|
HC NM GASTRIC EMPTYING
|
Facility
|
IP
|
$1,401.08
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$854.52 |
| Max. Negotiated Rate |
$1,260.97 |
| Rate for Payer: Aetna Commercial |
$1,190.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,082.75
|
| Rate for Payer: BCN Commercial |
$1,082.75
|
| Rate for Payer: Cash Price |
$1,120.86
|
| Rate for Payer: Cofinity Commercial |
$1,204.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.86
|
| Rate for Payer: Healthscope Commercial |
$1,260.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.81
|
| 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 HMO/PPO/Tiered Network |
$1,218.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$854.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,232.95
|
| Rate for Payer: UHC Core |
$1,169.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.81
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
OP
|
$1,401.08
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.56 |
| Max. Negotiated Rate |
$1,260.97 |
| Rate for Payer: Aetna Commercial |
$1,190.92
|
| Rate for Payer: Aetna Medicare |
$364.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.84
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$350.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,089.34
|
| Rate for Payer: BCN Commercial |
$1,089.34
|
| Rate for Payer: BCN Medicare Advantage |
$350.27
|
| Rate for Payer: Cash Price |
$1,120.86
|
| Rate for Payer: Cash Price |
$1,120.86
|
| Rate for Payer: Cofinity Commercial |
$1,204.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.27
|
| Rate for Payer: Healthscope Commercial |
$1,260.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,050.81
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$367.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,190.92
|
| Rate for Payer: PACE Senior Care Partners |
$332.76
|
| Rate for Payer: PACE SWMI |
$350.27
|
| Rate for Payer: PHP Commercial |
$1,190.92
|
| Rate for Payer: PHP Medicare Advantage |
$350.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$980.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,218.94
|
| Rate for Payer: Priority Health Medicare |
$350.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$854.52
|
| Rate for Payer: Railroad Medicare Medicare |
$350.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,232.95
|
| Rate for Payer: UHC Core |
$1,169.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.27
|
| Rate for Payer: UHC Medicare Advantage |
$360.78
|
| Rate for Payer: VA VA |
$350.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,050.81
|
|
|
HC NM GE REFLUX
|
Facility
|
IP
|
$1,240.94
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$756.85 |
| Max. Negotiated Rate |
$1,116.85 |
| Rate for Payer: Aetna Commercial |
$1,054.80
|
| Rate for Payer: BCBS Trust/PPO |
$959.00
|
| Rate for Payer: BCN Commercial |
$959.00
|
| Rate for Payer: Cash Price |
$992.75
|
| Rate for Payer: Cofinity Commercial |
$1,067.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$992.75
|
| Rate for Payer: Healthscope Commercial |
$1,116.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$930.70
|
| 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 HMO/PPO/Tiered Network |
$1,079.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$756.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,092.03
|
| Rate for Payer: UHC Core |
$1,036.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$930.70
|
|
|
HC NM GE REFLUX
|
Facility
|
OP
|
$1,240.94
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.56 |
| Max. Negotiated Rate |
$1,116.85 |
| Rate for Payer: Aetna Commercial |
$1,054.80
|
| Rate for Payer: Aetna Medicare |
$322.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$387.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$387.79
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$310.24
|
| Rate for Payer: BCBS Trust/PPO |
$964.83
|
| Rate for Payer: BCN Commercial |
$964.83
|
| Rate for Payer: BCN Medicare Advantage |
$310.24
|
| 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: Encore Health Key Benefits Commercial |
$992.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.24
|
| Rate for Payer: Healthscope Commercial |
$1,116.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$930.70
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$325.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,054.80
|
| Rate for Payer: PACE Senior Care Partners |
$294.72
|
| Rate for Payer: PACE SWMI |
$310.24
|
| Rate for Payer: PHP Commercial |
$1,054.80
|
| Rate for Payer: PHP Medicare Advantage |
$310.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,079.62
|
| Rate for Payer: Priority Health Medicare |
$310.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$756.85
|
| Rate for Payer: Railroad Medicare Medicare |
$310.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,092.03
|
| Rate for Payer: UHC Core |
$1,036.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$310.24
|
| Rate for Payer: UHC Medicare Advantage |
$319.54
|
| Rate for Payer: VA VA |
$310.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$930.70
|
|
|
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 |
