|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
IP
|
$274.85
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$120.93 |
| Max. Negotiated Rate |
$247.37 |
| Rate for Payer: Aetna American Axle |
$178.65
|
| Rate for Payer: Aetna Commercial |
$233.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.65
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cofinity Advantage |
$192.40
|
| Rate for Payer: Cofinity Commercial |
$236.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.88
|
| Rate for Payer: Healthscope Commercial |
$247.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.14
|
| Rate for Payer: PHP Commercial |
$233.62
|
| Rate for Payer: Priority Health SBD |
$173.16
|
| Rate for Payer: UMR Bronson Commercial |
$120.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.14
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
OP
|
$379.45
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.78 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna American Axle |
$246.64
|
| Rate for Payer: Aetna Commercial |
$322.53
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$245.04
|
| Rate for Payer: BCCCP Commercial |
$161.79
|
| Rate for Payer: BCN Commercial |
$245.04
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$303.56
|
| Rate for Payer: Cash Price |
$303.56
|
| Rate for Payer: Cofinity Advantage |
$265.62
|
| Rate for Payer: Cofinity Commercial |
$326.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$341.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.59
|
| Rate for Payer: Mclaren Medicaid |
$169.76
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.53
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.59
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$322.53
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health SBD |
$239.05
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$257.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: UMR Bronson Commercial |
$140.40
|
| Rate for Payer: VA VA |
$169.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.59
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
IP
|
$379.45
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$166.96 |
| Max. Negotiated Rate |
$341.50 |
| Rate for Payer: Aetna American Axle |
$246.64
|
| Rate for Payer: Aetna Commercial |
$322.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.64
|
| Rate for Payer: Cash Price |
$303.56
|
| Rate for Payer: Cofinity Advantage |
$265.62
|
| Rate for Payer: Cofinity Commercial |
$326.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.56
|
| Rate for Payer: Healthscope Commercial |
$341.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$284.59
|
| Rate for Payer: PHP Commercial |
$322.53
|
| Rate for Payer: Priority Health SBD |
$239.05
|
| Rate for Payer: UMR Bronson Commercial |
$166.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.59
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
IP
|
$274.85
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$120.93 |
| Max. Negotiated Rate |
$247.37 |
| Rate for Payer: Aetna American Axle |
$178.65
|
| Rate for Payer: Aetna Commercial |
$233.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.65
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cofinity Advantage |
$192.40
|
| Rate for Payer: Cofinity Commercial |
$236.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.88
|
| Rate for Payer: Healthscope Commercial |
$247.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.14
|
| Rate for Payer: PHP Commercial |
$233.62
|
| Rate for Payer: Priority Health SBD |
$173.16
|
| Rate for Payer: UMR Bronson Commercial |
$120.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.14
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
OP
|
$274.85
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.69 |
| Max. Negotiated Rate |
$1,155.01 |
| Rate for Payer: Aetna American Axle |
$178.65
|
| Rate for Payer: Aetna Commercial |
$233.62
|
| Rate for Payer: Aetna Medicare |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$199.48
|
| Rate for Payer: BCCCP Commercial |
$138.78
|
| Rate for Payer: BCN Commercial |
$199.48
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cash Price |
$219.88
|
| Rate for Payer: Cofinity Advantage |
$192.40
|
| Rate for Payer: Cofinity Commercial |
$236.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$247.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.14
|
| Rate for Payer: Mclaren Medicaid |
$357.16
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$375.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.62
|
| Rate for Payer: Nomi Health Commercial |
$1,071.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.14
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$233.62
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,155.01
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health SBD |
$173.16
|
| Rate for Payer: Priority Health Tiered Network |
$924.01
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.58
|
| Rate for Payer: UHC Core |
$539.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$539.58
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: UMR Bronson Commercial |
$101.69
|
| Rate for Payer: VA VA |
$357.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.14
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
OP
|
$1,499.49
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.81 |
| Max. Negotiated Rate |
$1,349.54 |
| Rate for Payer: Aetna American Axle |
$974.67
|
| Rate for Payer: Aetna Commercial |
$1,274.57
|
| Rate for Payer: Aetna Medicare |
$749.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.67
|
| Rate for Payer: BCBS Complete |
$599.80
|
| Rate for Payer: Cash Price |
$1,199.59
|
| Rate for Payer: Cofinity Advantage |
$1,049.64
|
| Rate for Payer: Cofinity Commercial |
$1,289.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,199.59
|
| Rate for Payer: Healthscope Commercial |
$1,349.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,049.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,124.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,199.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,274.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,124.62
|
| Rate for Payer: PHP Commercial |
$1,274.57
|
| Rate for Payer: Priority Health SBD |
$944.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.67
|
| Rate for Payer: UHC Core |
$781.23
|
| Rate for Payer: UHC Exchange |
$589.30
|
| Rate for Payer: UMR Bronson Commercial |
$554.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,124.62
|
|
|
HC TISSUE MARKER IMPLANTABLE
|
Facility
|
IP
|
$1,499.49
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.78 |
| Max. Negotiated Rate |
$1,349.54 |
| Rate for Payer: Aetna American Axle |
$974.67
|
| Rate for Payer: Aetna Commercial |
$1,274.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.67
|
| Rate for Payer: Cash Price |
$1,199.59
|
| Rate for Payer: Cofinity Advantage |
$1,049.64
|
