|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
IP
|
$1,946.46
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,226.27 |
| Max. Negotiated Rate |
$1,751.81 |
| Rate for Payer: Aetna Commercial |
$1,654.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.20
|
| Rate for Payer: Cash Price |
$1,557.17
|
| Rate for Payer: Cofinity Commercial |
$1,362.52
|
| Rate for Payer: Cofinity Commercial |
$1,673.96
|
| Rate for Payer: Healthscope Commercial |
$1,751.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,654.49
|
| Rate for Payer: PHP Commercial |
$1,654.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.52
|
| Rate for Payer: Priority Health SBD |
$1,226.27
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
OP
|
$1,946.46
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$639.17 |
| Max. Negotiated Rate |
$1,751.81 |
| Rate for Payer: Aetna Commercial |
$1,654.49
|
| Rate for Payer: Aetna Medicare |
$1,314.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.20
|
| 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 |
$953.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,263.47
|
| Rate for Payer: Cash Price |
$1,557.17
|
| Rate for Payer: Cash Price |
$1,557.17
|
| Rate for Payer: Cofinity Commercial |
$1,673.96
|
| Rate for Payer: Cofinity Commercial |
$1,362.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,263.47
|
| Rate for Payer: Healthscope Commercial |
$1,751.81
|
| 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 |
$1,654.49
|
| Rate for Payer: PACE Medicare |
$1,200.30
|
| Rate for Payer: PACE SWMI |
$1,263.47
|
| Rate for Payer: PHP Commercial |
$1,654.49
|
| 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 |
$1,362.52
|
| Rate for Payer: Priority Health Medicare |
$1,263.47
|
| Rate for Payer: Priority Health SBD |
$1,226.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1,263.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$703.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,263.47
|
| Rate for Payer: UHC Exchange |
$639.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,301.37
|
| Rate for Payer: VA VA |
$1,263.47
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
IP
|
$1,936.98
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,220.30 |
| Max. Negotiated Rate |
$1,743.28 |
| Rate for Payer: Aetna Commercial |
$1,646.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.04
|
| Rate for Payer: Cash Price |
$1,549.58
|
| Rate for Payer: Cofinity Commercial |
$1,355.89
|
| Rate for Payer: Cofinity Commercial |
$1,665.80
|
| Rate for Payer: Healthscope Commercial |
$1,743.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,646.43
|
| Rate for Payer: PHP Commercial |
$1,646.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,355.89
|
| Rate for Payer: Priority Health SBD |
$1,220.30
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
OP
|
$1,936.98
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$341.19 |
| Max. Negotiated Rate |
$1,743.28 |
| Rate for Payer: Aetna Commercial |
$1,646.43
|
| Rate for Payer: Aetna Medicare |
$1,314.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.04
|
| 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 |
$504.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,263.47
|
| Rate for Payer: Cash Price |
$1,549.58
|
| Rate for Payer: Cash Price |
$1,549.58
|
| Rate for Payer: Cofinity Commercial |
$1,355.89
|
| Rate for Payer: Cofinity Commercial |
$1,665.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,263.47
|
| Rate for Payer: Healthscope Commercial |
$1,743.28
|
| 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 |
$1,646.43
|
| Rate for Payer: PACE Medicare |
$1,200.30
|
| Rate for Payer: PACE SWMI |
$1,263.47
|
| Rate for Payer: PHP Commercial |
$1,646.43
|
| 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 |
$1,355.89
|
| Rate for Payer: Priority Health Medicare |
$1,263.47
|
| Rate for Payer: Priority Health SBD |
$1,220.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,263.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,263.47
|
| Rate for Payer: UHC Exchange |
$341.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,301.37
|
| Rate for Payer: VA VA |
$1,263.47
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
OP
|
$1,722.73
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,085.32 |
| Max. Negotiated Rate |
$15,628.84 |
| Rate for Payer: Aetna Commercial |
$1,464.32
|
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,185.80
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Cash Price |
$1,378.18
|
| Rate for Payer: Cash Price |
$1,378.18
|
| Rate for Payer: Cofinity Commercial |
$1,481.55