$610.36 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: BCBS Trust/PPO |
$773.39
|
| Rate for Payer: BCN Commercial |
$773.39
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.57
|
| 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 HMO/PPO/Tiered Network |
$870.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.67
|
| Rate for Payer: UHC Core |
$835.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.57
|
|
|
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 |
$237.68 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna Medicare |
$260.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$312.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$312.74
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$250.19
|
| Rate for Payer: BCBS Trust/PPO |
$778.09
|
| Rate for Payer: BCN Commercial |
$778.09
|
| Rate for Payer: BCN Medicare Advantage |
$250.19
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.19
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.57
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$262.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PACE Senior Care Partners |
$237.68
|
| Rate for Payer: PACE SWMI |
$250.19
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: PHP Medicare Advantage |
$250.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.66
|
| Rate for Payer: Priority Health Medicare |
$250.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.36
|
| Rate for Payer: Railroad Medicare Medicare |
$250.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.67
|
| Rate for Payer: UHC Core |
$835.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.19
|
| Rate for Payer: UHC Medicare Advantage |
$257.70
|
| Rate for Payer: VA VA |
$250.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.57
|
|
|
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 |
$882.90 |
| Max. Negotiated Rate |
$1,302.85 |
| Rate for Payer: Aetna Commercial |
$1,230.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.71
|
| Rate for Payer: BCN Commercial |
$1,118.71
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cofinity Commercial |
$1,244.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.09
|
| Rate for Payer: Healthscope Commercial |
$1,302.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.71
|
| 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 HMO/PPO/Tiered Network |
$1,259.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$882.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,273.90
|
| Rate for Payer: UHC Core |
$1,208.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.71
|
|
|
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 |
$270.56 |
| Max. Negotiated Rate |
$1,302.85 |
| Rate for Payer: Aetna Commercial |
$1,230.47
|
| Rate for Payer: Aetna Medicare |
$376.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$452.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$452.38
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$361.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,125.52
|
| Rate for Payer: BCN Commercial |
$1,125.52
|
| Rate for Payer: BCN Medicare Advantage |
$361.90
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cofinity Commercial |
$1,244.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.90
|
| Rate for Payer: Healthscope Commercial |
$1,302.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.71
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$380.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.47
|
| Rate for Payer: PACE Senior Care Partners |
$343.81
|
| Rate for Payer: PACE SWMI |
$361.90
|
| Rate for Payer: PHP Commercial |
$1,230.47
|
| Rate for Payer: PHP Medicare Advantage |
$361.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,259.42
|
| Rate for Payer: Priority Health Medicare |
$361.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$882.90
|
| Rate for Payer: Railroad Medicare Medicare |
$361.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,273.90
|
| Rate for Payer: UHC Core |
$1,208.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$361.90
|
| Rate for Payer: UHC Medicare Advantage |
$372.76
|
| Rate for Payer: VA VA |
$361.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.71
|
|
|
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 |
$882.90 |
| Max. Negotiated Rate |
$1,302.85 |
| Rate for Payer: Aetna Commercial |
$1,230.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.71
|
| Rate for Payer: BCN Commercial |
$1,118.71
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cofinity Commercial |
$1,244.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.09
|
| Rate for Payer: Healthscope Commercial |
$1,302.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.71
|
| 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 HMO/PPO/Tiered Network |
$1,259.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$882.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,273.90
|
| Rate for Payer: UHC Core |
$1,208.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.71
|
|
|
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 |
$343.81 |
| Max. Negotiated Rate |
$1,302.85 |
| Rate for Payer: Aetna Commercial |
$1,230.47
|
| Rate for Payer: Aetna Medicare |
