|
HC TISSUE MARKER PROSTATE
|
Facility
|
IP
|
$1,357.72
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.97 |
| Max. Negotiated Rate |
$1,221.95 |
| Rate for Payer: Aetna Commercial |
$1,154.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,121.34
|
| Rate for Payer: BCN Commercial |
$1,121.34
|
| Rate for Payer: Cash Price |
$1,086.18
|
| Rate for Payer: Cofinity Commercial |
$1,167.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,086.18
|
| Rate for Payer: Healthscope Commercial |
$1,221.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,018.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,154.06
|
| Rate for Payer: Nomi Health Commercial |
$1,113.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,018.29
|
| Rate for Payer: PHP Commercial |
$1,154.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,181.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$944.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,194.79
|
| Rate for Payer: UHC Core |
$1,133.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,018.29
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
OP
|
$1,357.72
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.37 |
| Max. Negotiated Rate |
$1,221.95 |
| Rate for Payer: Aetna Commercial |
$1,154.06
|
| Rate for Payer: Aetna Medicare |
$353.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$424.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$424.29
|
| Rate for Payer: BCBS Complete |
$251.31
|
| Rate for Payer: BCBS MAPPO |
$339.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.18
|
| Rate for Payer: BCN Commercial |
$1,116.18
|
| Rate for Payer: BCN Medicare Advantage |
$339.43
|
| Rate for Payer: Cash Price |
$1,086.18
|
| Rate for Payer: Cofinity Commercial |
$1,167.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,086.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.43
|
| Rate for Payer: Healthscope Commercial |
$1,221.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,018.29
|
| Rate for Payer: Mclaren Medicaid |
$239.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.40
|
| Rate for Payer: Meridian Medicaid |
$251.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$390.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$373.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,154.06
|
| Rate for Payer: Nomi Health Commercial |
$1,113.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,018.29
|
| Rate for Payer: PACE Senior Care Partners |
$322.46
|
| Rate for Payer: PACE SWMI |
$339.43
|
| Rate for Payer: PHP Commercial |
$1,154.06
|
| Rate for Payer: PHP Medicare Advantage |
$339.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,181.22
|
| Rate for Payer: Priority Health Medicare |
$342.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$944.97
|
| Rate for Payer: Railroad Medicare Medicare |
$339.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,194.79
|
| Rate for Payer: UHC Core |
$1,133.70
|
| Rate for Payer: UHC Exchange |
$339.43
|
| Rate for Payer: UHC Medicaid |
$239.37
|
| Rate for Payer: UHC Medicare Advantage |
$339.43
|
| Rate for Payer: UHCCP Medicaid |
$239.37
|
| Rate for Payer: VA VA |
$339.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,018.29
|
|
|
HC TISSUE PROCESSING
|
Facility
|
IP
|
$52.34
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: BCBS Trust/PPO |
$43.23
|
| Rate for Payer: BCN Commercial |
$43.23
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$42.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.06
|
| Rate for Payer: UHC Core |
$43.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.26
|
|
|
HC TISSUE PROCESSING
|
Facility
|
OP
|
$52.34
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare |
$13.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.36
|
| Rate for Payer: BCBS Complete |
$9.69
|
| Rate for Payer: BCBS MAPPO |
$13.09
|
| Rate for Payer: BCBS Trust/PPO |
$43.03
|
| Rate for Payer: BCN Commercial |
$43.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.09
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.09
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.26
|
| Rate for Payer: Mclaren Medicaid |
$9.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.74
|
| Rate for Payer: Meridian Medicaid |
$9.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$42.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PACE Senior Care Partners |
$12.43
|
| Rate for Payer: PACE SWMI |
$13.09
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: PHP Medicare Advantage |
$13.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.54
|
| Rate for Payer: Priority Health Medicare |
$13.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.43
|
| Rate for Payer: Railroad Medicare Medicare |
$13.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.06
|
| Rate for Payer: UHC Core |
$43.70
|
| Rate for Payer: UHC Exchange |
