|
HC NM RENAL NON FLOW STUDY
|
Facility
|
OP
|
$1,334.17
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
34100044
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$270.56 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Aetna Commercial |
$1,134.04
|
| Rate for Payer: Aetna Medicare |
$346.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$416.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$416.93
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$333.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.32
|
| Rate for Payer: BCN Commercial |
$1,037.32
|
| Rate for Payer: BCN Medicare Advantage |
$333.54
|
| Rate for Payer: Cash Price |
$1,067.34
|
| Rate for Payer: Cash Price |
$1,067.34
|
| Rate for Payer: Cofinity Commercial |
$1,147.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,067.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$333.54
|
| Rate for Payer: Healthscope Commercial |
$1,200.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,000.63
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$350.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$383.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,134.04
|
| Rate for Payer: PACE Senior Care Partners |
$316.87
|
| Rate for Payer: PACE SWMI |
$333.54
|
| Rate for Payer: PHP Commercial |
$1,134.04
|
| Rate for Payer: PHP Medicare Advantage |
$333.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,160.73
|
| Rate for Payer: Priority Health Medicare |
$333.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$813.71
|
| Rate for Payer: Railroad Medicare Medicare |
$333.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,174.07
|
| Rate for Payer: UHC Core |
$1,114.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$333.54
|
| Rate for Payer: UHC Medicare Advantage |
$343.55
|
| Rate for Payer: VA VA |
$333.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,000.63
|
|
|
HC NM RENAL NON FLOW STUDY
|
Facility
|
IP
|
$1,334.17
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
34100044
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$813.71 |
| Max. Negotiated Rate |
$1,200.75 |
| Rate for Payer: Aetna Commercial |
$1,134.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,031.05
|
| Rate for Payer: BCN Commercial |
$1,031.05
|
| Rate for Payer: Cash Price |
$1,067.34
|
| Rate for Payer: Cofinity Commercial |
$1,147.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,067.34
|
| Rate for Payer: Healthscope Commercial |
$1,200.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,000.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,134.04
|
| Rate for Payer: PHP Commercial |
$1,134.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$933.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,160.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$813.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,174.07
|
| Rate for Payer: UHC Core |
$1,114.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,000.63
|
|
|
HC NM RENOGRAM WITH FLOW
|
Facility
|
IP
|
$1,300.65
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
34100045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$793.27 |
| Max. Negotiated Rate |
$1,170.58 |
| Rate for Payer: Aetna Commercial |
$1,105.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,005.14
|
| Rate for Payer: BCN Commercial |
$1,005.14
|
| Rate for Payer: Cash Price |
$1,040.52
|
| Rate for Payer: Cofinity Commercial |
$1,118.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.52
|
| Rate for Payer: Healthscope Commercial |
$1,170.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$975.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.55
|
| Rate for Payer: PHP Commercial |
$1,105.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,131.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$793.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.57
|
| Rate for Payer: UHC Core |
$1,086.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$975.49
|
|
|
HC NM RENOGRAM WITH FLOW
|
Facility
|
OP
|
$1,300.65
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
34100045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$308.90 |
| Max. Negotiated Rate |
$1,170.58 |
| Rate for Payer: Aetna Commercial |
$1,105.55
|
| Rate for Payer: Aetna Medicare |
$338.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$406.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$406.45
|
| Rate for Payer: BCBS Complete |
$372.29
|
| Rate for Payer: BCBS MAPPO |
$325.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,011.26
|
| Rate for Payer: BCN Commercial |
$1,011.26
|
| Rate for Payer: BCN Medicare Advantage |
$325.16
|
| Rate for Payer: Cash Price |
$1,040.52
|
| Rate for Payer: Cash Price |
$1,040.52
|
| Rate for Payer: Cofinity Commercial |
$1,118.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.16
|
| Rate for Payer: Healthscope Commercial |
$1,170.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$975.49
|
| Rate for Payer: Mclaren Medicaid |
