|
HC NM CISTERNOGRAM
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$630.48 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.49
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$700.53
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health SBD |
$630.48
|
|
|
HC NM CSF LEAK
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$243.29 |
| Max. Negotiated Rate |
$1,579.34 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna Medicare |
$1,314.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,579.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,579.34
|
| Rate for Payer: BCBS Complete |
$725.74
|
| Rate for Payer: BCBS MAPPO |
$1,263.47
|
| Rate for Payer: BCBS Trust/PPO |
$377.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,263.47
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$700.53
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,263.47
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Mclaren Medicaid |
$691.12
|
| Rate for Payer: Mclaren Medicare |
$1,263.47
|
| Rate for Payer: Meridian Medicaid |
$725.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,326.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,452.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PACE Medicare |
$1,200.30
|
| Rate for Payer: PACE SWMI |
$1,263.47
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,263.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$691.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health Medicare |
$1,263.47
|
| Rate for Payer: Priority Health SBD |
$630.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,263.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,263.47
|
| Rate for Payer: UHC Exchange |
$243.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,301.37
|
| Rate for Payer: VA VA |
$1,263.47
|
|
|
HC NM CSF LEAK
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$630.48 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.49
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$700.53
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health SBD |
$630.48
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health SBD |
$283.50
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.45 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health SBD |
$72.45
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$72.45
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.84
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$18.87
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Mclaren Medicaid |
$13.18
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$13.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.36
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.12
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health SBD |
$51.41
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.91
|
| Rate for Payer: UHC Core |
$30.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$24.09
|
| Rate for Payer: UHC Medicare Advantage |
$24.81
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.41 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.12
|
| Rate for Payer: Priority Health SBD |
$51.41
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
IP
|
$1,401.08
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$882.68 |
| Max. Negotiated Rate |
$1,260.97 |
| Rate for Payer: Aetna Commercial |
$1,190.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.70
|
| Rate for Payer: Cash Price |
$1,120.86
|
| Rate for Payer: Cofinity Commercial |
$1,204.93
|
| Rate for Payer: Cofinity Commercial |
$980.76
|
| Rate for Payer: Healthscope Commercial |
$1,260.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,190.92
|
| Rate for Payer: PHP Commercial |
$1,190.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$980.76
|
| Rate for Payer: Priority Health SBD |
$882.68
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
OP
|
$1,401.08
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$1,260.97 |
| Rate for Payer: Aetna Commercial |
$1,190.92
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$447.90
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$1,120.86
|
| Rate for Payer: Cash Price |
$1,120.86
|
| Rate for Payer: Cofinity Commercial |
$980.76
|
| Rate for Payer: Cofinity Commercial |
$1,204.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$1,260.97
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,190.92
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$1,190.92
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$980.76
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$882.68
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$296.66
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC NM GE REFLUX
|
Facility
|
OP
|
$1,240.94
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$1,116.85 |
| Rate for Payer: Aetna Commercial |
$1,054.80
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$327.10
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$992.75
|
| Rate for Payer: Cash Price |
$992.75
|
| Rate for Payer: Cofinity Commercial |
$1,067.21
|
| Rate for Payer: Cofinity Commercial |
$868.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$1,116.85
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,054.80
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$1,054.80
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.66
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$781.79
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$222.33
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC NM GE REFLUX
|
Facility
|
IP
|
$1,240.94
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$781.79 |
| Max. Negotiated Rate |
$1,116.85 |
| Rate for Payer: Aetna Commercial |
$1,054.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.61
|
| Rate for Payer: Cash Price |
$992.75
|
| Rate for Payer: Cofinity Commercial |
$1,067.21
|
| Rate for Payer: Cofinity Commercial |
$868.66
|
| Rate for Payer: Healthscope Commercial |
$1,116.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,054.80
|
| Rate for Payer: PHP Commercial |
$1,054.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.66
|
| Rate for Payer: Priority Health SBD |
$781.79
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$460.58
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Cofinity Commercial |
$700.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$630.48
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$344.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$313.03
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$630.48 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.49
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$700.53
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health SBD |
$630.48