$13.09
|
| Rate for Payer: UHC Medicaid |
$9.23
|
| Rate for Payer: UHC Medicare Advantage |
$13.09
|
| Rate for Payer: UHCCP Medicaid |
$9.23
|
| Rate for Payer: VA VA |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.26
|
|
|
HC TISSUE TRANSFER ANY AREA 30.1-60 SQ CM
|
Facility
|
OP
|
$10,750.80
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
76100537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,895.37 |
| Max. Negotiated Rate |
$9,675.72 |
| Rate for Payer: Aetna Commercial |
$9,138.18
|
| Rate for Payer: Aetna Medicare |
$2,795.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,359.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,359.62
|
| Rate for Payer: BCBS Complete |
$1,989.97
|
| Rate for Payer: BCBS MAPPO |
$2,687.70
|
| Rate for Payer: BCBS Trust/PPO |
$8,838.23
|
| Rate for Payer: BCN Commercial |
$8,838.23
|
| Rate for Payer: BCN Medicare Advantage |
$2,687.70
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cofinity Commercial |
$9,245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,600.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,687.70
|
| Rate for Payer: Healthscope Commercial |
$9,675.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,063.10
|
| Rate for Payer: Mclaren Medicaid |
$1,895.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,822.09
|
| Rate for Payer: Meridian Medicaid |
$1,989.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,090.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,956.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,138.18
|
| Rate for Payer: Nomi Health Commercial |
$8,815.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,063.10
|
| Rate for Payer: PACE Senior Care Partners |
$2,553.32
|
| Rate for Payer: PACE SWMI |
$2,687.70
|
| Rate for Payer: PHP Commercial |
$9,138.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,687.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,895.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9,353.20
|
| Rate for Payer: Priority Health Medicare |
$2,714.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,482.56
|
| Rate for Payer: Railroad Medicare Medicare |
$2,687.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,460.70
|
| Rate for Payer: UHC Core |
$8,976.92
|
| Rate for Payer: UHC Exchange |
$2,687.70
|
| Rate for Payer: UHC Medicaid |
$1,895.37
|
| Rate for Payer: UHC Medicare Advantage |
$2,687.70
|
| Rate for Payer: UHCCP Medicaid |
$1,895.37
|
| Rate for Payer: VA VA |
$2,687.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,063.10
|
|
|
HC TISSUE TRANSFER ANY AREA 30.1-60 SQ CM
|
Facility
|
IP
|
$10,750.80
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
76100537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7,482.56 |
| Max. Negotiated Rate |
$9,675.72 |
| Rate for Payer: Aetna Commercial |
$9,138.18
|
| Rate for Payer: BCBS Trust/PPO |
$8,879.09
|
| Rate for Payer: BCN Commercial |
$8,879.09
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cofinity Commercial |
$9,245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,600.64
|
| Rate for Payer: Healthscope Commercial |
$9,675.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,063.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,138.18
|
| Rate for Payer: Nomi Health Commercial |
$8,815.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,063.10
|
| Rate for Payer: PHP Commercial |
$9,138.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9,353.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,482.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,460.70
|
| Rate for Payer: UHC Core |
$8,976.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,063.10
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: BCBS MAPPO |
$14.56
|
| Rate for Payer: BCBS Trust/PPO |
$47.90
|
| Rate for Payer: BCN Commercial |
$47.90
|
| Rate for Payer: BCN Medicare Advantage |
$14.56
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.70
|
| Rate for Payer: Mclaren Medicaid |
$10.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.29
|
| Rate for Payer: Meridian Medicaid |
$10.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$47.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PACE Senior Care Partners |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.56
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: PHP Medicare Advantage |
$14.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.69
|
| Rate for Payer: Priority Health Medicare |
$14.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.55
|
| Rate for Payer: Railroad Medicare Medicare |
$14.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.27
|
| Rate for Payer: UHC Core |
$48.65
|
| Rate for Payer: UHC Exchange |
$14.56
|
| Rate for Payer: UHC Medicaid |
$10.27
|
| Rate for Payer: UHC Medicare Advantage |
$14.56
|
| Rate for Payer: UHCCP Medicaid |
