|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
OP
|
$1,476.56
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.38 |
| Max. Negotiated Rate |
$1,477.71 |
| Rate for Payer: Aetna Commercial |
$1,255.08
|
| Rate for Payer: Aetna Medicare |
$545.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.20
|
| Rate for Payer: BCBS Complete |
$295.45
|
| Rate for Payer: BCBS MAPPO |
$524.96
|
| Rate for Payer: BCN Medicare Advantage |
$524.96
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,269.84
|
| Rate for Payer: Cofinity Commercial |
$1,033.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,033.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.96
|
| Rate for Payer: Healthscope Commercial |
$1,328.90
|
| Rate for Payer: Mclaren Medicaid |
$281.38
|
| Rate for Payer: Mclaren Medicare |
$524.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.21
|
| Rate for Payer: Meridian Medicaid |
$295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: PACE Medicare |
$498.71
|
| Rate for Payer: PACE SWMI |
$524.96
|
| Rate for Payer: PHP Commercial |
$1,255.08
|
| Rate for Payer: PHP Medicare Advantage |
$524.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: Priority Health Medicare |
$524.96
|
| Rate for Payer: Priority Health SBD |
$930.23
|
| Rate for Payer: Railroad Medicare Medicare |
$524.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,477.71
|
| Rate for Payer: UHC Core |
$1,092.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.96
|
| Rate for Payer: UHC Exchange |
$1,092.65
|
| Rate for Payer: UHC Medicare Advantage |
$524.96
|
| Rate for Payer: UHCCP Medicaid |
$295.55
|
| Rate for Payer: VA VA |
$524.96
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
OP
|
$918.57
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$780.78
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$734.86
|
| Rate for Payer: Cash Price |
$734.86
|
| Rate for Payer: Cofinity Commercial |
$789.97
|
| Rate for Payer: Cofinity Commercial |
$643.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$643.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$826.71
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.78
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$780.78
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.07
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$578.70
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$679.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$679.74
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
IP
|
$918.57
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$578.70 |
| Max. Negotiated Rate |
$826.71 |
| Rate for Payer: Aetna Commercial |
$780.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.07
|
| Rate for Payer: Cash Price |
$734.86
|
| Rate for Payer: Cofinity Commercial |
$643.00
|
| Rate for Payer: Cofinity Commercial |
$789.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$643.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.86
|
| Rate for Payer: Healthscope Commercial |
$826.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.78
|
| Rate for Payer: PHP Commercial |
$780.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.07
|
| Rate for Payer: Priority Health SBD |
$578.70
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
OP
|
$791.52
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$672.79
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$633.22
|
| Rate for Payer: Cash Price |
$633.22
|
| Rate for Payer: Cofinity Commercial |
$680.71
|
| Rate for Payer: Cofinity Commercial |
$554.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$554.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$712.37
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.79
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$672.79
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.49
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$498.66
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$585.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$585.72
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
IP
|
$791.52
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$498.66 |
| Max. Negotiated Rate |
$712.37 |
| Rate for Payer: Aetna Commercial |
$672.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.49
|
| Rate for Payer: Cash Price |
$633.22
|
| Rate for Payer: Cofinity Commercial |
$554.06
|
| Rate for Payer: Cofinity Commercial |
$680.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$554.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.22
|
| Rate for Payer: Healthscope Commercial |
$712.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.79
|
| Rate for Payer: PHP Commercial |
$672.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.49
|
| Rate for Payer: Priority Health SBD |
$498.66
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
OP
|
$1,288.73
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,159.86 |
| Rate for Payer: Aetna Commercial |
$1,095.42
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$1,030.98
|
| Rate for Payer: Cash Price |
$1,030.98
|
| Rate for Payer: Cofinity Commercial |
$902.11
|
| Rate for Payer: Cofinity Commercial |
$1,108.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$902.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,159.86
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.42
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,095.42
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.67
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$811.90
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$953.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$953.66
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
IP
|
$1,288.73
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$811.90 |
