|
HC TIAGABINE LEVEL
|
Facility
|
IP
|
$115.93
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.35 |
| Max. Negotiated Rate |
$104.34 |
| Rate for Payer: Aetna Commercial |
$98.54
|
| Rate for Payer: BCBS Trust/PPO |
$94.63
|
| Rate for Payer: BCN Commercial |
$89.59
|
| Rate for Payer: Cash Price |
$92.74
|
| Rate for Payer: Cofinity Commercial |
$99.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.74
|
| Rate for Payer: Healthscope Commercial |
$104.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.54
|
| Rate for Payer: Nomi Health Commercial |
$95.06
|
| Rate for Payer: PHP Commercial |
$98.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.35
|
| Rate for Payer: Priority Health HMO/PPO |
$100.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.02
|
| Rate for Payer: UHC Core |
$96.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.95
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
OP
|
$6,022.01
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,430.23 |
| Max. Negotiated Rate |
$5,419.81 |
| Rate for Payer: Aetna Commercial |
$5,118.71
|
| Rate for Payer: Aetna Medicare |
$1,565.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,881.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,881.88
|
| Rate for Payer: BCBS Complete |
$2,408.80
|
| Rate for Payer: BCBS MAPPO |
$1,505.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,950.69
|
| Rate for Payer: BCN Commercial |
$4,682.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,505.50
|
| Rate for Payer: Cash Price |
$4,817.61
|
| Rate for Payer: Cofinity Commercial |
$5,178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,817.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,505.50
|
| Rate for Payer: Healthscope Commercial |
$5,419.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,516.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,580.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,731.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,118.71
|
| Rate for Payer: Nomi Health Commercial |
$4,938.05
|
| Rate for Payer: PACE Senior Care Partners |
$1,430.23
|
| Rate for Payer: PACE SWMI |
$1,505.50
|
| Rate for Payer: PHP Commercial |
$5,118.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,505.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,914.31
|
| Rate for Payer: Priority Health HMO/PPO |
$5,239.15
|
| Rate for Payer: Priority Health Medicare |
$1,520.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,034.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,505.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,299.37
|
| Rate for Payer: UHC Core |
$5,028.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,505.50
|
| Rate for Payer: UHC Exchange |
$1,505.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,505.50
|
| Rate for Payer: VA VA |
$1,505.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,516.51
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
IP
|
$6,022.01
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,914.31 |
| Max. Negotiated Rate |
$5,419.81 |
| Rate for Payer: Aetna Commercial |
$5,118.71
|
| Rate for Payer: BCBS Trust/PPO |
$4,915.77
|
| Rate for Payer: BCN Commercial |
$4,653.81
|
| Rate for Payer: Cash Price |
$4,817.61
|
| Rate for Payer: Cofinity Commercial |
$5,178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,817.61
|
| Rate for Payer: Healthscope Commercial |
$5,419.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,516.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,118.71
|
| Rate for Payer: Nomi Health Commercial |
$4,938.05
|
| Rate for Payer: PHP Commercial |
$5,118.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,914.31
|
| Rate for Payer: Priority Health HMO/PPO |
$5,239.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,034.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,299.37
|
| Rate for Payer: UHC Core |
$5,028.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,516.51
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
OP
|
$4,592.66
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,090.76 |
| Max. Negotiated Rate |
$4,133.39 |
| Rate for Payer: Aetna Commercial |
$3,903.76
|
| Rate for Payer: Aetna Medicare |
$1,194.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,435.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,435.21
|
| Rate for Payer: BCBS Complete |
$1,837.06
|
| Rate for Payer: BCBS MAPPO |
$1,148.16
|
| Rate for Payer: BCBS Trust/PPO |
$3,775.63
|
| Rate for Payer: BCN Commercial |
$3,570.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,148.16
|
| Rate for Payer: Cash Price |
$3,674.13
|
| Rate for Payer: Cofinity Commercial |
$3,949.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,674.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,148.16
|
| Rate for Payer: Healthscope Commercial |
$4,133.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,444.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,205.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,320.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,903.76
|
| Rate for Payer: Nomi Health Commercial |
$3,765.98
|
| Rate for Payer: PACE Senior Care Partners |