$376.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$452.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$452.38
|
| Rate for Payer: BCBS Complete |
$372.29
|
| Rate for Payer: BCBS MAPPO |
$361.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,125.52
|
| Rate for Payer: BCN Commercial |
$1,125.52
|
| Rate for Payer: BCN Medicare Advantage |
$361.90
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cofinity Commercial |
$1,244.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.90
|
| Rate for Payer: Healthscope Commercial |
$1,302.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,085.71
|
| Rate for Payer: Mclaren Medicaid |
$354.56
|
| Rate for Payer: Meridian Medicaid |
$372.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$380.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.47
|
| Rate for Payer: PACE Senior Care Partners |
$343.81
|
| Rate for Payer: PACE SWMI |
$361.90
|
| Rate for Payer: PHP Commercial |
$1,230.47
|
| Rate for Payer: PHP Medicare Advantage |
$361.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,259.42
|
| Rate for Payer: Priority Health Medicare |
$361.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$882.90
|
| Rate for Payer: Railroad Medicare Medicare |
$361.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,273.90
|
| Rate for Payer: UHC Core |
$1,208.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$361.90
|
| Rate for Payer: UHC Medicare Advantage |
$372.76
|
| Rate for Payer: VA VA |
$361.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,085.71
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
IP
|
$900.56
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$549.25 |
| Max. Negotiated Rate |
$810.50 |
| Rate for Payer: Aetna Commercial |
$765.48
|
| Rate for Payer: BCBS Trust/PPO |
$695.95
|
| Rate for Payer: BCN Commercial |
$695.95
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cofinity Commercial |
$774.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.45
|
| Rate for Payer: Healthscope Commercial |
$810.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.42
|
| 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 HMO/PPO/Tiered Network |
$783.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$549.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.49
|
| Rate for Payer: UHC Core |
$751.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.42
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
OP
|
$900.56
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$213.88 |
| Max. Negotiated Rate |
$810.50 |
| Rate for Payer: Aetna Commercial |
$765.48
|
| Rate for Payer: Aetna Medicare |
$234.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$281.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$281.42
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$225.14
|
| Rate for Payer: BCBS Trust/PPO |
$700.19
|
| Rate for Payer: BCN Commercial |
$700.19
|
| Rate for Payer: BCN Medicare Advantage |
$225.14
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cofinity Commercial |
$774.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.14
|
| Rate for Payer: Healthscope Commercial |
$810.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.42
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$236.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.48
|
| Rate for Payer: PACE Senior Care Partners |
$213.88
|
| Rate for Payer: PACE SWMI |
$225.14
|
| Rate for Payer: PHP Commercial |
$765.48
|
| Rate for Payer: PHP Medicare Advantage |
$225.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$783.49
|
| Rate for Payer: Priority Health Medicare |
$225.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$549.25
|
| Rate for Payer: Railroad Medicare Medicare |
$225.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.49
|
| Rate for Payer: UHC Core |
$751.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.14
|
| Rate for Payer: UHC Medicare Advantage |
$231.89
|
| Rate for Payer: VA VA |
$225.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.42
|
|
|
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 |
$184.30 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Aetna Commercial |
$659.60
|
| Rate for Payer: Aetna Medicare |
$201.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.50
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$194.00
|
| Rate for Payer: BCBS Trust/PPO |
$603.34
|
| Rate for Payer: BCN Commercial |
$603.34
|
| Rate for Payer: BCN Medicare Advantage |
$194.00
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cofinity Commercial |
$667.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.00
|
| Rate for Payer: Healthscope Commercial |
$698.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$582.00
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$203.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$659.60
|
| Rate for Payer: PACE Senior Care Partners |
$184.30
|
| Rate for Payer: PACE SWMI |
$194.00
|
| Rate for Payer: PHP Commercial |
$659.60
|
| Rate for Payer: PHP Medicare Advantage |
$194.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$675.12
|
| Rate for Payer: Priority Health Medicare |
$194.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$473.28
|
