|
HC TISSUE PROCESSING
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna Medicare |
$13.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.03
|
| Rate for Payer: BCBS Complete |
$4.46
|
| Rate for Payer: BCBS MAPPO |
$12.83
|
| Rate for Payer: BCBS Trust/PPO |
$42.18
|
| Rate for Payer: BCN Commercial |
$39.89
|
| Rate for Payer: BCN Medicare Advantage |
$12.83
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.83
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.48
|
| Rate for Payer: Mclaren Medicaid |
$4.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.47
|
| Rate for Payer: Meridian Medicaid |
$4.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: PACE Senior Care Partners |
$12.19
|
| Rate for Payer: PACE SWMI |
$12.83
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: PHP Medicare Advantage |
$12.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO |
$44.64
|
| Rate for Payer: Priority Health Medicare |
$12.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.38
|
| Rate for Payer: Railroad Medicare Medicare |
$12.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.15
|
| Rate for Payer: UHC Core |
$42.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.83
|
| Rate for Payer: UHC Exchange |
$12.83
|
| Rate for Payer: UHC Medicare Advantage |
$12.83
|
| Rate for Payer: UHCCP Medicaid |
$4.25
|
| Rate for Payer: VA VA |
$12.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.48
|
|
|
HC TISSUE PROCESSING
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: BCBS Trust/PPO |
$41.88
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO |
$44.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.15
|
| Rate for Payer: UHC Core |
$42.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.48
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: BCBS Trust/PPO |
$46.63
|
| Rate for Payer: BCN Commercial |
$44.14
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO |
$49.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.27
|
| Rate for Payer: UHC Core |
$47.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.84
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna Medicare |
$14.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.85
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS MAPPO |
$14.28
|
| Rate for Payer: BCBS Trust/PPO |
$46.96
|
| Rate for Payer: BCN Commercial |
$44.41
|
| Rate for Payer: BCN Medicare Advantage |
$14.28
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.28
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.84
|
| Rate for Payer: Mclaren Medicaid |
$8.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.99
|
| Rate for Payer: Meridian Medicaid |
$8.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: PACE Senior Care Partners |
$13.57
|
| Rate for Payer: PACE SWMI |
$14.28
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: PHP Medicare Advantage |
$14.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO |
$49.69
|
| Rate for Payer: Priority Health Medicare |
$14.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.27
|
| Rate for Payer: Railroad Medicare Medicare |
$14.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.27
|
| Rate for Payer: UHC Core |
$47.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.28
|
| Rate for Payer: UHC Exchange |
$14.28
|
| Rate for Payer: UHC Medicare Advantage |
$14.28
|
| Rate for Payer: UHCCP Medicaid |
$8.34
|
| Rate for Payer: VA VA |
$14.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.84
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$9.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.38
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS MAPPO |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.93
|
| Rate for Payer: BCN Commercial |
$28.31
|
| Rate for Payer: BCN Medicare Advantage |
$9.10
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.10
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Mclaren Medicaid |
$8.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.56
|
| Rate for Payer: Meridian Medicaid |
$8.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.65
|
| Rate for Payer: PACE SWMI |
$9.10
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Medicare |
$9.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: Railroad Medicare Medicare |
$9.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.10
|
| Rate for Payer: UHC Exchange |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$9.10
|
| Rate for Payer: UHCCP Medicaid |
$8.34
|
| Rate for Payer: VA VA |
$9.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$28.14
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$28.14
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$9.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.38
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS MAPPO |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$29.93
|
| Rate for Payer: BCN Commercial |
$28.31
|
| Rate for Payer: BCN Medicare Advantage |
$9.10
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.10
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.31
|
| Rate for Payer: Mclaren Medicaid |
$8.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.56
|
| Rate for Payer: Meridian Medicaid |
$8.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$29.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.65
|
| Rate for Payer: PACE SWMI |