$10.27
|
| Rate for Payer: VA VA |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.70
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.55 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: BCBS Trust/PPO |
$48.12
|
| Rate for Payer: BCN Commercial |
$48.12
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$47.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.27
|
| Rate for Payer: UHC Core |
$48.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.70
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: BCBS Trust/PPO |
$30.67
|
| Rate for Payer: BCN Commercial |
$30.67
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.68
|
| Rate for Payer: UHC Core |
$31.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.61
|
| Rate for Payer: BCBS Complete |
$6.87
|
| Rate for Payer: BCBS MAPPO |
$9.29
|
| Rate for Payer: BCBS Trust/PPO |
$30.53
|
| Rate for Payer: BCN Commercial |
$30.53
|
| Rate for Payer: BCN Medicare Advantage |
$9.29
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.75
|
| Rate for Payer: Meridian Medicaid |
$6.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.82
|
| Rate for Payer: PACE SWMI |
$9.29
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: PHP Medicare Advantage |
$9.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.31
|
| Rate for Payer: Priority Health Medicare |
$9.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.85
|
| Rate for Payer: Railroad Medicare Medicare |
$9.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.68
|
| Rate for Payer: UHC Core |
$31.01
|
| Rate for Payer: UHC Exchange |
$9.29
|
| Rate for Payer: UHC Medicaid |
$6.55
|
| Rate for Payer: UHC Medicare Advantage |
$9.29
|
| Rate for Payer: UHCCP Medicaid |
$6.55
|
| Rate for Payer: VA VA |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: BCBS Trust/PPO |
$30.67
|
| Rate for Payer: BCN Commercial |
$30.67
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.68
|
| Rate for Payer: UHC Core |
$31.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.61
|
| Rate for Payer: BCBS Complete |
$6.87
|
| Rate for Payer: BCBS MAPPO |
$9.29
|
| Rate for Payer: BCBS Trust/PPO |
$30.53
|
| Rate for Payer: BCN Commercial |
$30.53
|
| Rate for Payer: BCN Medicare Advantage |
$9.29
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.75
|
| Rate for Payer: Meridian Medicaid |
$6.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.82
|
| Rate for Payer: PACE SWMI |
$9.29
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: PHP Medicare Advantage |
$9.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.31
|
| Rate for Payer: Priority Health Medicare |
$9.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.85
|
| Rate for Payer: Railroad Medicare Medicare |
$9.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.68
|
| Rate for Payer: UHC Core |
$31.01
|
| Rate for Payer: UHC Exchange |
$9.29
|
| Rate for Payer: UHC Medicaid |
$6.55
|
| Rate for Payer: UHC Medicare Advantage |
$9.29
|
| Rate for Payer: UHCCP Medicaid |
$6.55
|
| Rate for Payer: VA VA |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 150 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0220
|
| Hospital Charge Code |
63600197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 150 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0220
|
| Hospital Charge Code |
63600197
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.00
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS MAPPO |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.00
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$0.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: Meridian Medicaid |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.00
|
| Rate for Payer: PACE SWMI |
$0.00
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$0.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicaid |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: UHCCP Medicaid |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 300 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0221
|
| Hospital Charge Code |
63600203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC TIXAGEVIMAB/CILGAVIMAB 300 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0221
|
| Hospital Charge Code |
63600203
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.00
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS MAPPO |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.00
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$0.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: Meridian Medicaid |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.00
|
| Rate for Payer: PACE SWMI |
$0.00
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$0.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicaid |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: UHCCP Medicaid |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC TL 201 PER MCI