| Rate for Payer: Cofinity Commercial |
$1,289.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,199.59
|
| Rate for Payer: Healthscope Commercial |
$1,349.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,049.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,124.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,274.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,124.62
|
| Rate for Payer: PHP Commercial |
$1,274.57
|
| Rate for Payer: Priority Health SBD |
$944.68
|
| Rate for Payer: UMR Bronson Commercial |
$659.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,124.62
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
IP
|
$1,357.72
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.40 |
| Max. Negotiated Rate |
$1,221.95 |
| Rate for Payer: Aetna American Axle |
$882.52
|
| Rate for Payer: Aetna Commercial |
$1,154.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.52
|
| Rate for Payer: Cash Price |
$1,086.18
|
| Rate for Payer: Cofinity Advantage |
$950.40
|
| Rate for Payer: Cofinity Commercial |
$1,167.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,086.18
|
| Rate for Payer: Healthscope Commercial |
$1,221.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$950.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,018.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,154.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,018.29
|
| Rate for Payer: PHP Commercial |
$1,154.06
|
| Rate for Payer: Priority Health SBD |
$855.36
|
| Rate for Payer: UMR Bronson Commercial |
$597.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,018.29
|
|
|
HC TISSUE MARKER PROSTATE
|
Facility
|
OP
|
$1,357.72
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.36 |
| Max. Negotiated Rate |
$1,221.95 |
| Rate for Payer: Aetna American Axle |
$882.52
|
| Rate for Payer: Aetna Commercial |
$1,154.06
|
| Rate for Payer: Aetna Medicare |
$678.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.52
|
| Rate for Payer: BCBS Complete |
$543.09
|
| Rate for Payer: Cash Price |
$1,086.18
|
| Rate for Payer: Cofinity Advantage |
$950.40
|
| Rate for Payer: Cofinity Commercial |
$1,167.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,086.18
|
| Rate for Payer: Healthscope Commercial |
$1,221.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$950.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,018.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,086.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,154.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,018.29
|
| Rate for Payer: PHP Commercial |
$1,154.06
|
| Rate for Payer: Priority Health SBD |
$855.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$882.52
|
| Rate for Payer: UHC Core |
$707.37
|
| Rate for Payer: UHC Exchange |
$533.58
|
| Rate for Payer: UMR Bronson Commercial |
$502.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,018.29
|
|
|
HC TISSUE PROCESSING
|
Facility
|
OP
|
$52.34
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna American Axle |
$34.02
|
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.35
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$6.80
|
| Rate for Payer: BCN Commercial |
$6.80
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Advantage |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.26
|
| Rate for Payer: Mclaren Medicaid |
$5.88
|
| Rate for Payer: Mclaren Medicare |
$5.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: Meridian Medicaid |
$6.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$8.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PACE Medicare |
$5.59
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.88
|
| Rate for Payer: Priority Health Medicare |
$5.88
|
| Rate for Payer: Priority Health SBD |
$32.97
|
| Rate for Payer: Priority Health Tiered Network |
$4.70
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.82
|
| Rate for Payer: UHC Core |
$8.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.88
|
| Rate for Payer: UHC Exchange |
$8.82
|
| Rate for Payer: UHC Medicaid |
$3.08
|
| Rate for Payer: UHCCP Medicaid |
$3.08
|
| Rate for Payer: UMR Bronson Commercial |
$19.37
|
| Rate for Payer: VA VA |
$5.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.26
|
|
|
HC TISSUE PROCESSING
|
Facility
|
IP
|
$52.34
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
30600095
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.03 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna American Axle |
$34.02
|
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.02
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Advantage |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: Priority Health SBD |
$32.97
|
| Rate for Payer: UMR Bronson Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.26
|
|
|
HC TISSUE TRANSFER ANY AREA 30.1-60 SQ CM
|
Facility
|
IP
|
$10,750.80
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
76100537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,730.35 |
| Max. Negotiated Rate |
$9,675.72 |
| Rate for Payer: Aetna American Axle |
$6,988.02
|
| Rate for Payer: Aetna Commercial |
$9,138.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,988.02
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cofinity Advantage |
$7,525.56
|
| Rate for Payer: Cofinity Commercial |
$9,245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,600.64
|
| Rate for Payer: Healthscope Commercial |
$9,675.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,525.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,063.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,138.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,063.10
|
| Rate for Payer: PHP Commercial |
$9,138.18
|
| Rate for Payer: Priority Health SBD |
$6,773.00
|
| Rate for Payer: UMR Bronson Commercial |
$4,730.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,063.10
|
|
|
HC TISSUE TRANSFER ANY AREA 30.1-60 SQ CM
|
Facility
|
OP
|
$10,750.80
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
76100537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,846.70 |
| Max. Negotiated Rate |
$11,418.88 |
| Rate for Payer: Aetna American Axle |
$6,988.02
|
| Rate for Payer: Aetna Commercial |
$9,138.18
|
| Rate for Payer: Aetna Medicare |
$3,672.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,988.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,546.78
|
| Rate for Payer: BCN Commercial |
$2,546.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cash Price |
$8,600.64
|
| Rate for Payer: Cofinity Advantage |
$7,525.56
|
| Rate for Payer: Cofinity Commercial |
$9,245.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,600.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Healthscope Commercial |
$9,675.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,525.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,063.10
|
| Rate for Payer: Mclaren Medicaid |
$3,530.98
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$3,707.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,138.18