$9.10
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO |
$31.68
|
| Rate for Payer: Priority Health Medicare |
$9.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.39
|
| Rate for Payer: Railroad Medicare Medicare |
$9.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.04
|
| Rate for Payer: UHC Core |
$30.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.10
|
| Rate for Payer: UHC Exchange |
$9.10
|
| Rate for Payer: UHC Medicare Advantage |
$9.10
|
| Rate for Payer: UHCCP Medicaid |
$8.34
|
| Rate for Payer: VA VA |
$9.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.31
|
|
|
HC 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$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 Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 Dual Complete DSNP |
$0.00
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$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 Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 Dual Complete DSNP |
$0.00
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$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: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: 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 TL 201 PER MCI
|
Facility
|
IP
|
$193.26
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$125.62 |
| Max. Negotiated Rate |
$173.93 |
| Rate for Payer: Aetna Commercial |
$164.27
|
| Rate for Payer: BCBS Trust/PPO |
$157.76
|
| Rate for Payer: BCN Commercial |
$149.35
|
| Rate for Payer: Cash Price |
$154.61
|
| Rate for Payer: Cofinity Commercial |
$166.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.61
|
| Rate for Payer: Healthscope Commercial |
$173.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.27
|
| Rate for Payer: Nomi Health Commercial |
$158.47
|
| Rate for Payer: PHP Commercial |
$164.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.62
|
| Rate for Payer: Priority Health HMO/PPO |
$168.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.07
|
| Rate for Payer: UHC Core |
$161.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.94
|
|
|
HC TL 201 PER MCI
|
Facility
|
OP
|
$193.26
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$173.93 |
| Rate for Payer: Aetna Commercial |
$164.27
|
| Rate for Payer: Aetna Medicare |
$50.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.39
|
| Rate for Payer: BCBS Complete |
$77.30
|
| Rate for Payer: BCBS MAPPO |
$48.32
|
| Rate for Payer: BCBS Trust/PPO |
$158.88
|
| Rate for Payer: BCN Commercial |
$150.26
|
| Rate for Payer: BCN Medicare Advantage |
$48.32
|
| Rate for Payer: Cash Price |
$154.61
|
| Rate for Payer: Cofinity Commercial |
$166.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.32
|
| Rate for Payer: Healthscope Commercial |
$173.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.27
|
| Rate for Payer: Nomi Health Commercial |
$158.47
|
| Rate for Payer: PACE Senior Care Partners |
$45.90
|
| Rate for Payer: PACE SWMI |
$48.32
|
| Rate for Payer: PHP Commercial |
$164.27
|
| Rate for Payer: PHP Medicare Advantage |
$48.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.62
|
| Rate for Payer: Priority Health HMO/PPO |
$168.14
|
| Rate for Payer: Priority Health Medicare |
$48.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.48
|
| Rate for Payer: Railroad Medicare Medicare |
$48.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.07
|
| Rate for Payer: UHC Core |
$161.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.32
|
| Rate for Payer: UHC Exchange |
$48.32
|
| Rate for Payer: UHC Medicare Advantage |
$48.32
|
| Rate for Payer: VA VA |
$48.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.94
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna Medicare |
$27.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.60
|
| Rate for Payer: BCBS Complete |
$12.25
|
| Rate for Payer: BCBS MAPPO |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$88.38
|
| Rate for Payer: BCN Commercial |
$83.59
|
| Rate for Payer: BCN Medicare Advantage |
$26.88
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.88
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.63
|
| Rate for Payer: Mclaren Medicaid |
$11.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.22
|
| Rate for Payer: Meridian Medicaid |
$12.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: PACE Senior Care Partners |
$25.53
|
| Rate for Payer: PACE SWMI |
$26.88
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: PHP Medicare Advantage |
$26.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health HMO/PPO |
$93.53
|
| Rate for Payer: Priority Health Medicare |
$27.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.03
|
| Rate for Payer: Railroad Medicare Medicare |
$26.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.61
|
| Rate for Payer: UHC Core |
$89.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.88
|
| Rate for Payer: UHC Exchange |
$26.88
|
| Rate for Payer: UHC Medicare Advantage |
$26.88
|
| Rate for Payer: UHCCP Medicaid |
$11.66
|
| Rate for Payer: VA VA |
$26.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.63
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.88 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: BCBS Trust/PPO |
$87.76
|
| Rate for Payer: BCN Commercial |
$83.08
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health HMO/PPO |