$354.56
|
| Rate for Payer: Meridian Medicaid |
$372.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$341.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.55
|
| Rate for Payer: PACE Senior Care Partners |
$308.90
|
| Rate for Payer: PACE SWMI |
$325.16
|
| Rate for Payer: PHP Commercial |
$1,105.55
|
| Rate for Payer: PHP Medicare Advantage |
$325.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,131.57
|
| Rate for Payer: Priority Health Medicare |
$325.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$793.27
|
| Rate for Payer: Railroad Medicare Medicare |
$325.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.57
|
| Rate for Payer: UHC Core |
$1,086.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$325.16
|
| Rate for Payer: UHC Medicare Advantage |
$334.92
|
| Rate for Payer: VA VA |
$325.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$975.49
|
|
|
HC NM RENOGRAM WITH PHARM INTERVENTION
|
Facility
|
OP
|
$1,651.13
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
34100046
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$354.56 |
| Max. Negotiated Rate |
$1,486.02 |
| Rate for Payer: Aetna Commercial |
$1,403.46
|
| Rate for Payer: Aetna Medicare |
$429.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$515.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$515.98
|
| Rate for Payer: BCBS Complete |
$372.29
|
| Rate for Payer: BCBS MAPPO |
$412.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,283.75
|
| Rate for Payer: BCN Commercial |
$1,283.75
|
| Rate for Payer: BCN Medicare Advantage |
$412.78
|
| Rate for Payer: Cash Price |
$1,320.90
|
| Rate for Payer: Cash Price |
$1,320.90
|
| Rate for Payer: Cofinity Commercial |
$1,419.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$412.78
|
| Rate for Payer: Healthscope Commercial |
$1,486.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,238.35
|
| Rate for Payer: Mclaren Medicaid |
$354.56
|
| Rate for Payer: Meridian Medicaid |
$372.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$433.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$474.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,403.46
|
| Rate for Payer: PACE Senior Care Partners |
$392.14
|
| Rate for Payer: PACE SWMI |
$412.78
|
| Rate for Payer: PHP Commercial |
$1,403.46
|
| Rate for Payer: PHP Medicare Advantage |
$412.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,436.48
|
| Rate for Payer: Priority Health Medicare |
$412.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,007.02
|
| Rate for Payer: Railroad Medicare Medicare |
$412.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,452.99
|
| Rate for Payer: UHC Core |
$1,378.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$412.78
|
| Rate for Payer: UHC Medicare Advantage |
$425.17
|
| Rate for Payer: VA VA |
$412.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,238.35
|
|
|
HC NM RENOGRAM WITH PHARM INTERVENTION
|
Facility
|
IP
|
$1,651.13
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
34100046
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,007.02 |
| Max. Negotiated Rate |
$1,486.02 |
| Rate for Payer: Aetna Commercial |
$1,403.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,275.99
|
| Rate for Payer: BCN Commercial |
$1,275.99
|
| Rate for Payer: Cash Price |
$1,320.90
|
| Rate for Payer: Cofinity Commercial |
$1,419.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,320.90
|
| Rate for Payer: Healthscope Commercial |
$1,486.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,238.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,403.46
|
| Rate for Payer: PHP Commercial |
$1,403.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,436.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,007.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,452.99
|
| Rate for Payer: UHC Core |
$1,378.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,238.35
|
|
|
HC NM SENTINEL NODE INJECTION NON IMAGE BIL
|
Facility
|
IP
|
$785.40
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100622
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$479.02 |
| Max. Negotiated Rate |
$706.86 |
| Rate for Payer: Aetna Commercial |
$667.59
|
| Rate for Payer: BCBS Trust/PPO |
$606.96
|
| Rate for Payer: BCN Commercial |
$606.96
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cofinity Commercial |
$675.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.32
|
| Rate for Payer: Healthscope Commercial |
$706.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$667.59
|
| Rate for Payer: PHP Commercial |
$667.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$683.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$479.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$691.15
|
| Rate for Payer: UHC Core |
$655.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.05
|
|
|
HC NM SENTINEL NODE INJECTION NON IMAGE BIL
|
Facility
|
OP
|
$785.40
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100622