|
Facility
|
OP
|
$197.13
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$34.75 |
| Max. Negotiated Rate |
$177.42 |
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: Aetna Medicare |
$51.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.60
|
| Rate for Payer: BCBS Complete |
$36.49
|
| Rate for Payer: BCBS MAPPO |
$49.28
|
| Rate for Payer: BCBS Trust/PPO |
$162.06
|
| Rate for Payer: BCN Commercial |
$162.06
|
| Rate for Payer: BCN Medicare Advantage |
$49.28
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.28
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.85
|
| Rate for Payer: Mclaren Medicaid |
$34.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.75
|
| Rate for Payer: Meridian Medicaid |
$36.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Nomi Health Commercial |
$161.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: PACE Senior Care Partners |
$46.82
|
| Rate for Payer: PACE SWMI |
$49.28
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: PHP Medicare Advantage |
$49.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$171.50
|
| Rate for Payer: Priority Health Medicare |
$49.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.20
|
| Rate for Payer: Railroad Medicare Medicare |
$49.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.47
|
| Rate for Payer: UHC Core |
$164.60
|
| Rate for Payer: UHC Exchange |
$49.28
|
| Rate for Payer: UHC Medicaid |
$34.75
|
| Rate for Payer: UHC Medicare Advantage |
$49.28
|
| Rate for Payer: UHCCP Medicaid |
$34.75
|
| Rate for Payer: VA VA |
$49.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.85
|
|
|
HC TL 201 PER MCI
|
Facility
|
IP
|
$197.13
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$177.42 |
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: BCBS Trust/PPO |
$162.81
|
| Rate for Payer: BCN Commercial |
$162.81
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Nomi Health Commercial |
$161.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$171.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.47
|
| Rate for Payer: UHC Core |
$164.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.85
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
IP
|
$109.66
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: BCBS Trust/PPO |
$90.57
|
| Rate for Payer: BCN Commercial |
$90.57
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$89.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.50
|
| Rate for Payer: UHC Core |
$91.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.25
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
OP
|
$109.66
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.33 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: Aetna Medicare |
$28.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.27
|
| Rate for Payer: BCBS Complete |
$20.30
|
| Rate for Payer: BCBS MAPPO |
$27.41
|
| Rate for Payer: BCBS Trust/PPO |
$90.15
|
| Rate for Payer: BCN Commercial |
$90.15
|
| Rate for Payer: BCN Medicare Advantage |
$27.41
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.41
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.25
|
| Rate for Payer: Mclaren Medicaid |
$19.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.79
|
| Rate for Payer: Meridian Medicaid |
$20.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$89.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PACE Senior Care Partners |
$26.04
|
| Rate for Payer: PACE SWMI |
$27.41
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: PHP Medicare Advantage |
$27.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.40
|
| Rate for Payer: Priority Health Medicare |
$27.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.32
|
| Rate for Payer: Railroad Medicare Medicare |
$27.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.50
|
| Rate for Payer: UHC Core |
$91.57
|
| Rate for Payer: UHC Exchange |
$27.41
|
| Rate for Payer: UHC Medicaid |
$19.33
|
| Rate for Payer: UHC Medicare Advantage |
$27.41
|
| Rate for Payer: UHCCP Medicaid |
$19.33
|
| Rate for Payer: VA VA |
$27.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.25
|
|
|
HC TOMATO IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC TOMATO IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
IP
|
$4,826.42
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,359.19 |
| Max. Negotiated Rate |
$4,343.78 |
| Rate for Payer: Aetna Commercial |
$4,102.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,986.14
|
| Rate for Payer: BCN Commercial |
$3,986.14
|
| Rate for Payer: Cash Price |
$3,861.14
|
| Rate for Payer: Cofinity Commercial |
$4,150.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,861.14
|
| Rate for Payer: Healthscope Commercial |
$4,343.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,619.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,102.46