|
| Rate for Payer: Nomi Health Commercial |
$10,592.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,063.10
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Commercial |
$9,138.18
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,418.88
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health SBD |
$6,773.00
|
| Rate for Payer: Priority Health Tiered Network |
$9,135.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,988.02
|
| Rate for Payer: UHC Core |
$5,601.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,530.98
|
| Rate for Payer: UHC Exchange |
$4,225.06
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: UMR Bronson Commercial |
$3,977.80
|
| Rate for Payer: VA VA |
$3,530.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,063.10
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna American Axle |
$37.87
|
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.87
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Advantage |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: Priority Health SBD |
$36.70
|
| Rate for Payer: UMR Bronson Commercial |
$25.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.70
|
|
|
HC TISSUE TRANSGLT AB IGA OR IGG, S
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
CPT 86364
|
| Hospital Charge Code |
30200510
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna American Axle |
$37.87
|
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$13.33
|
| Rate for Payer: BCN Commercial |
$13.33
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Advantage |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.70
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.53
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$36.70
|
| Rate for Payer: Priority Health Tiered Network |
$9.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.30
|
| Rate for Payer: UHC Core |
$17.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.30
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: UMR Bronson Commercial |
$21.56
|
| Rate for Payer: VA VA |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.70
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna American Axle |
$24.14
|
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.14
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Advantage |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: Priority Health SBD |
$23.40
|
| Rate for Payer: UMR Bronson Commercial |
$16.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC TISSUE TRANSGLUTAMINASE IGA
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200010
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna American Axle |
$24.14
|
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$13.33
|
| Rate for Payer: BCN Commercial |
$13.33
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Advantage |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.53
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$23.40
|
| Rate for Payer: Priority Health Tiered Network |
$9.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.30
|
| Rate for Payer: UHC Core |
$17.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.30
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: UMR Bronson Commercial |
$13.74
|
| Rate for Payer: VA VA |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna American Axle |
$24.14
|
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$13.33
|
| Rate for Payer: BCN Commercial |
$13.33
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Advantage |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Mclaren Medicaid |
$11.53
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.53
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$23.40
|
| Rate for Payer: Priority Health Tiered Network |
$9.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.30
|
| Rate for Payer: UHC Core |
$17.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.53
|
| Rate for Payer: UHC Exchange |
$17.30
|
| Rate for Payer: UHC Medicaid |
$6.03
|
| Rate for Payer: UHCCP Medicaid |
$6.03
|
| Rate for Payer: UMR Bronson Commercial |
$13.74
|
| Rate for Payer: VA VA |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna American Axle |
$24.14
|
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.14
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Advantage |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: Priority Health SBD |
$23.40
|
| Rate for Payer: UMR Bronson Commercial |
$16.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
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 American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$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: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$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
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$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: Kalamazoo County Sherrif's Dept 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: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.00
|
| 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 American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$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: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$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
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$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: Kalamazoo County Sherrif's Dept 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: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC TL 201 PER MCI
|
Facility
|
OP
|
$197.13
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$53.91 |
| Max. Negotiated Rate |
$177.42 |
| Rate for Payer: Aetna American Axle |
$128.13
|
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: Aetna Medicare |
$98.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.13
|
| Rate for Payer: BCBS Complete |
$78.85
|
| Rate for Payer: BCBS Trust/PPO |
$53.91
|
| Rate for Payer: BCN Commercial |
$53.91
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cofinity Advantage |
$137.99
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: Priority Health SBD |
$124.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.80
|
| Rate for Payer: UHC Core |
$78.80
|
| Rate for Payer: UHC Exchange |
$78.80
|
| Rate for Payer: UMR Bronson Commercial |
$72.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.85
|
|
|
HC TL 201 PER MCI
|
Facility
|
IP
|
$197.13
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$86.74 |
| Max. Negotiated Rate |
$177.42 |
| Rate for Payer: Aetna American Axle |
$128.13
|
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.13
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cofinity Advantage |
$137.99
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: Priority Health SBD |
$124.19
|
| Rate for Payer: UMR Bronson Commercial |
$86.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.85
|
|