|
| Rate for Payer: Cofinity Commercial |
$1,205.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Healthscope Commercial |
$1,550.46
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,464.32
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Commercial |
$1,464.32
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,628.84
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,503.07
|
| Rate for Payer: Priority Health SBD |
$1,085.32
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
IP
|
$1,722.73
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,085.32 |
| Max. Negotiated Rate |
$1,550.46 |
| Rate for Payer: Aetna Commercial |
$1,464.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.77
|
| Rate for Payer: Cash Price |
$1,378.18
|
| Rate for Payer: Cofinity Commercial |
$1,205.91
|
| Rate for Payer: Cofinity Commercial |
$1,481.55
|
| Rate for Payer: Healthscope Commercial |
$1,550.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,464.32
|
| Rate for Payer: PHP Commercial |
$1,464.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.91
|
| Rate for Payer: Priority Health SBD |
$1,085.32
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
OP
|
$1,633.68
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$263.07 |
| Max. Negotiated Rate |
$1,470.31 |
| Rate for Payer: Aetna Commercial |
$1,388.63
|
| Rate for Payer: Aetna Medicare |
$500.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,061.89
|
| 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 |
$429.70
|
| Rate for Payer: BCN Medicare Advantage |
$480.94
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cofinity Commercial |
$1,404.96
|
| Rate for Payer: Cofinity Commercial |
$1,143.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.94
|
| Rate for Payer: Healthscope Commercial |
$1,470.31
|
| 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 |
$1,388.63
|
| Rate for Payer: PACE Medicare |
$456.89
|
| Rate for Payer: PACE SWMI |
$480.94
|
| Rate for Payer: PHP Commercial |
$1,388.63
|
| 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 |
$1,143.58
|
| Rate for Payer: Priority Health Medicare |
$480.94
|
| Rate for Payer: Priority Health SBD |
$1,029.22
|
| Rate for Payer: Railroad Medicare Medicare |
$480.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.94
|
| Rate for Payer: UHC Exchange |
$297.97
|
| Rate for Payer: UHC Medicare Advantage |
$495.37
|
| Rate for Payer: VA VA |
$480.94
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
IP
|
$1,633.68
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,029.22 |
| Max. Negotiated Rate |
$1,470.31 |
| Rate for Payer: Aetna Commercial |
$1,388.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,061.89
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cofinity Commercial |
$1,143.58
|
| Rate for Payer: Cofinity Commercial |
$1,404.96
|
| Rate for Payer: Healthscope Commercial |
$1,470.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,388.63
|
| Rate for Payer: PHP Commercial |
$1,388.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,143.58
|
| Rate for Payer: Priority Health SBD |
$1,029.22
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
IP
|
$1,195.27
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$753.02 |
| Max. Negotiated Rate |
$1,075.74 |
| Rate for Payer: Aetna Commercial |
$1,015.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.93
|
| Rate for Payer: Cash Price |
$956.22
|
| Rate for Payer: Cofinity Commercial |
$1,027.93
|
| Rate for Payer: Cofinity Commercial |
$836.69
|
| Rate for Payer: Healthscope Commercial |
$1,075.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,015.98
|
| Rate for Payer: PHP Commercial |
$1,015.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.69
|
| Rate for Payer: Priority Health SBD |
$753.02
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
OP
|
$1,195.27
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$1,075.74 |
| Rate for Payer: Aetna Commercial |
$1,015.98
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.93
|
| 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 |
$253.74
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$956.22
|
| Rate for Payer: Cash Price |
$956.22
|
| Rate for Payer: Cofinity Commercial |
$1,027.93
|
| Rate for Payer: Cofinity Commercial |
$836.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$1,075.74
|
| 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 |
$1,015.98
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$1,015.98
|
| 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 |
$836.69
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$753.02
