|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
IP
|
$1,172.40
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$815.99 |
| Max. Negotiated Rate |
$1,055.16 |
| Rate for Payer: Aetna Commercial |
$996.54
|
| Rate for Payer: BCBS Trust/PPO |
$968.29
|
| Rate for Payer: BCN Commercial |
$968.29
|
| Rate for Payer: Cash Price |
$937.92
|
| Rate for Payer: Cofinity Commercial |
$1,008.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.92
|
| Rate for Payer: Healthscope Commercial |
$1,055.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$879.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.54
|
| Rate for Payer: Nomi Health Commercial |
$961.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$879.30
|
| Rate for Payer: PHP Commercial |
$996.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,019.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$815.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,031.71
|
| Rate for Payer: UHC Core |
$978.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$879.30
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
OP
|
$1,172.40
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$206.69 |
| Max. Negotiated Rate |
$1,055.16 |
| Rate for Payer: Aetna Commercial |
$996.54
|
| Rate for Payer: Aetna Medicare |
$304.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$366.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$366.38
|
| Rate for Payer: BCBS Complete |
$217.01
|
| Rate for Payer: BCBS MAPPO |
$293.10
|
| Rate for Payer: BCBS Trust/PPO |
$963.83
|
| Rate for Payer: BCN Commercial |
$963.83
|
| Rate for Payer: BCN Medicare Advantage |
$293.10
|
| Rate for Payer: Cash Price |
$937.92
|
| Rate for Payer: Cofinity Commercial |
$1,008.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.10
|
| Rate for Payer: Healthscope Commercial |
$1,055.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$879.30
|
| Rate for Payer: Mclaren Medicaid |
$206.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.75
|
| Rate for Payer: Meridian Medicaid |
$217.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$322.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.54
|
| Rate for Payer: Nomi Health Commercial |
$961.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$879.30
|
| Rate for Payer: PACE Senior Care Partners |
$278.44
|
| Rate for Payer: PACE SWMI |
$293.10
|
| Rate for Payer: PHP Commercial |
$996.54
|
| Rate for Payer: PHP Medicare Advantage |
$293.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$206.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,019.99
|
| Rate for Payer: Priority Health Medicare |
$296.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$815.99
|
| Rate for Payer: Railroad Medicare Medicare |
$293.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,031.71
|
| Rate for Payer: UHC Core |
$978.95
|
| Rate for Payer: UHC Exchange |
$293.10
|
| Rate for Payer: UHC Medicaid |
$206.69
|
| Rate for Payer: UHC Medicare Advantage |
$293.10
|
| Rate for Payer: UHCCP Medicaid |
$206.69
|
| Rate for Payer: VA VA |
$293.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$879.30
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
IP
|
$1,087.65
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$757.00 |
| Max. Negotiated Rate |
$978.88 |
| Rate for Payer: Aetna Commercial |
$924.50
|
| Rate for Payer: BCBS Trust/PPO |
$898.29
|
| Rate for Payer: BCN Commercial |
$898.29
|
| Rate for Payer: Cash Price |
$870.12
|
| Rate for Payer: Cofinity Commercial |
$935.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.12
|
| Rate for Payer: Healthscope Commercial |
$978.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$815.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$924.50
|
| Rate for Payer: Nomi Health Commercial |
$891.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$815.74
|
| Rate for Payer: PHP Commercial |
$924.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$946.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$757.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$957.13
|
| Rate for Payer: UHC Core |
$908.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$815.74
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
OP
|
$1,087.65
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$191.75 |
| Max. Negotiated Rate |
$978.88 |
| Rate for Payer: Aetna Commercial |
$924.50
|
| Rate for Payer: Aetna Medicare |
$282.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$339.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$339.89
|
| Rate for Payer: BCBS Complete |
$201.32
|
| Rate for Payer: BCBS MAPPO |
$271.91
|
| Rate for Payer: BCBS Trust/PPO |
$894.16
|
| Rate for Payer: BCN Commercial |
$894.16
|
| Rate for Payer: BCN Medicare Advantage |
$271.91
|
| Rate for Payer: Cash Price |
$870.12
|
| Rate for Payer: Cofinity Commercial |
$935.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.91
|
| Rate for Payer: Healthscope Commercial |
$978.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$815.74
|
| Rate for Payer: Mclaren Medicaid |
$191.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.51
|
| Rate for Payer: Meridian Medicaid |
$201.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$299.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$924.50
|
| Rate for Payer: Nomi Health Commercial |
$891.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$815.74
|
| Rate for Payer: PACE Senior Care Partners |
$258.32
|
| Rate for Payer: PACE SWMI |
$271.91
|
| Rate for Payer: PHP Commercial |
$924.50
|
| Rate for Payer: PHP Medicare Advantage |
$271.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$946.26
|
| Rate for Payer: Priority Health Medicare |
