PHP Medicare Advantage |
$655.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,834.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,279.73
|
| Rate for Payer: Priority Health Medicare |
$655.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,598.17
|
| Rate for Payer: Railroad Medicare Medicare |
$655.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,305.93
|
| Rate for Payer: UHC Core |
$2,188.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$655.10
|
| Rate for Payer: UHC Medicare Advantage |
$674.75
|
| Rate for Payer: VA VA |
$655.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,965.28
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
IP
|
$2,620.38
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,598.17 |
| Max. Negotiated Rate |
$2,358.34 |
| Rate for Payer: Aetna Commercial |
$2,227.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,025.03
|
| Rate for Payer: BCN Commercial |
$2,025.03
|
| Rate for Payer: Cash Price |
$2,096.30
|
| Rate for Payer: Cofinity Commercial |
$2,253.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,096.30
|
| Rate for Payer: Healthscope Commercial |
$2,358.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,965.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,227.32
|
| Rate for Payer: PHP Commercial |
$2,227.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,834.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,279.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,598.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,305.93
|
| Rate for Payer: UHC Core |
$2,188.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,965.28
|
|
|
HC TILT TABLE STRESS
|
Facility
|
OP
|
$1,100.84
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$261.45 |
| Max. Negotiated Rate |
$990.76 |
| Rate for Payer: Aetna Commercial |
$935.71
|
| Rate for Payer: Aetna Medicare |
$286.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$344.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$344.01
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$275.21
|
| Rate for Payer: BCBS Trust/PPO |
$855.90
|
| Rate for Payer: BCN Commercial |
$855.90
|
| Rate for Payer: BCN Medicare Advantage |
$275.21
|
| Rate for Payer: Cash Price |
$880.67
|
| Rate for Payer: Cash Price |
$880.67
|
| Rate for Payer: Cofinity Commercial |
$946.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.21
|
| Rate for Payer: Healthscope Commercial |
$990.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$825.63
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$288.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.71
|
| Rate for Payer: PACE Senior Care Partners |
$261.45
|
| Rate for Payer: PACE SWMI |
$275.21
|
| Rate for Payer: PHP Commercial |
$935.71
|
| Rate for Payer: PHP Medicare Advantage |
$275.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$957.73
|
| Rate for Payer: Priority Health Medicare |
$275.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$671.40
|
| Rate for Payer: Railroad Medicare Medicare |
$275.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$968.74
|
| Rate for Payer: UHC Core |
$919.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.21
|
| Rate for Payer: UHC Medicare Advantage |
$283.47
|
| Rate for Payer: VA VA |
$275.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$825.63
|
|
|
HC TILT TABLE STRESS
|
Facility
|
IP
|
$1,100.84
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$671.40 |
| Max. Negotiated Rate |
$990.76 |
| Rate for Payer: Aetna Commercial |
$935.71
|
| Rate for Payer: BCBS Trust/PPO |
$850.73
|
| Rate for Payer: BCN Commercial |
$850.73
|
| Rate for Payer: Cash Price |
$880.67
|
| Rate for Payer: Cofinity Commercial |
$946.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.67
|
| Rate for Payer: Healthscope Commercial |
$990.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$825.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.71
|
| Rate for Payer: PHP Commercial |
$935.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$957.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$671.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$968.74
|
| Rate for Payer: UHC Core |
$919.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$825.63
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.12
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$32.66
|
| Rate for Payer: BCN Commercial |
$32.66
|
| Rate for Payer: BCN Medicare Advantage |
$10.50
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: PACE Senior Care Partners |
$9.98
|
| Rate for Payer: PACE SWMI |
$10.50
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: PHP Medicare Advantage |
$10.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.54
|
| Rate for Payer: Priority Health Medicare |
$10.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.62
|
| Rate for Payer: Railroad Medicare Medicare |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.50
|
| Rate for Payer: UHC Medicare Advantage |
$10.82
|
| Rate for Payer: VA VA |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: BCBS Trust/PPO |
$32.46
|
| Rate for Payer: BCN Commercial |
$32.46
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.60
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.96
|
| Rate for Payer: UHC Core |
$35.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.50
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
OP
|
$264.18
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$237.76 |
| Rate for Payer: Aetna Commercial |
$224.55
|
| Rate for Payer: Aetna Medicare |
$68.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.56
|
| Rate for Payer: BCBS Complete |
$105.67
|
| Rate for Payer: BCBS MAPPO |
$66.04
|
| Rate for Payer: BCBS Trust/PPO |
$205.40
|
| Rate for Payer: BCCCP Commercial |
$123.01