$1,090.76
|
| Rate for Payer: PACE SWMI |
$1,148.16
|
| Rate for Payer: PHP Commercial |
$3,903.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,148.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,985.23
|
| Rate for Payer: Priority Health HMO/PPO |
$3,995.61
|
| Rate for Payer: Priority Health Medicare |
$1,159.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,077.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,148.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,041.54
|
| Rate for Payer: UHC Core |
$3,834.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,148.16
|
| Rate for Payer: UHC Exchange |
$1,148.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,148.16
|
| Rate for Payer: VA VA |
$1,148.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,444.50
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
IP
|
$4,592.66
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,985.23 |
| Max. Negotiated Rate |
$4,133.39 |
| Rate for Payer: Aetna Commercial |
$3,903.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,748.99
|
| Rate for Payer: BCN Commercial |
$3,549.21
|
| Rate for Payer: Cash Price |
$3,674.13
|
| Rate for Payer: Cofinity Commercial |
$3,949.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,674.13
|
| Rate for Payer: Healthscope Commercial |
$4,133.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,444.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,903.76
|
| Rate for Payer: Nomi Health Commercial |
$3,765.98
|
| Rate for Payer: PHP Commercial |
$3,903.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,985.23
|
| Rate for Payer: Priority Health HMO/PPO |
$3,995.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,077.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,041.54
|
| Rate for Payer: UHC Core |
$3,834.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,444.50
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
IP
|
$3,503.03
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,276.97 |
| Max. Negotiated Rate |
$3,152.73 |
| Rate for Payer: Aetna Commercial |
$2,977.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,859.52
|
| Rate for Payer: BCN Commercial |
$2,707.14
|
| Rate for Payer: Cash Price |
$2,802.42
|
| Rate for Payer: Cofinity Commercial |
$3,012.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,802.42
|
| Rate for Payer: Healthscope Commercial |
$3,152.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,627.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,977.58
|
| Rate for Payer: Nomi Health Commercial |
$2,872.48
|
| Rate for Payer: PHP Commercial |
$2,977.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.97
|
| Rate for Payer: Priority Health HMO/PPO |
$3,047.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,347.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,082.67
|
| Rate for Payer: UHC Core |
$2,925.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,627.27
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
OP
|
$3,503.03
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$831.97 |
| Max. Negotiated Rate |
$3,152.73 |
| Rate for Payer: Aetna Commercial |
$2,977.58
|
| Rate for Payer: Aetna Medicare |
$910.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,094.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,094.70
|
| Rate for Payer: BCBS Complete |
$1,401.21
|
| Rate for Payer: BCBS MAPPO |
$875.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,879.84
|
| Rate for Payer: BCN Commercial |
$2,723.61
|
| Rate for Payer: BCN Medicare Advantage |
$875.76
|
| Rate for Payer: Cash Price |
$2,802.42
|
| Rate for Payer: Cofinity Commercial |
$3,012.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,802.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$875.76
|
| Rate for Payer: Healthscope Commercial |
$3,152.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,627.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$919.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,007.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,977.58
|
| Rate for Payer: Nomi Health Commercial |
$2,872.48
|
| Rate for Payer: PACE Senior Care Partners |
$831.97
|
| Rate for Payer: PACE SWMI |
$875.76
|
| Rate for Payer: PHP Commercial |
$2,977.58
|
| Rate for Payer: PHP Medicare Advantage |
$875.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,276.97
|
| Rate for Payer: Priority Health HMO/PPO |
$3,047.64
|
| Rate for Payer: Priority Health Medicare |
$884.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,347.03
|
| Rate for Payer: Railroad Medicare Medicare |
$875.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,082.67
|
| Rate for Payer: UHC Core |
$2,925.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$875.76
|
| Rate for Payer: UHC Exchange |
$875.76
|
| Rate for Payer: UHC Medicare Advantage |
$875.76
|
| Rate for Payer: VA VA |
$875.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,627.27
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
OP
|
$2,672.79
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$634.79 |
| Max. Negotiated Rate |
$2,405.51 |
| Rate for Payer: Aetna Commercial |