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$186.53 |
| Max. Negotiated Rate |
$706.86 |
| Rate for Payer: Aetna Commercial |
$667.59
|
| Rate for Payer: Aetna Medicare |
$204.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.44
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$196.35
|
| Rate for Payer: BCBS Trust/PPO |
$610.65
|
| Rate for Payer: BCN Commercial |
$610.65
|
| Rate for Payer: BCN Medicare Advantage |
$196.35
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cash Price |
$628.32
|
| Rate for Payer: Cofinity Commercial |
$675.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.35
|
| Rate for Payer: Healthscope Commercial |
$706.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$589.05
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$206.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$667.59
|
| Rate for Payer: PACE Senior Care Partners |
$186.53
|
| Rate for Payer: PACE SWMI |
$196.35
|
| Rate for Payer: PHP Commercial |
$667.59
|
| Rate for Payer: PHP Medicare Advantage |
$196.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$683.30
|
| Rate for Payer: Priority Health Medicare |
$196.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$479.02
|
| Rate for Payer: Railroad Medicare Medicare |
$196.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$691.15
|
| Rate for Payer: UHC Core |
$655.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.35
|
| Rate for Payer: UHC Medicare Advantage |
$202.24
|
| Rate for Payer: VA VA |
$196.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$589.05
|
|
|
HC NM SENTINEL NODE INJ NON-IMAGI
|
Facility
|
IP
|
$971.92
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$592.77 |
| Max. Negotiated Rate |
$874.73 |
| Rate for Payer: Aetna Commercial |
$826.13
|
| Rate for Payer: BCBS Trust/PPO |
$751.10
|
| Rate for Payer: BCN Commercial |
$751.10
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cofinity Commercial |
$835.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.54
|
| Rate for Payer: Healthscope Commercial |
$874.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$826.13
|
| Rate for Payer: PHP Commercial |
$826.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$592.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$855.29
|
| Rate for Payer: UHC Core |
$811.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.94
|
|
|
HC NM SENTINEL NODE INJ NON-IMAGI
|
Facility
|
OP
|
$971.92
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$230.83 |
| Max. Negotiated Rate |
$874.73 |
| Rate for Payer: Aetna Commercial |
$826.13
|
| Rate for Payer: Aetna Medicare |
$252.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$303.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$303.72
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$242.98
|
| Rate for Payer: BCBS Trust/PPO |
$755.67
|
| Rate for Payer: BCN Commercial |
$755.67
|
| Rate for Payer: BCN Medicare Advantage |
$242.98
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cofinity Commercial |
$835.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.98
|
| Rate for Payer: Healthscope Commercial |
$874.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.94
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$255.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$279.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$826.13
|
| Rate for Payer: PACE Senior Care Partners |
$230.83
|
| Rate for Payer: PACE SWMI |
$242.98
|
| Rate for Payer: PHP Commercial |
$826.13
|
| Rate for Payer: PHP Medicare Advantage |
$242.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.57
|
| Rate for Payer: Priority Health Medicare |
$242.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$592.77
|
| Rate for Payer: Railroad Medicare Medicare |
$242.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$855.29
|
| Rate for Payer: UHC Core |
$811.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.98
|
| Rate for Payer: UHC Medicare Advantage |
$250.27
|
| Rate for Payer: VA VA |
$242.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.94
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
IP
|
$938.10
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$572.15 |
| Max. Negotiated Rate |
$844.29 |
| Rate for Payer: Aetna Commercial |
$797.38
|
| Rate for Payer: BCBS Trust/PPO |
$724.96
|
| Rate for Payer: BCN Commercial |
$724.96
|
| Rate for Payer: Cash Price |
$750.48
|
| Rate for Payer: Cofinity Commercial |
$806.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.48
|
| Rate for Payer: Healthscope Commercial |
$844.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$797.38
|
| Rate for Payer: PHP Commercial |
$797.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$816.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$572.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$825.53
|
| Rate for Payer: UHC Core |
$783.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.58
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