|
| Rate for Payer: BCN Commercial |
$205.40
|
| Rate for Payer: BCN Medicare Advantage |
$66.04
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$227.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.04
|
| Rate for Payer: Healthscope Commercial |
$237.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.55
|
| Rate for Payer: PACE Senior Care Partners |
$62.74
|
| Rate for Payer: PACE SWMI |
$66.04
|
| Rate for Payer: PHP Commercial |
$224.55
|
| Rate for Payer: PHP Medicare Advantage |
$66.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.84
|
| Rate for Payer: Priority Health Medicare |
$66.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.12
|
| Rate for Payer: Railroad Medicare Medicare |
$66.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.48
|
| Rate for Payer: UHC Core |
$220.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.04
|
| Rate for Payer: UHC Medicare Advantage |
$68.03
|
| Rate for Payer: VA VA |
$66.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.14
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
IP
|
$264.18
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$161.12 |
| Max. Negotiated Rate |
$237.76 |
| Rate for Payer: Aetna Commercial |
$224.55
|
| Rate for Payer: BCBS Trust/PPO |
$204.16
|
| Rate for Payer: BCN Commercial |
$204.16
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$227.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.34
|
| Rate for Payer: Healthscope Commercial |
$237.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.55
|
| Rate for Payer: PHP Commercial |
$224.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.48
|
| Rate for Payer: UHC Core |
$220.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.14
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
IP
|
$330.21
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$201.40 |
| Max. Negotiated Rate |
$297.19 |
| Rate for Payer: Aetna Commercial |
$280.68
|
| Rate for Payer: BCBS Trust/PPO |
$255.19
|
| Rate for Payer: BCN Commercial |
$255.19
|
| Rate for Payer: Cash Price |
$264.17
|
| Rate for Payer: Cofinity Commercial |
$283.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.17
|
| Rate for Payer: Healthscope Commercial |
$297.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.68
|
| Rate for Payer: PHP Commercial |
$280.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.58
|
| Rate for Payer: UHC Core |
$275.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.66
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
OP
|
$330.21
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.42 |
| Max. Negotiated Rate |
$297.19 |
| Rate for Payer: Aetna Commercial |
$280.68
|
| Rate for Payer: Aetna Medicare |
$85.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.19
|
| Rate for Payer: BCBS Complete |
$117.65
|
| Rate for Payer: BCBS MAPPO |
$82.55
|
| Rate for Payer: BCBS Trust/PPO |
$256.74
|
| Rate for Payer: BCCCP Commercial |
$181.78
|
| Rate for Payer: BCN Commercial |
$256.74
|
| Rate for Payer: BCN Medicare Advantage |
$82.55
|
| Rate for Payer: Cash Price |
$264.17
|
| Rate for Payer: Cash Price |
$264.17
|
| Rate for Payer: Cofinity Commercial |
$283.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.55
|
| Rate for Payer: Healthscope Commercial |
$297.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.66
|
| Rate for Payer: Mclaren Medicaid |
$112.04
|
| Rate for Payer: Meridian Medicaid |
$117.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.68
|
| Rate for Payer: PACE Senior Care Partners |
$78.42
|
| Rate for Payer: PACE SWMI |
$82.55
|
| Rate for Payer: PHP Commercial |
$280.68
|
| Rate for Payer: PHP Medicare Advantage |
$82.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.28
|
| Rate for Payer: Priority Health Medicare |
$82.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.40
|
| Rate for Payer: Railroad Medicare Medicare |
$82.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.58
|
| Rate for Payer: UHC Core |
$275.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.55
|
| Rate for Payer: UHC Medicare Advantage |
$85.03
|
| Rate for Payer: VA VA |
$82.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.66
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
OP
|
$264.18
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$62.74 |
| Max. Negotiated Rate |
$247.59 |
| Rate for Payer: Aetna Commercial |
$224.55
|
| Rate for Payer: Aetna Medicare |
$68.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.56
|
| Rate for Payer: BCBS Complete |
$247.59
|
| Rate for Payer: BCBS MAPPO |
$66.04
|
| Rate for Payer: BCBS Trust/PPO |
$205.40
|
| Rate for Payer: BCCCP Commercial |
$143.46
|
| Rate for Payer: BCN Commercial |
$205.40
|
| Rate for Payer: BCN Medicare Advantage |
$66.04
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$227.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.04
|
| Rate for Payer: Healthscope Commercial |
$237.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.14
|
| Rate for Payer: Mclaren Medicaid |
$235.80
|
| Rate for Payer: Meridian Medicaid |
$247.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.55
|
| Rate for Payer: PACE Senior Care Partners |
$62.74
|
| Rate for Payer: PACE SWMI |
$66.04
|
| Rate for Payer: PHP Commercial |
$224.55
|
| Rate for Payer: PHP Medicare Advantage |
$66.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.84
|
| Rate for Payer: Priority Health Medicare |
$66.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.12
|
| Rate for Payer: Railroad Medicare Medicare |
$66.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.48
|
| Rate for Payer: UHC Core |
$220.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.04
|
| Rate for Payer: UHC Medicare Advantage |
$68.03
|
| Rate for Payer: VA VA |