$2,271.87
|
| Rate for Payer: Aetna Medicare |
$694.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$835.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$835.25
|
| Rate for Payer: BCBS Complete |
$1,069.12
|
| Rate for Payer: BCBS MAPPO |
$668.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,197.30
|
| Rate for Payer: BCN Commercial |
$2,078.09
|
| Rate for Payer: BCN Medicare Advantage |
$668.20
|
| Rate for Payer: Cash Price |
$2,138.23
|
| Rate for Payer: Cofinity Commercial |
$2,298.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,138.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$668.20
|
| Rate for Payer: Healthscope Commercial |
$2,405.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,004.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$701.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$768.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,271.87
|
| Rate for Payer: Nomi Health Commercial |
$2,191.69
|
| Rate for Payer: PACE Senior Care Partners |
$634.79
|
| Rate for Payer: PACE SWMI |
$668.20
|
| Rate for Payer: PHP Commercial |
$2,271.87
|
| Rate for Payer: PHP Medicare Advantage |
$668.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,737.31
|
| Rate for Payer: Priority Health HMO/PPO |
$2,325.33
|
| Rate for Payer: Priority Health Medicare |
$674.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,790.77
|
| Rate for Payer: Railroad Medicare Medicare |
$668.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,352.06
|
| Rate for Payer: UHC Core |
$2,231.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$668.20
|
| Rate for Payer: UHC Exchange |
$668.20
|
| Rate for Payer: UHC Medicare Advantage |
$668.20
|
| Rate for Payer: VA VA |
$668.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,004.59
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
IP
|
$2,672.79
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,737.31 |
| Max. Negotiated Rate |
$2,405.51 |
| Rate for Payer: Aetna Commercial |
$2,271.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,181.80
|
| Rate for Payer: BCN Commercial |
$2,065.53
|
| Rate for Payer: Cash Price |
$2,138.23
|
| Rate for Payer: Cofinity Commercial |
$2,298.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,138.23
|
| Rate for Payer: Healthscope Commercial |
$2,405.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,004.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,271.87
|
| Rate for Payer: Nomi Health Commercial |
$2,191.69
|
| Rate for Payer: PHP Commercial |
$2,271.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,737.31
|
| Rate for Payer: Priority Health HMO/PPO |
$2,325.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,790.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,352.06
|
| Rate for Payer: UHC Core |
$2,231.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,004.59
|
|
|
HC TILT TABLE STRESS
|
Facility
|
OP
|
$1,122.86
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$266.68 |
| Max. Negotiated Rate |
$1,010.57 |
| Rate for Payer: Aetna Commercial |
$954.43
|
| Rate for Payer: Aetna Medicare |
$291.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$350.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$350.89
|
| Rate for Payer: BCBS Complete |
$394.69
|
| Rate for Payer: BCBS MAPPO |
$280.72
|
| Rate for Payer: BCBS Trust/PPO |
$923.10
|
| Rate for Payer: BCN Commercial |
$873.02
|
| Rate for Payer: BCN Medicare Advantage |
$280.72
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$965.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.72
|
| Rate for Payer: Healthscope Commercial |
$1,010.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.14
|
| Rate for Payer: Mclaren Medicaid |
$375.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.75
|
| Rate for Payer: Meridian Medicaid |
$394.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: Nomi Health Commercial |
$920.75
|
| Rate for Payer: PACE Senior Care Partners |
$266.68
|
| Rate for Payer: PACE SWMI |
$280.72
|
| Rate for Payer: PHP Commercial |
$954.43
|
| Rate for Payer: PHP Medicare Advantage |
$280.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: Priority Health HMO/PPO |
$976.89
|
| Rate for Payer: Priority Health Medicare |
$283.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$752.32
|
| Rate for Payer: Railroad Medicare Medicare |
$280.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$988.12
|
| Rate for Payer: UHC Core |
$937.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.72
|
| Rate for Payer: UHC Exchange |
$280.72
|
| Rate for Payer: UHC Medicare Advantage |
$280.72
|
| Rate for Payer: UHCCP Medicaid |
$375.87
|
| Rate for Payer: VA VA |
$280.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.14
|
|
|
HC TILT TABLE STRESS
|
Facility
|
IP
|
$1,122.86
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$729.86 |
| Max. Negotiated Rate |
$1,010.57 |
| Rate for Payer: Aetna Commercial |
$954.43
|
| Rate for Payer: BCBS Trust/PPO |
$916.59
|
| Rate for Payer: BCN Commercial |
$867.75
|
| Rate for Payer: Cash Price |
$898.29
|
| Rate for Payer: Cofinity Commercial |
$965.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.29