| Max. Negotiated Rate |
$1,159.86 |
| Rate for Payer: Aetna Commercial |
$1,095.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.67
|
| Rate for Payer: Cash Price |
$1,030.98
|
| Rate for Payer: Cofinity Commercial |
$1,108.31
|
| Rate for Payer: Cofinity Commercial |
$902.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$902.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.98
|
| Rate for Payer: Healthscope Commercial |
$1,159.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.42
|
| Rate for Payer: PHP Commercial |
$1,095.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.67
|
| Rate for Payer: Priority Health SBD |
$811.90
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
OP
|
$1,734.99
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$682.44 |
| Max. Negotiated Rate |
$3,583.96 |
| Rate for Payer: Aetna Commercial |
$1,474.74
|
| Rate for Payer: Aetna Medicare |
$1,324.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,127.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,591.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,591.51
|
| Rate for Payer: BCBS Complete |
$716.56
|
| Rate for Payer: BCBS MAPPO |
$1,273.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,273.21
|
| Rate for Payer: Cash Price |
$1,387.99
|
| Rate for Payer: Cash Price |
$1,387.99
|
| Rate for Payer: Cofinity Commercial |
$1,492.09
|
| Rate for Payer: Cofinity Commercial |
$1,214.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,214.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,387.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,273.21
|
| Rate for Payer: Healthscope Commercial |
$1,561.49
|
| Rate for Payer: Mclaren Medicaid |
$682.44
|
| Rate for Payer: Mclaren Medicare |
$1,273.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,336.87
|
| Rate for Payer: Meridian Medicaid |
$716.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,464.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.74
|
| Rate for Payer: PACE Medicare |
$1,209.55
|
| Rate for Payer: PACE SWMI |
$1,273.21
|
| Rate for Payer: PHP Commercial |
$1,474.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,273.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.74
|
| Rate for Payer: Priority Health Medicare |
$1,273.21
|
| Rate for Payer: Priority Health SBD |
$1,093.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,273.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,583.96
|
| Rate for Payer: UHC Core |
$1,283.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,273.21
|
| Rate for Payer: UHC Exchange |
$1,283.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,273.21
|
| Rate for Payer: UHCCP Medicaid |
$716.82
|
| Rate for Payer: VA VA |
$1,273.21
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
IP
|
$1,734.99
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,093.04 |
| Max. Negotiated Rate |
$1,561.49 |
| Rate for Payer: Aetna Commercial |
$1,474.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,127.74
|
| Rate for Payer: Cash Price |
$1,387.99
|
| Rate for Payer: Cofinity Commercial |
$1,214.49
|
| Rate for Payer: Cofinity Commercial |
$1,492.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,214.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,387.99
|
| Rate for Payer: Healthscope Commercial |
$1,561.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.74
|
| Rate for Payer: PHP Commercial |
$1,474.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.74
|
| Rate for Payer: Priority Health SBD |
$1,093.04
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
IP
|
$833.44
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$525.07 |
| Max. Negotiated Rate |
$750.10 |
| Rate for Payer: Aetna Commercial |
$708.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.74
|
| Rate for Payer: Cash Price |
$666.75
|
| Rate for Payer: Cofinity Commercial |
$583.41
|
| Rate for Payer: Cofinity Commercial |
$716.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$583.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.75
|
| Rate for Payer: Healthscope Commercial |
$750.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.42
|
| Rate for Payer: PHP Commercial |
$708.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.74
|
| Rate for Payer: Priority Health SBD |
$525.07
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
OP
|
$833.44
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$708.42
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$666.75
|
| Rate for Payer: Cash Price |
$666.75
|
| Rate for Payer: Cofinity Commercial |
$716.76
|
| Rate for Payer: Cofinity Commercial |
$583.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$583.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$750.10
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.42
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$708.42
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.74
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$525.07
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$616.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$616.75
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Cofinity Commercial |
$714.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$643.09
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$755.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$755.38
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$643.09 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.51
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$714.55
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health SBD |
$643.09
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
IP
|
$1,314.40
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$828.07 |
| Max. Negotiated Rate |
$1,182.96 |
| Rate for Payer: Aetna Commercial |