$274.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$757.00
|
| Rate for Payer: Railroad Medicare Medicare |
$271.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$957.13
|
| Rate for Payer: UHC Core |
$908.19
|
| Rate for Payer: UHC Exchange |
$271.91
|
| Rate for Payer: UHC Medicaid |
$191.75
|
| Rate for Payer: UHC Medicare Advantage |
$271.91
|
| Rate for Payer: UHCCP Medicaid |
$191.75
|
| Rate for Payer: VA VA |
$271.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$815.74
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
OP
|
$1,322.01
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$233.07 |
| Max. Negotiated Rate |
$1,189.81 |
| Rate for Payer: Aetna Commercial |
$1,123.71
|
| Rate for Payer: Aetna Medicare |
$343.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$413.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$413.13
|
| Rate for Payer: BCBS Complete |
$244.70
|
| Rate for Payer: BCBS MAPPO |
$330.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.82
|
| Rate for Payer: BCN Commercial |
$1,086.82
|
| Rate for Payer: BCN Medicare Advantage |
$330.50
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cofinity Commercial |
$1,136.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,057.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$330.50
|
| Rate for Payer: Healthscope Commercial |
$1,189.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$991.51
|
| Rate for Payer: Mclaren Medicaid |
$233.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$347.03
|
| Rate for Payer: Meridian Medicaid |
$244.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$380.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$363.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.71
|
| Rate for Payer: Nomi Health Commercial |
$1,084.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$991.51
|
| Rate for Payer: PACE Senior Care Partners |
$313.98
|
| Rate for Payer: PACE SWMI |
$330.50
|
| Rate for Payer: PHP Commercial |
$1,123.71
|
| Rate for Payer: PHP Medicare Advantage |
$330.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,150.15
|
| Rate for Payer: Priority Health Medicare |
$333.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$920.12
|
| Rate for Payer: Railroad Medicare Medicare |
$330.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,163.37
|
| Rate for Payer: UHC Core |
$1,103.88
|
| Rate for Payer: UHC Exchange |
$330.50
|
| Rate for Payer: UHC Medicaid |
$233.07
|
| Rate for Payer: UHC Medicare Advantage |
$330.50
|
| Rate for Payer: UHCCP Medicaid |
$233.07
|
| Rate for Payer: VA VA |
$330.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$991.51
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
IP
|
$1,322.01
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$920.12 |
| Max. Negotiated Rate |
$1,189.81 |
| Rate for Payer: Aetna Commercial |
$1,123.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.85
|
| Rate for Payer: BCN Commercial |
$1,091.85
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cofinity Commercial |
$1,136.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,057.61
|
| Rate for Payer: Healthscope Commercial |
$1,189.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$991.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.71
|
| Rate for Payer: Nomi Health Commercial |
$1,084.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$991.51
|
| Rate for Payer: PHP Commercial |
$1,123.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,150.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$920.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,163.37
|
| Rate for Payer: UHC Core |
$1,103.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$991.51
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
OP
|
$1,228.56
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$216.60 |
| Max. Negotiated Rate |
$1,105.70 |
| Rate for Payer: Aetna Commercial |
$1,044.28
|
| Rate for Payer: Aetna Medicare |
$319.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$383.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$383.93
|
| Rate for Payer: BCBS Complete |
$227.41
|
| Rate for Payer: BCBS MAPPO |
$307.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,010.00
|
| Rate for Payer: BCN Commercial |
$1,010.00
|
| Rate for Payer: BCN Medicare Advantage |
$307.14
|
| Rate for Payer: Cash Price |
$982.85
|
| Rate for Payer: Cofinity Commercial |
$1,056.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.14
|
| Rate for Payer: Healthscope Commercial |
$1,105.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$921.42
|
| Rate for Payer: Mclaren Medicaid |
$216.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$322.50
|
| Rate for Payer: Meridian Medicaid |
$227.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$337.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.28
|
| Rate for Payer: Nomi Health Commercial |
$1,007.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.42
|
| Rate for Payer: PACE Senior Care Partners |
$291.78
|
| Rate for Payer: PACE SWMI |
$307.14
|
| Rate for Payer: PHP Commercial |
$1,044.28
|
| Rate for Payer: PHP Medicare Advantage |
$307.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$216.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,068.85
|
| Rate for Payer: Priority Health Medicare |
$310.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.08
|
| Rate for Payer: Railroad Medicare Medicare |
$307.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,081.13
|
| Rate for Payer: UHC Core |
$1,025.85
|
| Rate for Payer: UHC Exchange |
$307.14
|
| Rate for Payer: UHC Medicaid |
$216.60
|
| Rate for Payer: UHC Medicare Advantage |
$307.14
|