|
| Rate for Payer: Nomi Health Commercial |
$3,957.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,619.82
|
| Rate for Payer: PHP Commercial |
$4,102.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,198.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,359.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,247.25
|
| Rate for Payer: UHC Core |
$4,030.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,619.82
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
OP
|
$4,826.42
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$850.90 |
| Max. Negotiated Rate |
$4,343.78 |
| Rate for Payer: Aetna Commercial |
$4,102.46
|
| Rate for Payer: Aetna Medicare |
$1,254.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,508.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,508.26
|
| Rate for Payer: BCBS Complete |
$893.37
|
| Rate for Payer: BCBS MAPPO |
$1,206.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,967.80
|
| Rate for Payer: BCN Commercial |
$3,967.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,206.61
|
| Rate for Payer: Cash Price |
$3,861.14
|
| Rate for Payer: Cofinity Commercial |
$4,150.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,861.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,206.61
|
| Rate for Payer: Healthscope Commercial |
$4,343.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,619.82
|
| Rate for Payer: Mclaren Medicaid |
$850.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,266.94
|
| Rate for Payer: Meridian Medicaid |
$893.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,387.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,327.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,102.46
|
| Rate for Payer: Nomi Health Commercial |
$3,957.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,619.82
|
| Rate for Payer: PACE Senior Care Partners |
$1,146.27
|
| Rate for Payer: PACE SWMI |
$1,206.61
|
| Rate for Payer: PHP Commercial |
$4,102.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,206.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,198.99
|
| Rate for Payer: Priority Health Medicare |
$1,218.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,359.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,206.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,247.25
|
| Rate for Payer: UHC Core |
$4,030.06
|
| Rate for Payer: UHC Exchange |
$1,206.61
|
| Rate for Payer: UHC Medicaid |
$850.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,206.61
|
| Rate for Payer: UHCCP Medicaid |
$850.90
|
| Rate for Payer: VA VA |
$1,206.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,619.82
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
OP
|
$3,312.83
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$584.05 |
| Max. Negotiated Rate |
$2,981.55 |
| Rate for Payer: Aetna Commercial |
$2,815.91
|
| Rate for Payer: Aetna Medicare |
$861.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,035.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,035.26
|
| Rate for Payer: BCBS Complete |
$613.20
|
| Rate for Payer: BCBS MAPPO |
$828.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,723.48
|
| Rate for Payer: BCN Commercial |
$2,723.48
|
| Rate for Payer: BCN Medicare Advantage |
$828.21
|
| Rate for Payer: Cash Price |
$2,650.26
|
| Rate for Payer: Cofinity Commercial |
$2,849.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,650.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$828.21
|
| Rate for Payer: Healthscope Commercial |
$2,981.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,484.62
|
| Rate for Payer: Mclaren Medicaid |
$584.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$869.62
|
| Rate for Payer: Meridian Medicaid |
$613.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$952.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$911.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,815.91
|
| Rate for Payer: Nomi Health Commercial |
$2,716.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,484.62
|
| Rate for Payer: PACE Senior Care Partners |
$786.80
|
| Rate for Payer: PACE SWMI |
$828.21
|
| Rate for Payer: PHP Commercial |
$2,815.91
|
| Rate for Payer: PHP Medicare Advantage |
$828.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,882.16
|
| Rate for Payer: Priority Health Medicare |
$836.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,305.73
|
| Rate for Payer: Railroad Medicare Medicare |
$828.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,915.29
|
| Rate for Payer: UHC Core |
$2,766.21
|
| Rate for Payer: UHC Exchange |
$828.21
|
| Rate for Payer: UHC Medicaid |
$584.05
|
| Rate for Payer: UHC Medicare Advantage |
$828.21
|
| Rate for Payer: UHCCP Medicaid |
$584.05
|
| Rate for Payer: VA VA |
$828.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,484.62
|
|
