|
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 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 |
$402.83
|
| Rate for Payer: BCBS MAPPO |
$280.71
|
| Rate for Payer: BCBS Trust/PPO |
$923.10
|
| Rate for Payer: BCN Commercial |
$873.02
|
| Rate for Payer: BCN Medicare Advantage |
$280.71
|
| 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 |
$280.71
|
| Rate for Payer: Healthscope Commercial |
$1,010.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.14
|
| Rate for Payer: Mclaren Medicaid |
$383.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.75
|
| Rate for Payer: Meridian Medicaid |
$402.83
|
| 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 |
$280.71
|
| Rate for Payer: PHP Commercial |
$954.43
|
| Rate for Payer: PHP Medicare Advantage |
$280.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.62
|
| 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 |
$280.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$988.12
|
| Rate for Payer: UHC Core |
$937.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.71
|
| Rate for Payer: UHC Exchange |
$280.71
|
| Rate for Payer: UHC Medicare Advantage |
$280.71
|
| Rate for Payer: UHCCP Medicaid |
$383.62
|
| Rate for Payer: VA VA |
$280.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.14
|
|
|
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 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 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 |
$202.09
|
| 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 |
$202.09
|
|
|
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: BCN Commercial |
$209.51
|
| Rate for Payer: BCN Medicare Advantage |
$67.36
|
| 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 |
$202.09
|
| 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 |
$202.09
|
|
|
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 |
$130.10
|
| Rate for Payer: BCBS MAPPO |
$88.86
|
| Rate for Payer: BCBS Trust/PPO |
$292.22
|
| 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 |
$123.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.31
|
| Rate for Payer: Meridian Medicaid |
$130.10
|
| 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 |
$123.89
|
| 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 |
$123.89
|
| 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
|
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 |
$202.09
|
| 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 |
$202.09
|
|
|
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 |
$273.10 |
| 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 |
$273.10
|
| Rate for Payer: BCBS MAPPO |
$67.36
|
| Rate for Payer: BCBS Trust/PPO |
$221.52
|
| 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 |
$202.09
|
| Rate for Payer: Mclaren Medicaid |
$260.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.73
|
| Rate for Payer: Meridian Medicaid |
$273.10
|
| 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 |
$260.08
|
| 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 |
$260.08
|
| Rate for Payer: VA VA |
$67.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.09
|
|
|
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 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 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 |
$1,131.43
|
| 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 |
$332.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,094.30
|
| Rate for Payer: BCN Commercial |
$1,034.93
|
| Rate for Payer: BCN Medicare Advantage |
$332.77
|
| 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 |
$332.77
|
| Rate for Payer: Healthscope Commercial |
$1,197.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$998.33
|
| 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 |
$1,131.43
|
| Rate for Payer: Nomi Health Commercial |
$1,091.50
|
| Rate for Payer: PACE Senior Care Partners |
$316.14
|
| Rate for Payer: PACE SWMI |
$332.77
|
| Rate for Payer: PHP Commercial |
$1,131.43
|
| Rate for Payer: PHP Medicare Advantage |
$332.77
|
| 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 |
$332.77
|
| 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 |
$332.77
|
| Rate for Payer: UHC Exchange |
$332.77
|
| Rate for Payer: UHC Medicare Advantage |
$332.77
|
| Rate for Payer: VA VA |
$332.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$998.33
|
|
|
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 |
$1,131.43
|
| 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 |
$998.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,131.43
|
| Rate for Payer: Nomi Health Commercial |
$1,091.50
|
| Rate for Payer: PHP Commercial |
$1,131.43
|
| 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 |
$998.33
|
|
|
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 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 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
|
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 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 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
|
|