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$169.29
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
IP
|
$1,633.68
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,029.22 |
| Max. Negotiated Rate |
$1,470.31 |
| Rate for Payer: Aetna Commercial |
$1,388.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,061.89
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cofinity Commercial |
$1,404.96
|
| Rate for Payer: Cofinity Commercial |
$1,143.58
|
| Rate for Payer: Healthscope Commercial |
$1,470.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,388.63
|
| Rate for Payer: PHP Commercial |
$1,388.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,143.58
|
| Rate for Payer: Priority Health SBD |
$1,029.22
|
|
|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
OP
|
$1,633.68
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$263.07 |
| Max. Negotiated Rate |
$1,470.31 |
| Rate for Payer: Aetna Commercial |
$1,388.63
|
| Rate for Payer: Aetna Medicare |
$500.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,061.89
|
| 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 |
$401.56
|
| Rate for Payer: BCN Medicare Advantage |
$480.94
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cofinity Commercial |
$1,404.96
|
| Rate for Payer: Cofinity Commercial |
$1,143.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.94
|
| Rate for Payer: Healthscope Commercial |
$1,470.31
|
| 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 |
$1,388.63
|
| Rate for Payer: PACE Medicare |
$456.89
|
| Rate for Payer: PACE SWMI |
$480.94
|
| Rate for Payer: PHP Commercial |
$1,388.63
|
| 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 |
$1,143.58
|
| Rate for Payer: Priority Health Medicare |
$480.94
|
| Rate for Payer: Priority Health SBD |
$1,029.22
|
| Rate for Payer: Railroad Medicare Medicare |
$480.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.94
|
| Rate for Payer: UHC Exchange |
$270.47
|
| Rate for Payer: UHC Medicare Advantage |
$495.37
|
| Rate for Payer: VA VA |
$480.94
|
|
|
HC NM VOID CYSTO
|
Facility
|
IP
|
$1,048.31
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$660.44 |
| Max. Negotiated Rate |
$943.48 |
| Rate for Payer: Aetna Commercial |
$891.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.40
|
| Rate for Payer: Cash Price |
$838.65
|
| Rate for Payer: Cofinity Commercial |
$901.55
|
| Rate for Payer: Cofinity Commercial |
$733.82
|
| Rate for Payer: Healthscope Commercial |
$943.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$891.06
|
| Rate for Payer: PHP Commercial |
$891.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.82
|
| Rate for Payer: Priority Health SBD |
$660.44
|
|
|
HC NM VOID CYSTO
|
Facility
|
OP
|
$1,048.31
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.74 |
| Max. Negotiated Rate |
$943.48 |
| Rate for Payer: Aetna Commercial |
$891.06
|
| Rate for Payer: Aetna Medicare |
$381.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.40
|
| 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 |
$294.00
|
| Rate for Payer: BCN Medicare Advantage |
$366.99
|
| Rate for Payer: Cash Price |
$838.65
|
| Rate for Payer: Cash Price |
$838.65
|
| Rate for Payer: Cofinity Commercial |
$733.82
|
| Rate for Payer: Cofinity Commercial |
$901.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.99
|
| Rate for Payer: Healthscope Commercial |
$943.48
|
| 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 |
$891.06
|
| Rate for Payer: PACE Medicare |
$348.64
|
| Rate for Payer: PACE SWMI |
$366.99
|
| Rate for Payer: PHP Commercial |
$891.06
|
| 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 |
$733.82
|
| Rate for Payer: Priority Health Medicare |
$366.99
|
| Rate for Payer: Priority Health SBD |
$660.44
|
| Rate for Payer: Railroad Medicare Medicare |
$366.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.99
|
| Rate for Payer: UHC Exchange |
$206.62
|
| Rate for Payer: UHC Medicare Advantage |
$378.00
|
| Rate for Payer: VA VA |
$366.99
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
OP
|
$1,901.83
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$121.09 |
| Max. Negotiated Rate |
$1,711.65 |
| Rate for Payer: Aetna Commercial |
$1,616.56
|
| Rate for Payer: Aetna Medicare |
$230.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$276.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$276.71
|
| Rate for Payer: BCBS Complete |
$127.15
|
| Rate for Payer: BCBS MAPPO |
$221.37
|
| Rate for Payer: BCBS Trust/PPO |
$154.44
|
| Rate for Payer: BCN Medicare Advantage |
$221.37
|
| Rate for Payer: Cash Price |
$1,521.46
|
| Rate for Payer: Cash Price |
$1,521.46