|
| Rate for Payer: Healthscope Commercial |
$1,010.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.43
|
| Rate for Payer: Nomi Health Commercial |
$920.75
|
| Rate for Payer: PHP Commercial |
$954.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$729.86
|
| Rate for Payer: Priority Health HMO/PPO |
$976.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$752.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$988.12
|
| Rate for Payer: UHC Core |
$937.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.14
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
IP
|
$42.84
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: BCBS Trust/PPO |
$34.97
|
| Rate for Payer: BCN Commercial |
$33.11
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
OP
|
$42.84
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.39
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS MAPPO |
$10.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.22
|
| Rate for Payer: BCN Commercial |
$33.31
|
| Rate for Payer: BCN Medicare Advantage |
$10.71
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: PACE Senior Care Partners |
$10.17
|
| Rate for Payer: PACE SWMI |
$10.71
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Medicare |
$10.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.70
|
| Rate for Payer: Railroad Medicare Medicare |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.71
|
| Rate for Payer: UHC Exchange |
$10.71
|
| Rate for Payer: UHC Medicare Advantage |
$10.71
|
| Rate for Payer: VA VA |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
IP
|
$269.46
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$175.15 |
| Max. Negotiated Rate |
$242.51 |
| Rate for Payer: Aetna Commercial |
$229.04
|
| Rate for Payer: BCBS Trust/PPO |
$219.96
|
| Rate for Payer: BCN Commercial |
$208.24
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$231.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Healthscope Commercial |
$242.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: Nomi Health Commercial |
$220.96
|
| Rate for Payer: PHP Commercial |
$229.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: Priority Health HMO/PPO |
$234.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.12
|
| Rate for Payer: UHC Core |
$225.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.10
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
OP
|
$269.46
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$242.51 |
| Rate for Payer: Aetna Commercial |
$229.04
|
| Rate for Payer: Aetna Medicare |
$70.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.21
|
| Rate for Payer: BCBS Complete |
$107.78
|
| Rate for Payer: BCBS MAPPO |
$67.36
|
| Rate for Payer: BCBS Trust/PPO |
$221.52
|
| Rate for Payer: BCCCP Commercial |
$121.51
|
| Rate for Payer: BCN Commercial |
$209.51
|
| Rate for Payer: BCN Medicare Advantage |
$67.36
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$231.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.36
|
| Rate for Payer: Healthscope Commercial |
$242.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: Nomi Health Commercial |
$220.96
|
| Rate for Payer: PACE Senior Care Partners |
$64.00
|
| Rate for Payer: PACE SWMI |
$67.36
|
| Rate for Payer: PHP Commercial |
$229.04
|
| Rate for Payer: PHP Medicare Advantage |
$67.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: Priority Health HMO/PPO |
$234.43
|
| Rate for Payer: Priority Health Medicare |
$68.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.54
|
| Rate for Payer: Railroad Medicare Medicare |
$67.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.12
|
| Rate for Payer: UHC Core |
$225.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.36
|
| Rate for Payer: UHC Exchange |
$67.36
|
| Rate for Payer: UHC Medicare Advantage |
$67.36
|
| Rate for Payer: VA VA |
$67.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.10
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
OP
|
$355.46
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$84.42 |
| Max. Negotiated Rate |
$319.91 |
| Rate for Payer: Aetna Commercial |
$302.14
|
| Rate for Payer: Aetna Medicare |
$92.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.08
|
| Rate for Payer: BCBS Complete |
$127.47
|
| Rate for Payer: BCBS MAPPO |
$88.86
|
| Rate for Payer: BCBS Trust/PPO |
$292.22
|
| Rate for Payer: BCCCP Commercial |
$161.79
|
| Rate for Payer: BCN Commercial |
$276.37
|
| Rate for Payer: BCN Medicare Advantage |
$88.86
|
| Rate for Payer: Cash Price |
$284.37
|
| Rate for Payer: Cash Price |
$284.37
|
| Rate for Payer: Cofinity Commercial |
$305.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.86
|
| Rate for Payer: Healthscope Commercial |
$319.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.60
|
| Rate for Payer: Mclaren Medicaid |
$121.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.31
|
| Rate for Payer: Meridian Medicaid |
$127.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.14
|
| Rate for Payer: Nomi Health Commercial |
$291.48
|
| Rate for Payer: PACE Senior Care Partners |
$84.42
|
| Rate for Payer: PACE SWMI |
$88.86
|