$66.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.14
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
IP
|
$264.18
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$161.12 |
| Max. Negotiated Rate |
$237.76 |
| Rate for Payer: Aetna Commercial |
$224.55
|
| Rate for Payer: BCBS Trust/PPO |
$204.16
|
| Rate for Payer: BCN Commercial |
$204.16
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$227.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.34
|
| Rate for Payer: Healthscope Commercial |
$237.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.55
|
| Rate for Payer: PHP Commercial |
$224.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.48
|
| Rate for Payer: UHC Core |
$220.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.14
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
IP
|
$1,441.26
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$879.02 |
| Max. Negotiated Rate |
$1,297.13 |
| Rate for Payer: Aetna Commercial |
$1,225.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.81
|
| Rate for Payer: BCN Commercial |
$1,113.81
|
| Rate for Payer: Cash Price |
$1,153.01
|
| Rate for Payer: Cofinity Commercial |
$1,239.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,153.01
|
| Rate for Payer: Healthscope Commercial |
$1,297.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,080.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,225.07
|
| Rate for Payer: PHP Commercial |
$1,225.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,253.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$879.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,268.31
|
| Rate for Payer: UHC Core |
$1,203.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,080.94
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
OP
|
$1,441.26
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$342.30 |
| Max. Negotiated Rate |
$1,297.13 |
| Rate for Payer: Aetna Commercial |
$1,225.07
|
| Rate for Payer: Aetna Medicare |
$374.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$450.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$450.39
|
| Rate for Payer: BCBS Complete |
$576.50
|
| Rate for Payer: BCBS MAPPO |
$360.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,120.58
|
| Rate for Payer: BCN Commercial |
$1,120.58
|
| Rate for Payer: BCN Medicare Advantage |
$360.32
|
| Rate for Payer: Cash Price |
$1,153.01
|
| Rate for Payer: Cofinity Commercial |
$1,239.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,153.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$360.32
|
| Rate for Payer: Healthscope Commercial |
$1,297.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,080.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$378.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$414.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,225.07
|
| Rate for Payer: PACE Senior Care Partners |
$342.30
|
| Rate for Payer: PACE SWMI |
$360.32
|
| Rate for Payer: PHP Commercial |
$1,225.07
|
| Rate for Payer: PHP Medicare Advantage |
$360.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,253.90
|
| Rate for Payer: Priority Health Medicare |
$360.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$879.02
|
| Rate for Payer: Railroad Medicare Medicare |
$360.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,268.31
|
| Rate for Payer: UHC Core |
$1,203.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$360.32
|
| Rate for Payer: UHC Medicare Advantage |
$371.12
|
| Rate for Payer: VA VA |
$360.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,080.94
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$309.94 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Aetna Commercial |
$1,109.25
|
| Rate for Payer: Aetna Medicare |
$339.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$407.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$407.81
|
| Rate for Payer: BCBS Complete |
$522.00
|
| Rate for Payer: BCBS MAPPO |
$326.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.64
|
| Rate for Payer: BCN Commercial |
$1,014.64
|
| Rate for Payer: BCN Medicare Advantage |
$326.25
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cofinity Commercial |
$1,122.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.25
|
| Rate for Payer: Healthscope Commercial |
$1,174.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$978.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$342.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$375.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,109.25
|
| Rate for Payer: PACE Senior Care Partners |
$309.94
|
| Rate for Payer: PACE SWMI |
$326.25
|
| Rate for Payer: PHP Commercial |
$1,109.25
|
| Rate for Payer: PHP Medicare Advantage |
$326.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,135.35
|
| Rate for Payer: Priority Health Medicare |
$326.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$795.92
|
| Rate for Payer: Railroad Medicare Medicare |
$326.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,148.40
|
| Rate for Payer: UHC Core |
$1,089.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.25
|
| Rate for Payer: UHC Medicare Advantage |
$336.04
|
| Rate for Payer: VA VA |
$326.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$978.75
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
IP
|
$1,305.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$795.92 |
| Max. Negotiated Rate |
$1,174.50 |
| Rate for Payer: Aetna Commercial |
$1,109.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.50
|
| Rate for Payer: BCN Commercial |
$1,008.50
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cofinity Commercial |
$1,122.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.00
|
| Rate for Payer: Healthscope Commercial |