OP
|
$938.10
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$222.80 |
| Max. Negotiated Rate |
$844.29 |
| Rate for Payer: Aetna Commercial |
$797.38
|
| Rate for Payer: Aetna Medicare |
$243.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.16
|
| Rate for Payer: BCBS Complete |
$375.24
|
| Rate for Payer: BCBS MAPPO |
$234.52
|
| Rate for Payer: BCBS Trust/PPO |
$729.37
|
| Rate for Payer: BCN Commercial |
$729.37
|
| Rate for Payer: BCN Medicare Advantage |
$234.52
|
| Rate for Payer: Cash Price |
$750.48
|
| Rate for Payer: Cofinity Commercial |
$806.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$750.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.52
|
| Rate for Payer: Healthscope Commercial |
$844.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$246.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$797.38
|
| Rate for Payer: PACE Senior Care Partners |
$222.80
|
| Rate for Payer: PACE SWMI |
$234.52
|
| Rate for Payer: PHP Commercial |
$797.38
|
| Rate for Payer: PHP Medicare Advantage |
$234.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$816.15
|
| Rate for Payer: Priority Health Medicare |
$234.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$572.15
|
| Rate for Payer: Railroad Medicare Medicare |
$234.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$825.53
|
| Rate for Payer: UHC Core |
$783.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.52
|
| Rate for Payer: UHC Medicare Advantage |
$241.56
|
| Rate for Payer: VA VA |
$234.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.58
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
IP
|
$1,238.67
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$755.46 |
| Max. Negotiated Rate |
$1,114.80 |
| Rate for Payer: Aetna Commercial |
$1,052.87
|
| Rate for Payer: BCBS Trust/PPO |
$957.24
|
| Rate for Payer: BCN Commercial |
$957.24
|
| Rate for Payer: Cash Price |
$990.94
|
| Rate for Payer: Cofinity Commercial |
$1,065.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.94
|
| Rate for Payer: Healthscope Commercial |
$1,114.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$929.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,052.87
|
| Rate for Payer: PHP Commercial |
$1,052.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$867.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,077.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$755.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,090.03
|
| Rate for Payer: UHC Core |
$1,034.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$929.00
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
OP
|
$1,238.67
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$294.18 |
| Max. Negotiated Rate |
$1,114.80 |
| Rate for Payer: Aetna Commercial |
$1,052.87
|
| Rate for Payer: Aetna Medicare |
$322.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$387.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$387.08
|
| Rate for Payer: BCBS Complete |
$372.29
|
| Rate for Payer: BCBS MAPPO |
$309.67
|
| Rate for Payer: BCBS Trust/PPO |
$963.07
|
| Rate for Payer: BCN Commercial |
$963.07
|
| Rate for Payer: BCN Medicare Advantage |
$309.67
|
| Rate for Payer: Cash Price |
$990.94
|
| Rate for Payer: Cash Price |
$990.94
|
| Rate for Payer: Cofinity Commercial |
$1,065.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.67
|
| Rate for Payer: Healthscope Commercial |
$1,114.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$929.00
|
| Rate for Payer: Mclaren Medicaid |
$354.56
|
| Rate for Payer: Meridian Medicaid |
$372.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$325.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$356.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,052.87
|
| Rate for Payer: PACE Senior Care Partners |
$294.18
|
| Rate for Payer: PACE SWMI |
$309.67
|
| Rate for Payer: PHP Commercial |
$1,052.87
|
| Rate for Payer: PHP Medicare Advantage |
$309.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$867.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,077.64
|
| Rate for Payer: Priority Health Medicare |
$309.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$755.46
|
| Rate for Payer: Railroad Medicare Medicare |
$309.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,090.03
|
| Rate for Payer: UHC Core |
$1,034.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.67
|
| Rate for Payer: UHC Medicare Advantage |
$318.96
|
| Rate for Payer: VA VA |
$309.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$929.00
|
|
|
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 |
$462.28 |
| Max. Negotiated Rate |
$1,751.81 |
| Rate for Payer: Aetna Commercial |
$1,654.49
|
| Rate for Payer: Aetna Medicare |
$506.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$608.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$608.27
|
| Rate for Payer: BCBS Complete |
$978.06
|
| Rate for Payer: BCBS MAPPO |
$486.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,513.37
|