| Rate for Payer: PHP Commercial |
$302.14
|
| Rate for Payer: PHP Medicare Advantage |
$88.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.05
|
| Rate for Payer: Priority Health HMO/PPO |
$309.25
|
| Rate for Payer: Priority Health Medicare |
$89.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.16
|
| Rate for Payer: Railroad Medicare Medicare |
$88.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.80
|
| Rate for Payer: UHC Core |
$296.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.86
|
| Rate for Payer: UHC Exchange |
$88.86
|
| Rate for Payer: UHC Medicare Advantage |
$88.86
|
| Rate for Payer: UHCCP Medicaid |
$121.39
|
| Rate for Payer: VA VA |
$88.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.60
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
IP
|
$355.46
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$231.05 |
| Max. Negotiated Rate |
$319.91 |
| Rate for Payer: Aetna Commercial |
$302.14
|
| Rate for Payer: BCBS Trust/PPO |
$290.16
|
| Rate for Payer: BCN Commercial |
$274.70
|
| Rate for Payer: Cash Price |
$284.37
|
| Rate for Payer: Cofinity Commercial |
$305.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.37
|
| Rate for Payer: Healthscope Commercial |
$319.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.14
|
| Rate for Payer: Nomi Health Commercial |
$291.48
|
| Rate for Payer: PHP Commercial |
$302.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.05
|
| Rate for Payer: Priority Health HMO/PPO |
$309.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.80
|
| Rate for Payer: UHC Core |
$296.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.60
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
OP
|
$269.46
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$267.58 |
| Rate for Payer: Aetna Commercial |
$229.04
|
| Rate for Payer: Aetna Medicare |
$70.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.21
|
| Rate for Payer: BCBS Complete |
$267.58
|
| Rate for Payer: BCBS MAPPO |
$67.36
|
| Rate for Payer: BCBS Trust/PPO |
$221.52
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$209.51
|
| Rate for Payer: BCN Medicare Advantage |
$67.36
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$231.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.36
|
| Rate for Payer: Healthscope Commercial |
$242.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.10
|
| Rate for Payer: Mclaren Medicaid |
$254.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.73
|
| Rate for Payer: Meridian Medicaid |
$267.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: Nomi Health Commercial |
$220.96
|
| Rate for Payer: PACE Senior Care Partners |
$64.00
|
| Rate for Payer: PACE SWMI |
$67.36
|
| Rate for Payer: PHP Commercial |
$229.04
|
| Rate for Payer: PHP Medicare Advantage |
$67.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: Priority Health HMO/PPO |
$234.43
|
| Rate for Payer: Priority Health Medicare |
$68.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.54
|
| Rate for Payer: Railroad Medicare Medicare |
$67.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.12
|
| Rate for Payer: UHC Core |
$225.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.36
|
| Rate for Payer: UHC Exchange |
$67.36
|
| Rate for Payer: UHC Medicare Advantage |
$67.36
|
| Rate for Payer: UHCCP Medicaid |
$254.82
|
| Rate for Payer: VA VA |
$67.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.10
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
IP
|
$269.46
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$175.15 |
| Max. Negotiated Rate |
$242.51 |
| Rate for Payer: Aetna Commercial |
$229.04
|
| Rate for Payer: BCBS Trust/PPO |
$219.96
|
| Rate for Payer: BCN Commercial |
$208.24
|
| Rate for Payer: Cash Price |
$215.57
|
| Rate for Payer: Cofinity Commercial |
$231.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.57
|
| Rate for Payer: Healthscope Commercial |
$242.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.04
|
| Rate for Payer: Nomi Health Commercial |
$220.96
|
| Rate for Payer: PHP Commercial |
$229.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.15
|
| Rate for Payer: Priority Health HMO/PPO |
$234.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.12
|
| Rate for Payer: UHC Core |
$225.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.10
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
OP
|
$1,470.09
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.15 |
| Max. Negotiated Rate |
$1,323.08 |
| Rate for Payer: Aetna Commercial |
$1,249.58
|
| Rate for Payer: Aetna Medicare |
$382.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$459.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$459.40
|
| Rate for Payer: BCBS Complete |
$588.04
|
| Rate for Payer: BCBS MAPPO |
$367.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,208.56
|
| Rate for Payer: BCN Commercial |
$1,142.99
|
| Rate for Payer: BCN Medicare Advantage |
$367.52
|
| Rate for Payer: Cash Price |
$1,176.07
|
| Rate for Payer: Cofinity Commercial |
$1,264.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,176.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$367.52
|