$1,174.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$978.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,109.25
|
| Rate for Payer: PHP Commercial |
$1,109.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,135.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$795.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,148.40
|
| Rate for Payer: UHC Core |
$1,089.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$978.75
|
|
|
HC TISSUE PROCESSING
|
Facility
|
OP
|
$50.30
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$45.27 |
| Rate for Payer: Aetna Commercial |
$42.76
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.72
|
| Rate for Payer: BCBS Complete |
$4.56
|
| Rate for Payer: BCBS MAPPO |
$12.58
|
| Rate for Payer: BCBS Trust/PPO |
$39.11
|
| Rate for Payer: BCN Commercial |
$39.11
|
| Rate for Payer: BCN Medicare Advantage |
$12.58
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cofinity Commercial |
$43.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$45.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.72
|
| Rate for Payer: Mclaren Medicaid |
$4.34
|
| Rate for Payer: Meridian Medicaid |
$4.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.76
|
| Rate for Payer: PACE Senior Care Partners |
$11.95
|
| Rate for Payer: PACE SWMI |
$12.58
|
| Rate for Payer: PHP Commercial |
$42.76
|
| Rate for Payer: PHP Medicare Advantage |
$12.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.76
|
| Rate for Payer: Priority Health Medicare |
$12.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.68
|
| Rate for Payer: Railroad Medicare Medicare |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.26
|
| Rate for Payer: UHC Core |
$42.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.58
|
| Rate for Payer: UHC Medicare Advantage |
$12.95
|
| Rate for Payer: VA VA |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.72
|
|
|
HC TISSUE PROCESSING
|
Facility
|
IP
|
$50.30
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.68 |
| Max. Negotiated Rate |
$45.27 |
| Rate for Payer: Aetna Commercial |
$42.76
|
| Rate for Payer: BCBS Trust/PPO |
$38.87
|
| Rate for Payer: BCN Commercial |
$38.87
|
| Rate for Payer: Cash Price |
$40.24
|
| Rate for Payer: Cofinity Commercial |
$43.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.24
|
| Rate for Payer: Healthscope Commercial |
$45.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.76
|
| Rate for Payer: PHP Commercial |
$42.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.26
|
| Rate for Payer: UHC Core |
$42.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.72
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.15 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: BCBS Trust/PPO |
$43.28
|
| Rate for Payer: BCN Commercial |
$43.28
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$46.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.50
|
| Rate for Payer: BCBS Complete |
$8.93
|
| Rate for Payer: BCBS MAPPO |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$43.54
|
| Rate for Payer: BCN Commercial |
$43.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.00
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.00
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Mclaren Medicaid |
$8.51
|
| Rate for Payer: Meridian Medicaid |
$8.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PACE Senior Care Partners |
$13.30
|
| Rate for Payer: PACE SWMI |
$14.00
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: PHP Medicare Advantage |
$14.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.72
|
| Rate for Payer: Priority Health Medicare |
$14.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.15
|
| Rate for Payer: Railroad Medicare Medicare |
$14.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$46.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.00
|
| Rate for Payer: UHC Medicare Advantage |
$14.42
|
| Rate for Payer: VA VA |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$8.93
|
| Rate for Payer: BCBS MAPPO |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$27.76
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: BCN Medicare Advantage |
$8.92
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.92
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Mclaren Medicaid |
$8.51
|
| Rate for Payer: Meridian Medicaid |
$8.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Senior Care Partners |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.92
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.06
|
| Rate for Payer: Priority Health Medicare |
$8.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: Railroad Medicare Medicare |
$8.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.92
|
| Rate for Payer: UHC Medicare Advantage |
$9.19
|
| Rate for Payer: VA VA |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: BCBS Trust/PPO |
$27.59
|
| Rate for Payer: BCN Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$8.93
|
| Rate for Payer: BCBS MAPPO |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$27.76
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: BCN Medicare Advantage |
$8.92
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.92
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Mclaren Medicaid |
$8.51
|
| Rate for Payer: Meridian Medicaid |
$8.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Senior Care Partners |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.92
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.06
|
| Rate for Payer: Priority Health Medicare |
$8.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: Railroad Medicare Medicare |
$8.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.92
|
| Rate for Payer: UHC Medicare Advantage |
$9.19
|
| Rate for Payer: VA VA |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