| Rate for Payer: Railroad Medicare Medicare |
$194.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.88
|
| Rate for Payer: UHC Core |
$647.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.00
|
| Rate for Payer: UHC Medicare Advantage |
$199.82
|
| Rate for Payer: VA VA |
$194.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$582.00
|
|
|
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 |
$473.28 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Aetna Commercial |
$659.60
|
| Rate for Payer: BCBS Trust/PPO |
$599.69
|
| Rate for Payer: BCN Commercial |
$599.69
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cofinity Commercial |
$667.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.80
|
| Rate for Payer: Healthscope Commercial |
$698.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$582.00
|
| 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 HMO/PPO/Tiered Network |
$675.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$473.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.88
|
| Rate for Payer: UHC Core |
$647.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$582.00
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
OP
|
$1,263.46
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.56 |
| Max. Negotiated Rate |
$1,137.11 |
| Rate for Payer: Aetna Commercial |
$1,073.94
|
| Rate for Payer: Aetna Medicare |
$328.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$394.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$394.83
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$315.86
|
| Rate for Payer: BCBS Trust/PPO |
$982.34
|
| Rate for Payer: BCN Commercial |
$982.34
|
| Rate for Payer: BCN Medicare Advantage |
$315.86
|
| Rate for Payer: Cash Price |
$1,010.77
|
| Rate for Payer: Cash Price |
$1,010.77
|
| Rate for Payer: Cofinity Commercial |
$1,086.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.86
|
| Rate for Payer: Healthscope Commercial |
$1,137.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$947.60
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$331.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,073.94
|
| Rate for Payer: PACE Senior Care Partners |
$300.07
|
| Rate for Payer: PACE SWMI |
$315.86
|
| Rate for Payer: PHP Commercial |
$1,073.94
|
| Rate for Payer: PHP Medicare Advantage |
$315.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.21
|
| Rate for Payer: Priority Health Medicare |
$315.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$770.58
|
| Rate for Payer: Railroad Medicare Medicare |
$315.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,111.84
|
| Rate for Payer: UHC Core |
$1,054.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.86
|
| Rate for Payer: UHC Medicare Advantage |
$325.34
|
| Rate for Payer: VA VA |
$315.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$947.60
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
IP
|
$1,263.46
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$770.58 |
| Max. Negotiated Rate |
$1,137.11 |
| Rate for Payer: Aetna Commercial |
$1,073.94
|
| Rate for Payer: BCBS Trust/PPO |
$976.40
|
| Rate for Payer: BCN Commercial |
$976.40
|
| Rate for Payer: Cash Price |
$1,010.77
|
| Rate for Payer: Cofinity Commercial |
$1,086.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.77
|
| Rate for Payer: Healthscope Commercial |
$1,137.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$947.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,073.94
|
| Rate for Payer: PHP Commercial |
$1,073.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$770.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,111.84
|
| Rate for Payer: UHC Core |
$1,054.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$947.60
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
IP
|
$1,700.97
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,037.42 |
| Max. Negotiated Rate |
$1,530.87 |
| Rate for Payer: Aetna Commercial |
$1,445.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,314.51
|
| Rate for Payer: BCN Commercial |
$1,314.51
|
| Rate for Payer: Cash Price |
$1,360.78
|
| Rate for Payer: Cofinity Commercial |
$1,462.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.78
|
| Rate for Payer: Healthscope Commercial |
$1,530.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,275.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,445.82
|
| Rate for Payer: PHP Commercial |
$1,445.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,479.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,037.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,496.85
|
| Rate for Payer: UHC Core |
$1,420.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,275.73
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
OP
|
$1,700.97
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$403.98 |
| Max. Negotiated Rate |
$1,530.87 |
| Rate for Payer: Aetna Commercial |
$1,445.82
|
| Rate for Payer: Aetna Medicare |
$442.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$531.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$531.55
|
| Rate for Payer: BCBS Complete |
$978.06
|
| Rate for Payer: BCBS MAPPO |
$425.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,322.50
|