| Rate for Payer: UHCCP Medicaid |
$216.60
|
| Rate for Payer: VA VA |
$307.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$921.42
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
IP
|
$1,228.56
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$855.08 |
| Max. Negotiated Rate |
$1,105.70 |
| Rate for Payer: Aetna Commercial |
$1,044.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.67
|
| Rate for Payer: BCN Commercial |
$1,014.67
|
| Rate for Payer: Cash Price |
$982.85
|
| Rate for Payer: Cofinity Commercial |
$1,056.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.85
|
| Rate for Payer: Healthscope Commercial |
$1,105.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$921.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,044.28
|
| Rate for Payer: Nomi Health Commercial |
$1,007.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$921.42
|
| Rate for Payer: PHP Commercial |
$1,044.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,068.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,081.13
|
| Rate for Payer: UHC Core |
$1,025.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$921.42
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
IP
|
$1,801.27
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,253.68 |
| Max. Negotiated Rate |
$1,621.14 |
| Rate for Payer: Aetna Commercial |
$1,531.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,487.67
|
| Rate for Payer: BCN Commercial |
$1,487.67
|
| Rate for Payer: Cash Price |
$1,441.02
|
| Rate for Payer: Cofinity Commercial |
$1,549.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.02
|
| Rate for Payer: Healthscope Commercial |
$1,621.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,350.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.08
|
| Rate for Payer: Nomi Health Commercial |
$1,477.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.95
|
| Rate for Payer: PHP Commercial |
$1,531.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,567.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,253.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,585.12
|
| Rate for Payer: UHC Core |
$1,504.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,350.95
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
OP
|
$1,801.27
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$317.56 |
| Max. Negotiated Rate |
$1,621.14 |
| Rate for Payer: Aetna Commercial |
$1,531.08
|
| Rate for Payer: Aetna Medicare |
$468.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$562.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$562.90
|
| Rate for Payer: BCBS Complete |
$333.42
|
| Rate for Payer: BCBS MAPPO |
$450.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,480.82
|
| Rate for Payer: BCN Commercial |
$1,480.82
|
| Rate for Payer: BCN Medicare Advantage |
$450.32
|
| Rate for Payer: Cash Price |
$1,441.02
|
| Rate for Payer: Cofinity Commercial |
$1,549.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$450.32
|
| Rate for Payer: Healthscope Commercial |
$1,621.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,350.95
|
| Rate for Payer: Mclaren Medicaid |
$317.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$472.83
|
| Rate for Payer: Meridian Medicaid |
$333.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$517.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$495.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.08
|
| Rate for Payer: Nomi Health Commercial |
$1,477.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.95
|
| Rate for Payer: PACE Senior Care Partners |
$427.80
|
| Rate for Payer: PACE SWMI |
$450.32
|
| Rate for Payer: PHP Commercial |
$1,531.08
|
| Rate for Payer: PHP Medicare Advantage |
$450.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$317.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,567.10
|
| Rate for Payer: Priority Health Medicare |
$454.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,253.68
|
| Rate for Payer: Railroad Medicare Medicare |
$450.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,585.12
|
| Rate for Payer: UHC Core |
$1,504.06
|
| Rate for Payer: UHC Exchange |
$450.32
|
| Rate for Payer: UHC Medicaid |
$317.56
|
| Rate for Payer: UHC Medicare Advantage |
$450.32
|
| Rate for Payer: UHCCP Medicaid |
$317.56
|
| Rate for Payer: VA VA |
$450.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,350.95
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
IP
|
$1,769.94
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,231.88 |
| Max. Negotiated Rate |
$1,592.95 |
| Rate for Payer: Aetna Commercial |
$1,504.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,461.79
|
| Rate for Payer: BCN Commercial |
$1,461.79
|
| Rate for Payer: Cash Price |
$1,415.95
|
| Rate for Payer: Cofinity Commercial |
$1,522.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.95
|
| Rate for Payer: Healthscope Commercial |
$1,592.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,327.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,504.45
|
| Rate for Payer: Nomi Health Commercial |
$1,451.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,327.45
|
| Rate for Payer: PHP Commercial |
$1,504.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,539.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,231.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,557.55
|
| Rate for Payer: UHC Core |
$1,477.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,327.45
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
OP
|
$1,769.94
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$312.04 |
| Max. Negotiated Rate |
$1,592.95 |
| Rate for Payer: Aetna Commercial |
$1,504.45
|
| Rate for Payer: Aetna Medicare |