|
| Rate for Payer: Cofinity Commercial |
$1,635.57
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.37
|
| Rate for Payer: Healthscope Commercial |
$1,711.65
|
| Rate for Payer: Mclaren Medicaid |
$121.09
|
| Rate for Payer: Mclaren Medicare |
$221.37
|
| Rate for Payer: Meridian Medicaid |
$127.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,616.56
|
| Rate for Payer: PACE Medicare |
$210.30
|
| Rate for Payer: PACE SWMI |
$221.37
|
| Rate for Payer: PHP Commercial |
$1,616.56
|
| Rate for Payer: PHP Medicare Advantage |
$221.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,331.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$787.85
|
| Rate for Payer: Priority Health Medicare |
$221.37
|
| Rate for Payer: Priority Health Narrow Network |
$630.28
|
| Rate for Payer: Priority Health SBD |
$1,198.15
|
| Rate for Payer: Railroad Medicare Medicare |
$221.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.37
|
| Rate for Payer: UHC Exchange |
$205.31
|
| Rate for Payer: UHC Medicare Advantage |
$228.01
|
| Rate for Payer: VA VA |
$221.37
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
IP
|
$1,901.83
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,198.15 |
| Max. Negotiated Rate |
$1,711.65 |
| Rate for Payer: Aetna Commercial |
$1,616.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.19
|
| Rate for Payer: Cash Price |
$1,521.46
|
| Rate for Payer: Cofinity Commercial |
$1,635.57
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Healthscope Commercial |
$1,711.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,616.56
|
| Rate for Payer: PHP Commercial |
$1,616.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,331.28
|
| Rate for Payer: Priority Health SBD |
$1,198.15
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.65
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.70
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.85
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health SBD |
$0.63
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Aetna Commercial |
$0.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.70
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.85
|
| Rate for Payer: PHP Commercial |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health SBD |
$0.63
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
IP
|
$85.59
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.92 |
| Max. Negotiated Rate |
$77.03 |
| Rate for Payer: Aetna Commercial |
$72.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.63
|
| Rate for Payer: Cash Price |
$68.47
|
| Rate for Payer: Cofinity Commercial |
$59.91
|
| Rate for Payer: Cofinity Commercial |
$73.61
|
| Rate for Payer: Healthscope Commercial |
$77.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.75
|
| Rate for Payer: PHP Commercial |
$72.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.91
|
| Rate for Payer: Priority Health SBD |
$53.92
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
OP
|
$85.59
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Aetna Commercial |
$72.75
|
| Rate for Payer: Aetna Medicare |
$37.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.60
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$35.68
|
| Rate for Payer: BCBS Trust/PPO |
$52.54
|
| Rate for Payer: BCN Medicare Advantage |
$35.68
|
| Rate for Payer: Cash Price |
$68.47
|
| Rate for Payer: Cash Price |
$68.47
|
| Rate for Payer: Cofinity Commercial |
$59.91
|
| Rate for Payer: Cofinity Commercial |
$73.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.68
|
| Rate for Payer: Healthscope Commercial |
$77.03
|
| Rate for Payer: Mclaren Medicaid |
$19.52
|
| Rate for Payer: Mclaren Medicare |
$35.68
|
| Rate for Payer: Meridian Medicaid |
$20.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.75
|
| Rate for Payer: PACE Medicare |
$33.90
|
| Rate for Payer: PACE SWMI |
$35.68
|
| Rate for Payer: PHP Commercial |
$72.75
|
| Rate for Payer: PHP Medicare Advantage |
$35.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.40
|
| Rate for Payer: Priority Health Medicare |
$35.68
|
| Rate for Payer: Priority Health Narrow Network |
$84.32
|
| Rate for Payer: Priority Health SBD |
$53.92
|
| Rate for Payer: Railroad Medicare Medicare |
$35.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.76
|
| Rate for Payer: UHC Core |
$20.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.68
|
| Rate for Payer: UHC Exchange |
$74.33
|
| Rate for Payer: UHC Medicare Advantage |
$36.75
|
| Rate for Payer: VA VA |
$35.68
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
IP
|
$2,421.31
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,525.43 |