$1,117.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.36
|
| Rate for Payer: Cash Price |
$1,051.52
|
| Rate for Payer: Cofinity Commercial |
$1,130.38
|
| Rate for Payer: Cofinity Commercial |
$920.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$920.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.52
|
| Rate for Payer: Healthscope Commercial |
$1,182.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.24
|
| Rate for Payer: PHP Commercial |
$1,117.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.36
|
| Rate for Payer: Priority Health SBD |
$828.07
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
OP
|
$1,314.40
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.38 |
| Max. Negotiated Rate |
$1,477.71 |
| Rate for Payer: Aetna Commercial |
$1,117.24
|
| Rate for Payer: Aetna Medicare |
$545.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.20
|
| Rate for Payer: BCBS Complete |
$295.45
|
| Rate for Payer: BCBS MAPPO |
$524.96
|
| Rate for Payer: BCN Medicare Advantage |
$524.96
|
| Rate for Payer: Cash Price |
$1,051.52
|
| Rate for Payer: Cash Price |
$1,051.52
|
| Rate for Payer: Cofinity Commercial |
$920.08
|
| Rate for Payer: Cofinity Commercial |
$1,130.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$920.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.96
|
| Rate for Payer: Healthscope Commercial |
$1,182.96
|
| Rate for Payer: Mclaren Medicaid |
$281.38
|
| Rate for Payer: Mclaren Medicare |
$524.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.21
|
| Rate for Payer: Meridian Medicaid |
$295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.24
|
| Rate for Payer: PACE Medicare |
$498.71
|
| Rate for Payer: PACE SWMI |
$524.96
|
| Rate for Payer: PHP Commercial |
$1,117.24
|
| Rate for Payer: PHP Medicare Advantage |
$524.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.36
|
| Rate for Payer: Priority Health Medicare |
$524.96
|
| Rate for Payer: Priority Health SBD |
$828.07
|
| Rate for Payer: Railroad Medicare Medicare |
$524.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,477.71
|
| Rate for Payer: UHC Core |
$972.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.96
|
| Rate for Payer: UHC Exchange |
$972.66
|
| Rate for Payer: UHC Medicare Advantage |
$524.96
|
| Rate for Payer: UHCCP Medicaid |
$295.55
|
| Rate for Payer: VA VA |
$524.96
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
IP
|
$1,146.04
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$722.01 |
| Max. Negotiated Rate |
$1,031.44 |
| Rate for Payer: Aetna Commercial |
$974.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.93
|
| Rate for Payer: Cash Price |
$916.83
|
| Rate for Payer: Cofinity Commercial |
$802.23
|
| Rate for Payer: Cofinity Commercial |
$985.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$802.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.83
|
| Rate for Payer: Healthscope Commercial |
$1,031.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$974.13
|
| Rate for Payer: PHP Commercial |
$974.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.93
|
| Rate for Payer: Priority Health SBD |
$722.01
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
OP
|
$1,146.04
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$974.13
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$916.83
|
| Rate for Payer: Cash Price |
$916.83
|
| Rate for Payer: Cofinity Commercial |
$985.59
|
| Rate for Payer: Cofinity Commercial |
$802.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$802.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,031.44
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$974.13
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$974.13
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.93
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$722.01
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$848.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$848.07
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM MYOCARD PERF SPECT EF WM MU
|
Facility
|
OP
|
$5,128.21
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
34100029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$682.44 |
| Max. Negotiated Rate |
$4,615.39 |
| Rate for Payer: Aetna Commercial |
$4,358.98
|
| Rate for Payer: Aetna Medicare |
$1,324.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,333.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,591.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,591.51
|
| Rate for Payer: BCBS Complete |
$716.56
|
| Rate for Payer: BCBS MAPPO |
$1,273.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,273.21
|
| Rate for Payer: Cash Price |
$4,102.57
|
| Rate for Payer: Cash Price |
$4,102.57
|
| Rate for Payer: Cofinity Commercial |
$4,410.26
|
| Rate for Payer: Cofinity Commercial |
$3,589.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,589.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,102.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,273.21
|
| Rate for Payer: Healthscope Commercial |
$4,615.39
|
| Rate for Payer: Mclaren Medicaid |
$682.44
|
| Rate for Payer: Mclaren Medicare |
$1,273.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,336.87
|
| Rate for Payer: Meridian Medicaid |
$716.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,464.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,358.98
|
| Rate for Payer: PACE Medicare |
$1,209.55
|
| Rate for Payer: PACE SWMI |
$1,273.21
|
| Rate for Payer: PHP Commercial |
$4,358.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,273.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,333.34
|
| Rate for Payer: Priority Health Medicare |
$1,273.21
|
| Rate for Payer: Priority Health SBD |
$3,230.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,273.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,583.96