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
OP
|
$1,447.61
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$1,302.85 |
| Rate for Payer: Aetna Commercial |
$1,230.47
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$443.48
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cofinity Commercial |
$1,013.33
|
| Rate for Payer: Cofinity Commercial |
$1,244.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$1,302.85
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.47
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$1,230.47
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.33
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$911.99
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$291.42
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
IP
|
$1,447.61
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$911.99 |
| Max. Negotiated Rate |
$1,302.85 |
| Rate for Payer: Aetna Commercial |
$1,230.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.95
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cofinity Commercial |
$1,013.33
|
| Rate for Payer: Cofinity Commercial |
$1,244.94
|
| Rate for Payer: Healthscope Commercial |
$1,302.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.47
|
| Rate for Payer: PHP Commercial |
$1,230.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.33
|
| Rate for Payer: Priority Health SBD |
$911.99
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
OP
|
$1,447.61
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$263.07 |
| Max. Negotiated Rate |
$1,302.85 |
| Rate for Payer: Aetna Commercial |
$1,230.47
|
| Rate for Payer: Aetna Medicare |
$500.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$601.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$601.18
|
| Rate for Payer: BCBS Complete |
$276.25
|
| Rate for Payer: BCBS MAPPO |
$480.94
|
| Rate for Payer: BCBS Trust/PPO |
$603.45
|
| Rate for Payer: BCN Medicare Advantage |
$480.94
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cofinity Commercial |
$1,013.33
|
| Rate for Payer: Cofinity Commercial |
$1,244.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.94
|
| Rate for Payer: Healthscope Commercial |
$1,302.85
|
| Rate for Payer: Mclaren Medicaid |
$263.07
|
| Rate for Payer: Mclaren Medicare |
$480.94
|
| Rate for Payer: Meridian Medicaid |
$276.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.47
|
| Rate for Payer: PACE Medicare |
$456.89
|
| Rate for Payer: PACE SWMI |
$480.94
|
| Rate for Payer: PHP Commercial |
$1,230.47
|
| Rate for Payer: PHP Medicare Advantage |
$480.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.33
|
| Rate for Payer: Priority Health Medicare |
$480.94
|
| Rate for Payer: Priority Health SBD |
$911.99
|
| Rate for Payer: Railroad Medicare Medicare |
$480.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$430.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.94
|
| Rate for Payer: UHC Exchange |
$390.97
|
| Rate for Payer: UHC Medicare Advantage |
$495.37
|
| Rate for Payer: VA VA |
$480.94
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
IP
|
$1,447.61
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$911.99 |
| Max. Negotiated Rate |
$1,302.85 |
| Rate for Payer: Aetna Commercial |
$1,230.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.95
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cofinity Commercial |
$1,244.94
|
| Rate for Payer: Cofinity Commercial |
$1,013.33
|
| Rate for Payer: Healthscope Commercial |
$1,302.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.47
|
| Rate for Payer: PHP Commercial |
$1,230.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.33
|
| Rate for Payer: Priority Health SBD |
$911.99
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
OP
|
$900.56
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$178.78 |
| Max. Negotiated Rate |
$810.50 |
| Rate for Payer: Aetna Commercial |
$765.48
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$266.98
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cofinity Commercial |
$774.48
|
| Rate for Payer: Cofinity Commercial |
$630.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$810.50
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.48
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$765.48
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.39
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$567.35
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$178.78
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
IP
|
$900.56
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$567.35 |
| Max. Negotiated Rate |
$810.50 |
| Rate for Payer: Aetna Commercial |
$765.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.36
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cofinity Commercial |
$774.48
|
| Rate for Payer: Cofinity Commercial |
$630.39
|
| Rate for Payer: Healthscope Commercial |
$810.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.48
|
| Rate for Payer: PHP Commercial |
$765.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.39
|
| Rate for Payer: Priority Health SBD |
$567.35
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$488.88 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Aetna Commercial |
$659.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.40
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cofinity Commercial |
$543.20
|
| Rate for Payer: Cofinity Commercial |
$667.36
|
| Rate for Payer: Healthscope Commercial |
$698.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$659.60
|
| Rate for Payer: PHP Commercial |
$659.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.20
|
| Rate for Payer: Priority Health SBD |
$488.88
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Aetna Commercial |
$659.60
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.74
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$366.99
|
| Rate for Payer: BCBS Trust/PPO |
$339.23
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cofinity Commercial |
$667.36
|
| Rate for Payer: Cofinity Commercial |
$543.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$698.40
|
| Rate for Payer: Mclaren Medicaid |
$200.74
|
| Rate for Payer: Mclaren Medicare |
$366.99
|
| Rate for Payer: Meridian Medicaid |
$210.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$385.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$422.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$659.60
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$659.60
|
| Rate for Payer: PHP Medicare Advantage |
$366.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.20
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$488.88
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$228.23
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