| Rate for Payer: BCN Commercial |
$1,322.50
|
| Rate for Payer: BCN Medicare Advantage |
$425.24
|
| Rate for Payer: Cash Price |
$1,360.78
|
| Rate for Payer: Cash Price |
$1,360.78
|
| Rate for Payer: Cofinity Commercial |
$1,462.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.24
|
| Rate for Payer: Healthscope Commercial |
$1,530.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,275.73
|
| Rate for Payer: Mclaren Medicaid |
$931.49
|
| Rate for Payer: Meridian Medicaid |
$978.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$446.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$489.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,445.82
|
| Rate for Payer: PACE Senior Care Partners |
$403.98
|
| Rate for Payer: PACE SWMI |
$425.24
|
| Rate for Payer: PHP Commercial |
$1,445.82
|
| Rate for Payer: PHP Medicare Advantage |
$425.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$931.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,479.84
|
| Rate for Payer: Priority Health Medicare |
$425.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,037.42
|
| Rate for Payer: Railroad Medicare Medicare |
$425.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,496.85
|
| Rate for Payer: UHC Core |
$1,420.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$425.24
|
| Rate for Payer: UHC Medicare Advantage |
$438.00
|
| Rate for Payer: VA VA |
$425.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,275.73
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
IP
|
$817.10
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$498.35 |
| Max. Negotiated Rate |
$735.39 |
| Rate for Payer: Aetna Commercial |
$694.54
|
| Rate for Payer: BCBS Trust/PPO |
$631.45
|
| Rate for Payer: BCN Commercial |
$631.45
|
| Rate for Payer: Cash Price |
$653.68
|
| Rate for Payer: Cofinity Commercial |
$702.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.68
|
| Rate for Payer: Healthscope Commercial |
$735.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$694.54
|
| Rate for Payer: PHP Commercial |
$694.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$710.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$498.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.05
|
| Rate for Payer: UHC Core |
$682.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.82
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
OP
|
$817.10
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$194.06 |
| Max. Negotiated Rate |
$735.39 |
| Rate for Payer: Aetna Commercial |
$694.54
|
| Rate for Payer: Aetna Medicare |
$212.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$255.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$255.34
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$204.28
|
| Rate for Payer: BCBS Trust/PPO |
$635.30
|
| Rate for Payer: BCN Commercial |
$635.30
|
| Rate for Payer: BCN Medicare Advantage |
$204.28
|
| Rate for Payer: Cash Price |
$653.68
|
| Rate for Payer: Cash Price |
$653.68
|
| Rate for Payer: Cofinity Commercial |
$702.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.28
|
| Rate for Payer: Healthscope Commercial |
$735.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$612.82
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$214.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$694.54
|
| Rate for Payer: PACE Senior Care Partners |
$194.06
|
| Rate for Payer: PACE SWMI |
$204.28
|
| Rate for Payer: PHP Commercial |
$694.54
|
| Rate for Payer: PHP Medicare Advantage |
$204.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$710.88
|
| Rate for Payer: Priority Health Medicare |
$204.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$498.35
|
| Rate for Payer: Railroad Medicare Medicare |
$204.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.05
|
| Rate for Payer: UHC Core |
$682.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.28
|
| Rate for Payer: UHC Medicare Advantage |
$210.40
|
| Rate for Payer: VA VA |
$204.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$612.82
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$610.36 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: BCBS Trust/PPO |
$773.39
|
| Rate for Payer: BCN Commercial |
$773.39
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.57
|
| 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 HMO/PPO/Tiered Network |
$870.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.67
|
| Rate for Payer: UHC Core |
$835.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.57
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$237.68 |
| Max. Negotiated Rate |
$900.68 |
| Rate for Payer: Aetna Commercial |
$850.65
|
| Rate for Payer: Aetna Medicare |
$260.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$312.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$312.74
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$250.19
|
| Rate for Payer: BCBS Trust/PPO |
$778.09
|
| Rate for Payer: BCN Commercial |
$778.09
|
| Rate for Payer: BCN Medicare Advantage |
$250.19
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$860.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.19
|
| Rate for Payer: Healthscope Commercial |
$900.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$750.57