|
| Rate for Payer: UHC Core |
$3,794.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,273.21
|
| Rate for Payer: UHC Exchange |
$3,794.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,273.21
|
| Rate for Payer: UHCCP Medicaid |
$716.82
|
| Rate for Payer: VA VA |
$1,273.21
|
|
|
HC NM MYOCARD PERF SPECT EF WM MU
|
Facility
|
IP
|
$5,128.21
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
34100029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,230.77 |
| Max. Negotiated Rate |
$4,615.39 |
| Rate for Payer: Aetna Commercial |
$4,358.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,333.34
|
| Rate for Payer: Cash Price |
$4,102.57
|
| Rate for Payer: Cofinity Commercial |
$3,589.75
|
| Rate for Payer: Cofinity Commercial |
$4,410.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,589.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,102.57
|
| Rate for Payer: Healthscope Commercial |
$4,615.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,358.98
|
| Rate for Payer: PHP Commercial |
$4,358.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,333.34
|
| Rate for Payer: Priority Health SBD |
$3,230.77
|
|
|
HC NM MYOCARD PERF SPECT EF WM SI
|
Facility
|
IP
|
$1,831.50
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
34100067
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,153.85 |
| Max. Negotiated Rate |
$1,648.35 |
| Rate for Payer: Aetna Commercial |
$1,556.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.47
|
| Rate for Payer: Cash Price |
$1,465.20
|
| Rate for Payer: Cofinity Commercial |
$1,282.05
|
| Rate for Payer: Cofinity Commercial |
$1,575.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,282.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.20
|
| Rate for Payer: Healthscope Commercial |
$1,648.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,556.78
|
| Rate for Payer: PHP Commercial |
$1,556.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.47
|
| Rate for Payer: Priority Health SBD |
$1,153.85
|
|
|
HC NM MYOCARD PERF SPECT EF WM SI
|
Facility
|
OP
|
$1,831.50
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
34100067
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$682.44 |
| Max. Negotiated Rate |
$3,583.96 |
| Rate for Payer: Aetna Commercial |
$1,556.78
|
| Rate for Payer: Aetna Medicare |
$1,324.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,591.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,591.51
|
| Rate for Payer: BCBS Complete |
$716.56
|
| Rate for Payer: BCBS MAPPO |
$1,273.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,273.21
|
| Rate for Payer: Cash Price |
$1,465.20
|
| Rate for Payer: Cash Price |
$1,465.20
|
| Rate for Payer: Cofinity Commercial |
$1,575.09
|
| Rate for Payer: Cofinity Commercial |
$1,282.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,282.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,273.21
|
| Rate for Payer: Healthscope Commercial |
$1,648.35
|
| Rate for Payer: Mclaren Medicaid |
$682.44
|
| Rate for Payer: Mclaren Medicare |
$1,273.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,336.87
|
| Rate for Payer: Meridian Medicaid |
$716.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,464.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,556.78
|
| Rate for Payer: PACE Medicare |
$1,209.55
|
| Rate for Payer: PACE SWMI |
$1,273.21
|
| Rate for Payer: PHP Commercial |
$1,556.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,273.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.47
|
| Rate for Payer: Priority Health Medicare |
$1,273.21
|
| Rate for Payer: Priority Health SBD |
$1,153.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,273.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,583.96
|
| Rate for Payer: UHC Core |
$1,355.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,273.21
|
| Rate for Payer: UHC Exchange |
$1,355.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,273.21
|
| Rate for Payer: UHCCP Medicaid |
$716.82
|
| Rate for Payer: VA VA |
$1,273.21
|
|
|
HC NMO/AQP4 FACS TITER SERUM
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| 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 |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMO/AQP4 FACS TITER SERUM
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health SBD |
$64.26
|
|
|
HC NMO/AQP4-IGG CBA, S
|
Facility
|
OP
|
$351.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$316.71 |
| Rate for Payer: Aetna Commercial |
$299.12
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.74
|
| 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 |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cofinity Commercial |
$302.63
|
| Rate for Payer: Cofinity Commercial |
$246.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$316.71
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.12
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$299.12
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.74
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$221.70
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMO/AQP4-IGG CBA, S
|
Facility
|
IP
|
$351.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$221.70 |
| Max. Negotiated Rate |
$316.71 |
| Rate for Payer: Aetna Commercial |
$299.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.74
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cofinity Commercial |
$246.33
|
| Rate for Payer: Cofinity Commercial |
$302.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.52
|
| Rate for Payer: Healthscope Commercial |
$316.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.12
|
| Rate for Payer: PHP Commercial |
$299.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.74
|
| Rate for Payer: Priority Health SBD |
$221.70
|
|