| Max. Negotiated Rate |
$2,179.18 |
| Rate for Payer: Aetna Commercial |
$2,058.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,573.85
|
| Rate for Payer: Cash Price |
$1,937.05
|
| Rate for Payer: Cofinity Commercial |
$1,694.92
|
| Rate for Payer: Cofinity Commercial |
$2,082.33
|
| Rate for Payer: Healthscope Commercial |
$2,179.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,058.11
|
| Rate for Payer: PHP Commercial |
$2,058.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.92
|
| Rate for Payer: Priority Health SBD |
$1,525.43
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
OP
|
$2,421.31
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$319.91 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$2,058.11
|
| Rate for Payer: Aetna Medicare |
$1,101.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,573.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,323.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,323.71
|
| Rate for Payer: BCBS Complete |
$608.27
|
| Rate for Payer: BCBS MAPPO |
$1,058.97
|
| Rate for Payer: BCBS Trust/PPO |
$379.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,058.97
|
| Rate for Payer: Cash Price |
$1,937.05
|
| Rate for Payer: Cash Price |
$1,937.05
|
| Rate for Payer: Cofinity Commercial |
$2,082.33
|
| Rate for Payer: Cofinity Commercial |
$1,694.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,058.97
|
| Rate for Payer: Healthscope Commercial |
$2,179.18
|
| Rate for Payer: Mclaren Medicaid |
$579.26
|
| Rate for Payer: Mclaren Medicare |
$1,058.97
|
| Rate for Payer: Meridian Medicaid |
$608.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,111.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,217.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,058.11
|
| Rate for Payer: PACE Medicare |
$1,006.02
|
| Rate for Payer: PACE SWMI |
$1,058.97
|
| Rate for Payer: PHP Commercial |
$2,058.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,058.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$579.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.92
|
| Rate for Payer: Priority Health Medicare |
$1,058.97
|
| Rate for Payer: Priority Health SBD |
$1,525.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,058.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.90
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,058.97
|
| Rate for Payer: UHC Exchange |
$319.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,090.74
|
| Rate for Payer: VA VA |
$1,058.97
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$1,110.46
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$444.18 |
| Max. Negotiated Rate |
$999.41 |
| Rate for Payer: Aetna Commercial |
$943.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$721.80
|
| Rate for Payer: BCBS Complete |
$444.18
|
| Rate for Payer: Cash Price |
$888.37
|
| Rate for Payer: Cofinity Commercial |
$777.32
|
| Rate for Payer: Cofinity Commercial |
$955.00
|
| Rate for Payer: Healthscope Commercial |
$999.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$943.89
|
| Rate for Payer: PHP Commercial |
$943.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.32
|
| Rate for Payer: Priority Health SBD |
$699.59
|
|
|
HC NON OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$1,110.46
|
|
| Hospital Charge Code |
27000389
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$699.59 |
| Max. Negotiated Rate |
$999.41 |
| Rate for Payer: Aetna Commercial |
$943.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$721.80
|
| Rate for Payer: Cash Price |
$888.37
|
| Rate for Payer: Cofinity Commercial |
$777.32
|
| Rate for Payer: Cofinity Commercial |
$955.00
|
| Rate for Payer: Healthscope Commercial |
$999.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$943.89
|
| Rate for Payer: PHP Commercial |
$943.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$777.32
|
| Rate for Payer: Priority Health SBD |
$699.59
|
|
|
HC NON OPEN HEART TEG
|
Facility
|
IP
|
$906.19
|
|
| Hospital Charge Code |
27000197
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$570.90 |
| Max. Negotiated Rate |
$815.57 |
| Rate for Payer: Aetna Commercial |
$770.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.02
|
| Rate for Payer: Cash Price |
$724.95
|
| Rate for Payer: Cofinity Commercial |
$634.33
|
| Rate for Payer: Cofinity Commercial |
$779.32
|
| Rate for Payer: Healthscope Commercial |
$815.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$770.26
|
| Rate for Payer: PHP Commercial |
$770.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.33
|
| Rate for Payer: Priority Health SBD |
$570.90
|
|