$93.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.61
|
| Rate for Payer: UHC Core |
$89.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.63
|
|
|
HC TOMATO IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
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 TOMATO IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
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 TOMO GUIDED BREAST BIOPSY
|
Facility
|
OP
|
$4,731.78
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,123.80 |
| Max. Negotiated Rate |
$4,258.60 |
| Rate for Payer: Aetna Commercial |
$4,022.01
|
| Rate for Payer: Aetna Medicare |
$1,230.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,478.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,478.68
|
| Rate for Payer: BCBS Complete |
$2,848.40
|
| Rate for Payer: BCBS MAPPO |
$1,182.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,890.00
|
| Rate for Payer: BCN Commercial |
$3,678.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,182.94
|
| Rate for Payer: Cash Price |
$3,785.42
|
| Rate for Payer: Cash Price |
$3,785.42
|
| Rate for Payer: Cofinity Commercial |
$4,069.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,785.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,182.94
|
| Rate for Payer: Healthscope Commercial |
$4,258.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,548.84
|
| Rate for Payer: Mclaren Medicaid |
$2,712.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,242.09
|
| Rate for Payer: Meridian Medicaid |
$2,848.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,360.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,022.01
|
| Rate for Payer: Nomi Health Commercial |
$3,880.06
|
| Rate for Payer: PACE Senior Care Partners |
$1,123.80
|
| Rate for Payer: PACE SWMI |
$1,182.94
|
| Rate for Payer: PHP Commercial |
$4,022.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,182.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,712.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.66
|
| Rate for Payer: Priority Health HMO/PPO |
$4,116.65
|
| Rate for Payer: Priority Health Medicare |
$1,194.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,170.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,182.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,163.97
|
| Rate for Payer: UHC Core |
$3,951.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,182.94
|
| Rate for Payer: UHC Exchange |
$1,182.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,182.94
|
| Rate for Payer: UHCCP Medicaid |
$2,712.59
|
| Rate for Payer: VA VA |
$1,182.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,548.84
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
IP
|
$4,731.78
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,075.66 |
| Max. Negotiated Rate |
$4,258.60 |
| Rate for Payer: Aetna Commercial |
$4,022.01
|
| Rate for Payer: BCBS Trust/PPO |
$3,862.55
|
| Rate for Payer: BCN Commercial |
$3,656.72
|
| Rate for Payer: Cash Price |
$3,785.42
|
| Rate for Payer: Cofinity Commercial |
$4,069.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,785.42
|
| Rate for Payer: Healthscope Commercial |
$4,258.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,548.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,022.01
|
| Rate for Payer: Nomi Health Commercial |
$3,880.06
|
| Rate for Payer: PHP Commercial |
$4,022.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.66
|
| Rate for Payer: Priority Health HMO/PPO |
$4,116.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,170.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,163.97
|
| Rate for Payer: UHC Core |
$3,951.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,548.84
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
OP
|
$3,155.08
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$749.33 |
| Max. Negotiated Rate |
$2,848.40 |
| Rate for Payer: Aetna Commercial |
$2,681.82
|
| Rate for Payer: Aetna Medicare |
$820.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$985.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$985.96
|
| Rate for Payer: BCBS Complete |
$2,848.40
|
| Rate for Payer: BCBS MAPPO |
$788.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,593.79
|
| Rate for Payer: BCN Commercial |
$2,453.07
|
| Rate for Payer: BCN Medicare Advantage |
$788.77
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cofinity Commercial |
$2,713.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,524.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$788.77
|
| Rate for Payer: Healthscope Commercial |
$2,839.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,366.31
|
| Rate for Payer: Mclaren Medicaid |
$2,712.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$828.21
|
| Rate for Payer: Meridian Medicaid |
$2,848.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$907.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,681.82
|
| Rate for Payer: Nomi Health Commercial |
$2,587.17
|
| Rate for Payer: PACE Senior Care Partners |
$749.33
|
| Rate for Payer: PACE SWMI |
$788.77
|
| Rate for Payer: PHP Commercial |
$2,681.82
|
| Rate for Payer: PHP Medicare Advantage |
$788.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,712.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,050.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,744.92
|
| Rate for Payer: Priority Health Medicare |