| Rate for Payer: BCN Commercial |
$1,513.37
|
| Rate for Payer: BCN Medicare Advantage |
$486.62
|
| 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: Encore Health Key Benefits Commercial |
$1,557.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.62
|
| Rate for Payer: Healthscope Commercial |
$1,751.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,459.84
|
| Rate for Payer: Mclaren Medicaid |
$931.49
|
| Rate for Payer: Meridian Medicaid |
$978.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$510.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$559.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,654.49
|
| Rate for Payer: PACE Senior Care Partners |
$462.28
|
| Rate for Payer: PACE SWMI |
$486.62
|
| Rate for Payer: PHP Commercial |
$1,654.49
|
| Rate for Payer: PHP Medicare Advantage |
$486.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$931.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,693.42
|
| Rate for Payer: Priority Health Medicare |
$486.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,187.15
|
| Rate for Payer: Railroad Medicare Medicare |
$486.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,712.88
|
| Rate for Payer: UHC Core |
$1,625.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.62
|
| Rate for Payer: UHC Medicare Advantage |
$501.21
|
| Rate for Payer: VA VA |
$486.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,459.84
|
|
|
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 |
$1,187.15 |
| Max. Negotiated Rate |
$1,751.81 |
| Rate for Payer: Aetna Commercial |
$1,654.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,504.22
|
| Rate for Payer: BCN Commercial |
$1,504.22
|
| Rate for Payer: Cash Price |
$1,557.17
|
| Rate for Payer: Cofinity Commercial |
$1,673.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,557.17
|
| Rate for Payer: Healthscope Commercial |
$1,751.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,459.84
|
| 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 HMO/PPO/Tiered Network |
$1,693.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,187.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,712.88
|
| Rate for Payer: UHC Core |
$1,625.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,459.84
|
|
|
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 |
$1,181.36 |
| Max. Negotiated Rate |
$1,743.28 |
| Rate for Payer: Aetna Commercial |
$1,646.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,496.90
|
| Rate for Payer: BCN Commercial |
$1,496.90
|
| Rate for Payer: Cash Price |
$1,549.58
|
| Rate for Payer: Cofinity Commercial |
$1,665.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,549.58
|
| Rate for Payer: Healthscope Commercial |
$1,743.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,452.74
|
| 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 HMO/PPO/Tiered Network |
$1,685.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,181.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,704.54
|
| Rate for Payer: UHC Core |
$1,617.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,452.74
|
|
|
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 |
$460.03 |
| Max. Negotiated Rate |
$1,743.28 |
| Rate for Payer: Aetna Commercial |
$1,646.43
|
| Rate for Payer: Aetna Medicare |
$503.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$605.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$605.31
|
| Rate for Payer: BCBS Complete |
$978.06
|
| Rate for Payer: BCBS MAPPO |
$484.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,506.00
|
| Rate for Payer: BCN Commercial |
$1,506.00
|
| Rate for Payer: BCN Medicare Advantage |
$484.24
|
| Rate for Payer: Cash Price |
$1,549.58
|
| Rate for Payer: Cash Price |
$1,549.58
|
| Rate for Payer: Cofinity Commercial |
$1,665.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,549.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.24
|
| Rate for Payer: Healthscope Commercial |
$1,743.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,452.74
|
| Rate for Payer: Mclaren Medicaid |
$931.49
|
| Rate for Payer: Meridian Medicaid |
$978.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$508.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$556.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,646.43
|
| Rate for Payer: PACE Senior Care Partners |
$460.03
|
| Rate for Payer: PACE SWMI |
$484.24
|
| Rate for Payer: PHP Commercial |
$1,646.43
|
| Rate for Payer: PHP Medicare Advantage |
$484.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$931.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,355.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,685.17
|
| Rate for Payer: Priority Health Medicare |
$484.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,181.36
|
| Rate for Payer: Railroad Medicare Medicare |
$484.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,704.54
|
| Rate for Payer: UHC Core |
$1,617.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$484.24
|