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$262.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PACE Senior Care Partners |
$237.68
|
| Rate for Payer: PACE SWMI |
$250.19
|
| Rate for Payer: PHP Commercial |
$850.65
|
| Rate for Payer: PHP Medicare Advantage |
$250.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$870.66
|
| Rate for Payer: Priority Health Medicare |
$250.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$610.36
|
| Rate for Payer: Railroad Medicare Medicare |
$250.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$880.67
|
| Rate for Payer: UHC Core |
$835.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.19
|
| Rate for Payer: UHC Medicare Advantage |
$257.70
|
| Rate for Payer: VA VA |
$250.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$750.57
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
OP
|
$1,288.63
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$306.05 |
| Max. Negotiated Rate |
$1,159.77 |
| Rate for Payer: Aetna Commercial |
$1,095.34
|
| Rate for Payer: Aetna Medicare |
$335.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$402.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$402.70
|
| Rate for Payer: BCBS Complete |
$372.29
|
| Rate for Payer: BCBS MAPPO |
$322.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.91
|
| Rate for Payer: BCN Commercial |
$1,001.91
|
| Rate for Payer: BCN Medicare Advantage |
$322.16
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Cofinity Commercial |
$1,108.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.16
|
| Rate for Payer: Healthscope Commercial |
$1,159.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.47
|
| Rate for Payer: Mclaren Medicaid |
$354.56
|
| Rate for Payer: Meridian Medicaid |
$372.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$338.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,095.34
|
| Rate for Payer: PACE Senior Care Partners |
$306.05
|
| Rate for Payer: PACE SWMI |
$322.16
|
| Rate for Payer: PHP Commercial |
$1,095.34
|
| Rate for Payer: PHP Medicare Advantage |
$322.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,121.11
|
| Rate for Payer: Priority Health Medicare |
$322.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$785.94
|
| Rate for Payer: Railroad Medicare Medicare |
$322.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,133.99
|
| Rate for Payer: UHC Core |
$1,076.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.16
|
| Rate for Payer: UHC Medicare Advantage |
$331.82
|
| Rate for Payer: VA VA |
$322.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.47
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
IP
|
$1,288.63
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$785.94 |
| Max. Negotiated Rate |
$1,159.77 |
| Rate for Payer: Aetna Commercial |
$1,095.34
|
| Rate for Payer: BCBS Trust/PPO |
$995.85
|
| Rate for Payer: BCN Commercial |
$995.85
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Cofinity Commercial |
$1,108.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.90
|
| Rate for Payer: Healthscope Commercial |
$1,159.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,095.34
|
| Rate for Payer: PHP Commercial |
$1,095.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,121.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$785.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,133.99
|
| Rate for Payer: UHC Core |
$1,076.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.47
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
OP
|
$1,123.57
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$266.85 |
| Max. Negotiated Rate |
$1,011.21 |
| Rate for Payer: Aetna Commercial |
$955.03
|
| Rate for Payer: Aetna Medicare |
$292.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$351.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$351.12
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$280.89
|
| Rate for Payer: BCBS Trust/PPO |
$873.58
|
| Rate for Payer: BCN Commercial |
$873.58
|
| Rate for Payer: BCN Medicare Advantage |
$280.89
|
| Rate for Payer: Cash Price |
$898.86
|
| Rate for Payer: Cash Price |
$898.86
|
| Rate for Payer: Cofinity Commercial |
$966.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.89
|
| Rate for Payer: Healthscope Commercial |
$1,011.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$842.68
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$294.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$955.03
|
| Rate for Payer: PACE Senior Care Partners |
$266.85
|
| Rate for Payer: PACE SWMI |
$280.89
|
| Rate for Payer: PHP Commercial |
$955.03
|
| Rate for Payer: PHP Medicare Advantage |
$280.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$977.51
|
| Rate for Payer: Priority Health Medicare |
$280.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$685.27
|
| Rate for Payer: Railroad Medicare Medicare |
$280.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$988.74
|
| Rate for Payer: UHC Core |
$938.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.89
|
| Rate for Payer: UHC Medicare Advantage |
$289.32
|
| Rate for Payer: VA VA |
$280.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$842.68
|
|