$796.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,113.90
|
| Rate for Payer: Railroad Medicare Medicare |
$788.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,776.47
|
| Rate for Payer: UHC Core |
$2,634.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$788.77
|
| Rate for Payer: UHC Exchange |
$788.77
|
| Rate for Payer: UHC Medicare Advantage |
$788.77
|
| Rate for Payer: UHCCP Medicaid |
$2,712.59
|
| Rate for Payer: VA VA |
$788.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,366.31
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
IP
|
$3,155.08
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,050.80 |
| Max. Negotiated Rate |
$2,839.57 |
| Rate for Payer: Aetna Commercial |
$2,681.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,575.49
|
| Rate for Payer: BCN Commercial |
$2,438.25
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cofinity Commercial |
$2,713.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,524.06
|
| Rate for Payer: Healthscope Commercial |
$2,839.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,366.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,681.82
|
| Rate for Payer: Nomi Health Commercial |
$2,587.17
|
| Rate for Payer: PHP Commercial |
$2,681.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,050.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,744.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,113.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,776.47
|
| Rate for Payer: UHC Core |
$2,634.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,366.31
|
|
|
HC TONE DECAY HEARING TEST
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
CPT 92563
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: BCBS Trust/PPO |
$46.63
|
| Rate for Payer: BCN Commercial |
$44.14
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO |
$49.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.27
|
| Rate for Payer: UHC Core |
$47.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.84
|
|
|
HC TONE DECAY HEARING TEST
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
CPT 92563
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna Medicare |
$14.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.85
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS MAPPO |
$14.28
|
| Rate for Payer: BCBS Trust/PPO |
$46.96
|
| Rate for Payer: BCN Commercial |
$44.41
|
| Rate for Payer: BCN Medicare Advantage |
$14.28
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.28
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.84
|
| Rate for Payer: Mclaren Medicaid |
$27.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.99
|
| Rate for Payer: Meridian Medicaid |
$29.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: PACE Senior Care Partners |
$13.57
|
| Rate for Payer: PACE SWMI |
$14.28
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: PHP Medicare Advantage |
$14.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO |
$49.69
|
| Rate for Payer: Priority Health Medicare |
$14.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.27
|
| Rate for Payer: Railroad Medicare Medicare |
$14.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.27
|
| Rate for Payer: UHC Core |
$47.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.28
|
| Rate for Payer: UHC Exchange |
$14.28
|
| Rate for Payer: UHC Medicare Advantage |
$14.28
|
| Rate for Payer: UHCCP Medicaid |
$27.81
|
| Rate for Payer: VA VA |
$14.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.84
|
|
|
HC TOPIRAMATE LEVEL
|
Facility
|
OP
|
$58.62
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
30100050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$52.76 |
| Rate for Payer: Aetna Commercial |
$49.83
|
| Rate for Payer: Aetna Medicare |
$15.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.32
|
| Rate for Payer: BCBS Complete |
$9.05
|
| Rate for Payer: BCBS MAPPO |
$14.66
|
| Rate for Payer: BCBS Trust/PPO |
$48.19
|
| Rate for Payer: BCN Commercial |
$45.58
|
| Rate for Payer: BCN Medicare Advantage |
$14.66
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$50.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.66
|
| Rate for Payer: Healthscope Commercial |
$52.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.96
|
| Rate for Payer: Mclaren Medicaid |
$8.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.39
|
| Rate for Payer: Meridian Medicaid |
$9.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.83
|
| Rate for Payer: Nomi Health Commercial |
$48.07
|
| Rate for Payer: PACE Senior Care Partners |
$13.92
|
| Rate for Payer: PACE SWMI |
$14.66
|
| Rate for Payer: PHP Commercial |
$49.83
|
| Rate for Payer: PHP Medicare Advantage |
$14.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.10
|
| Rate for Payer: Priority Health HMO/PPO |
$51.00
|
| Rate for Payer: Priority Health Medicare |
$14.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.28
|
| Rate for Payer: Railroad Medicare Medicare |
$14.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.59
|
| Rate for Payer: UHC Core |
$48.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.66
|
| Rate for Payer: UHC Exchange |
$14.66
|
| Rate for Payer: UHC Medicare Advantage |
$14.66
|
| Rate for Payer: UHCCP Medicaid |
$8.62
|
| Rate for Payer: VA VA |
$14.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.96
|
|