| Rate for Payer: UHC Medicare Advantage |
$498.77
|
| Rate for Payer: VA VA |
$484.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,452.74
|
|
|
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 |
$1,050.69 |
| Max. Negotiated Rate |
$1,550.46 |
| Rate for Payer: Aetna Commercial |
$1,464.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,331.33
|
| Rate for Payer: BCN Commercial |
$1,331.33
|
| Rate for Payer: Cash Price |
$1,378.18
|
| Rate for Payer: Cofinity Commercial |
$1,481.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,378.18
|
| Rate for Payer: Healthscope Commercial |
$1,550.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,292.05
|
| 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 HMO/PPO/Tiered Network |
$1,498.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,050.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,516.00
|
| Rate for Payer: UHC Core |
$1,438.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,292.05
|
|
|
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 |
$409.15 |
| Max. Negotiated Rate |
$3,974.31 |
| Rate for Payer: Aetna Commercial |
$1,464.32
|
| Rate for Payer: Aetna Medicare |
$447.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$538.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$538.35
|
| Rate for Payer: BCBS Complete |
$3,974.31
|
| Rate for Payer: BCBS MAPPO |
$430.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.42
|
| Rate for Payer: BCN Commercial |
$1,339.42
|
| Rate for Payer: BCN Medicare Advantage |
$430.68
|
| 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: Encore Health Key Benefits Commercial |
$1,378.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$430.68
|
| Rate for Payer: Healthscope Commercial |
$1,550.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,292.05
|
| Rate for Payer: Mclaren Medicaid |
$3,785.06
|
| Rate for Payer: Meridian Medicaid |
$3,974.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$452.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$495.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,464.32
|
| Rate for Payer: PACE Senior Care Partners |
$409.15
|
| Rate for Payer: PACE SWMI |
$430.68
|
| Rate for Payer: PHP Commercial |
$1,464.32
|
| Rate for Payer: PHP Medicare Advantage |
$430.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,785.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,498.78
|
| Rate for Payer: Priority Health Medicare |
$430.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,050.69
|
| Rate for Payer: Railroad Medicare Medicare |
$430.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,516.00
|
| Rate for Payer: UHC Core |
$1,438.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$430.68
|
| Rate for Payer: UHC Medicare Advantage |
$443.60
|
| Rate for Payer: VA VA |
$430.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,292.05
|
|
|
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 |
$996.38 |
| Max. Negotiated Rate |
$1,470.31 |
| Rate for Payer: Aetna Commercial |
$1,388.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.51
|
| Rate for Payer: BCN Commercial |
$1,262.51
|
| Rate for Payer: Cash Price |
$1,306.94
|
| Rate for Payer: Cofinity Commercial |
$1,404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,306.94
|
| Rate for Payer: Healthscope Commercial |
$1,470.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,225.26
|
| 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 HMO/PPO/Tiered Network |
$1,421.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$996.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,437.64
|
| Rate for Payer: UHC Core |
$1,364.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,225.26
|
|
|
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 |
$354.56 |
| Max. Negotiated Rate |
$1,470.31 |
| Rate for Payer: Aetna Commercial |
$1,388.63
|
| Rate for Payer: Aetna Medicare |
$424.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$510.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$510.52
|
| Rate for Payer: BCBS Complete |
$372.29
|
| Rate for Payer: BCBS MAPPO |
$408.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,270.19
|
| Rate for Payer: BCN Commercial |
$1,270.19
|
| Rate for Payer: BCN Medicare Advantage |
$408.42
|
| 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: Encore Health Key Benefits Commercial |
$1,306.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$1,470.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,225.26
|
| Rate for Payer: Mclaren Medicaid |
$354.56
|
| Rate for Payer: Meridian Medicaid |
$372.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$428.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$469.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,388.63
|
| Rate for Payer: PACE Senior Care Partners |
$388.00
|
| Rate for Payer: PACE SWMI |
$408.42
|
| Rate for Payer: PHP Commercial |
$1,388.63
|
| Rate for Payer: PHP Medicare Advantage |
$408.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,143.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,421.30