| Rate for Payer: Healthscope Commercial |
$1,323.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,102.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$385.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.58
|
| Rate for Payer: Nomi Health Commercial |
$1,205.47
|
| Rate for Payer: PACE Senior Care Partners |
$349.15
|
| Rate for Payer: PACE SWMI |
$367.52
|
| Rate for Payer: PHP Commercial |
$1,249.58
|
| Rate for Payer: PHP Medicare Advantage |
$367.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.56
|
| Rate for Payer: Priority Health HMO/PPO |
$1,278.98
|
| Rate for Payer: Priority Health Medicare |
$371.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$984.96
|
| Rate for Payer: Railroad Medicare Medicare |
$367.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,293.68
|
| Rate for Payer: UHC Core |
$1,227.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$367.52
|
| Rate for Payer: UHC Exchange |
$367.52
|
| Rate for Payer: UHC Medicare Advantage |
$367.52
|
| Rate for Payer: VA VA |
$367.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,102.57
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
IP
|
$1,470.09
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.56 |
| Max. Negotiated Rate |
$1,323.08 |
| Rate for Payer: Aetna Commercial |
$1,249.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,200.03
|
| Rate for Payer: BCN Commercial |
$1,136.09
|
| Rate for Payer: Cash Price |
$1,176.07
|
| Rate for Payer: Cofinity Commercial |
$1,264.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,176.07
|
| Rate for Payer: Healthscope Commercial |
$1,323.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,102.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,249.58
|
| Rate for Payer: Nomi Health Commercial |
$1,205.47
|
| Rate for Payer: PHP Commercial |
$1,249.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.56
|
| Rate for Payer: Priority Health HMO/PPO |
$1,278.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$984.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,293.68
|
| Rate for Payer: UHC Core |
$1,227.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,102.57
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
IP
|
$1,331.10
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.22 |
| Max. Negotiated Rate |
$1,197.99 |
| Rate for Payer: Aetna Commercial |
$1,131.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.58
|
| Rate for Payer: BCN Commercial |
$1,028.67
|
| Rate for Payer: Cash Price |
$1,064.88
|
| Rate for Payer: Cofinity Commercial |
$1,144.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.88
|
| Rate for Payer: Healthscope Commercial |
$1,197.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$998.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,131.44
|
| Rate for Payer: Nomi Health Commercial |
$1,091.50
|
| Rate for Payer: PHP Commercial |
$1,131.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$865.22
|
| Rate for Payer: Priority Health HMO/PPO |
$1,158.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$891.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,171.37
|
| Rate for Payer: UHC Core |
$1,111.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$998.32
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
OP
|
$1,331.10
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$316.14 |
| Max. Negotiated Rate |
$1,197.99 |
| Rate for Payer: Aetna Commercial |
$1,131.44
|
| Rate for Payer: Aetna Medicare |
$346.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$415.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$415.97
|
| Rate for Payer: BCBS Complete |
$532.44
|
| Rate for Payer: BCBS MAPPO |
$332.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,094.30
|
| Rate for Payer: BCN Commercial |
$1,034.93
|
| Rate for Payer: BCN Medicare Advantage |
$332.78
|
| Rate for Payer: Cash Price |
$1,064.88
|
| Rate for Payer: Cofinity Commercial |
$1,144.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,064.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.78
|
| Rate for Payer: Healthscope Commercial |
$1,197.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$998.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$382.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,131.44
|
| Rate for Payer: Nomi Health Commercial |
$1,091.50
|
| Rate for Payer: PACE Senior Care Partners |
$316.14
|
| Rate for Payer: PACE SWMI |
$332.78
|
| Rate for Payer: PHP Commercial |
$1,131.44
|
| Rate for Payer: PHP Medicare Advantage |
$332.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$865.22
|
| Rate for Payer: Priority Health HMO/PPO |
$1,158.06
|
| Rate for Payer: Priority Health Medicare |
$336.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$891.84
|
| Rate for Payer: Railroad Medicare Medicare |
$332.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,171.37
|
| Rate for Payer: UHC Core |
$1,111.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$332.78
|
| Rate for Payer: UHC Exchange |
$332.78
|
| Rate for Payer: UHC Medicare Advantage |
$332.78
|
| Rate for Payer: VA VA |
$332.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$998.32
|
|