|
| Rate for Payer: Priority Health Medicare |
$408.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$996.38
|
| Rate for Payer: Railroad Medicare Medicare |
$408.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,437.64
|
| Rate for Payer: UHC Core |
$1,364.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$408.42
|
| Rate for Payer: UHC Medicare Advantage |
$420.67
|
| Rate for Payer: VA VA |
$408.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,225.26
|
|
|
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 |
$729.00 |
| Max. Negotiated Rate |
$1,075.74 |
| Rate for Payer: Aetna Commercial |
$1,015.98
|
| Rate for Payer: BCBS Trust/PPO |
$923.70
|
| Rate for Payer: BCN Commercial |
$923.70
|
| Rate for Payer: Cash Price |
$956.22
|
| Rate for Payer: Cofinity Commercial |
$1,027.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$956.22
|
| Rate for Payer: Healthscope Commercial |
$1,075.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$896.45
|
| 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 HMO/PPO/Tiered Network |
$1,039.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$729.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,051.84
|
| Rate for Payer: UHC Core |
$998.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$896.45
|
|
|
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 |
$270.56 |
| Max. Negotiated Rate |
$1,075.74 |
| Rate for Payer: Aetna Commercial |
$1,015.98
|
| Rate for Payer: Aetna Medicare |
$310.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$373.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$373.52
|
| Rate for Payer: BCBS Complete |
$284.09
|
| Rate for Payer: BCBS MAPPO |
$298.82
|
| Rate for Payer: BCBS Trust/PPO |
$929.32
|
| Rate for Payer: BCN Commercial |
$929.32
|
| Rate for Payer: BCN Medicare Advantage |
$298.82
|
| 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: Encore Health Key Benefits Commercial |
$956.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.82
|
| Rate for Payer: Healthscope Commercial |
$1,075.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$896.45
|
| Rate for Payer: Mclaren Medicaid |
$270.56
|
| Rate for Payer: Meridian Medicaid |
$284.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$313.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,015.98
|
| Rate for Payer: PACE Senior Care Partners |
$283.88
|
| Rate for Payer: PACE SWMI |
$298.82
|
| Rate for Payer: PHP Commercial |
$1,015.98
|
| Rate for Payer: PHP Medicare Advantage |
$298.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,039.88
|
| Rate for Payer: Priority Health Medicare |
$298.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$729.00
|
| Rate for Payer: Railroad Medicare Medicare |
$298.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,051.84
|
| Rate for Payer: UHC Core |
$998.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.82
|
| Rate for Payer: UHC Medicare Advantage |
$307.78
|
| Rate for Payer: VA VA |
$298.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$896.45
|
|
|
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 |
$354.56 |
| Max. Negotiated Rate |
$1,470.31 |
| Rate for Payer: Aetna Commercial |
$1,388.63
|
| Rate for Payer: Aetna Medicare |
$424.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$510.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$510.52
|
| Rate for Payer: BCBS Complete |
$372.29
|
| Rate for Payer: BCBS MAPPO |
$408.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,270.19
|
| Rate for Payer: BCN Commercial |
$1,270.19
|
| Rate for Payer: BCN Medicare Advantage |
$408.42
|
| 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: Encore Health Key Benefits Commercial |
$1,306.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.42
|
| Rate for Payer: Healthscope Commercial |
$1,470.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,225.26
|
| Rate for Payer: Mclaren Medicaid |
$354.56
|
| Rate for Payer: Meridian Medicaid |
$372.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$428.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$469.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,388.63
|
| Rate for Payer: PACE Senior Care Partners |
$388.00
|
| Rate for Payer: PACE SWMI |
$408.42
|
| Rate for Payer: PHP Commercial |
$1,388.63
|
| Rate for Payer: PHP Medicare Advantage |
$408.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,143.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,421.30
|
| Rate for Payer: Priority Health Medicare |
$408.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$996.38
|
| Rate for Payer: Railroad Medicare Medicare |
$408.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,437.64
|
| Rate for Payer: UHC Core |
$1,364.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$408.42
|
| Rate for Payer: UHC Medicare Advantage |
$420.67
|
| Rate for Payer: VA VA |
$408.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,225.26
|
|