$460.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$553.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$553.11
|
| Rate for Payer: BCBS Complete |
$327.62
|
| Rate for Payer: BCBS MAPPO |
$442.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,455.07
|
| Rate for Payer: BCN Commercial |
$1,455.07
|
| Rate for Payer: BCN Medicare Advantage |
$442.49
|
| Rate for Payer: Cash Price |
$1,415.95
|
| Rate for Payer: Cofinity Commercial |
$1,522.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.49
|
| Rate for Payer: Healthscope Commercial |
$1,592.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,327.45
|
| Rate for Payer: Mclaren Medicaid |
$312.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$464.61
|
| Rate for Payer: Meridian Medicaid |
$327.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$508.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$486.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,504.45
|
| Rate for Payer: Nomi Health Commercial |
$1,451.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,327.45
|
| Rate for Payer: PACE Senior Care Partners |
$420.36
|
| Rate for Payer: PACE SWMI |
$442.49
|
| Rate for Payer: PHP Commercial |
$1,504.45
|
| Rate for Payer: PHP Medicare Advantage |
$442.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,539.85
|
| Rate for Payer: Priority Health Medicare |
$446.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,231.88
|
| Rate for Payer: Railroad Medicare Medicare |
$442.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,557.55
|
| Rate for Payer: UHC Core |
$1,477.90
|
| Rate for Payer: UHC Exchange |
$442.49
|
| Rate for Payer: UHC Medicaid |
$312.04
|
| Rate for Payer: UHC Medicare Advantage |
$442.49
|
| Rate for Payer: UHCCP Medicaid |
$312.04
|
| Rate for Payer: VA VA |
$442.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,327.45
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
OP
|
$1,322.01
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$233.07 |
| Max. Negotiated Rate |
$1,189.81 |
| Rate for Payer: Aetna Commercial |
$1,123.71
|
| Rate for Payer: Aetna Medicare |
$343.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$413.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$413.13
|
| Rate for Payer: BCBS Complete |
$244.70
|
| Rate for Payer: BCBS MAPPO |
$330.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.82
|
| Rate for Payer: BCN Commercial |
$1,086.82
|
| Rate for Payer: BCN Medicare Advantage |
$330.50
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cofinity Commercial |
$1,136.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,057.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$330.50
|
| Rate for Payer: Healthscope Commercial |
$1,189.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$991.51
|
| Rate for Payer: Mclaren Medicaid |
$233.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$347.03
|
| Rate for Payer: Meridian Medicaid |
$244.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$380.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$363.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.71
|
| Rate for Payer: Nomi Health Commercial |
$1,084.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$991.51
|
| Rate for Payer: PACE Senior Care Partners |
$313.98
|
| Rate for Payer: PACE SWMI |
$330.50
|
| Rate for Payer: PHP Commercial |
$1,123.71
|
| Rate for Payer: PHP Medicare Advantage |
$330.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,150.15
|
| Rate for Payer: Priority Health Medicare |
$333.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$920.12
|
| Rate for Payer: Railroad Medicare Medicare |
$330.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,163.37
|
| Rate for Payer: UHC Core |
$1,103.88
|
| Rate for Payer: UHC Exchange |
$330.50
|
| Rate for Payer: UHC Medicaid |
$233.07
|
| Rate for Payer: UHC Medicare Advantage |
$330.50
|
| Rate for Payer: UHCCP Medicaid |
$233.07
|
| Rate for Payer: VA VA |
$330.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$991.51
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
IP
|
$1,322.01
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$920.12 |
| Max. Negotiated Rate |
$1,189.81 |
| Rate for Payer: Aetna Commercial |
$1,123.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.85
|
| Rate for Payer: BCN Commercial |
$1,091.85
|
| Rate for Payer: Cash Price |
$1,057.61
|
| Rate for Payer: Cofinity Commercial |
$1,136.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,057.61
|
| Rate for Payer: Healthscope Commercial |
$1,189.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$991.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.71
|
| Rate for Payer: Nomi Health Commercial |
$1,084.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$991.51
|
| Rate for Payer: PHP Commercial |
$1,123.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,150.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$920.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,163.37
|
| Rate for Payer: UHC Core |
$1,103.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$991.51
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
IP
|
$1,207.13
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$840.16 |
| Max. Negotiated Rate |
$1,086.42 |
| Rate for Payer: Aetna Commercial |
$1,026.06
|
| Rate for Payer: BCBS Trust/PPO |
$996.97
|
| Rate for Payer: BCN Commercial |
$996.97
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Cofinity Commercial |
$1,038.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$965.70
|
| Rate for Payer: Healthscope Commercial |
$1,086.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$905.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.06
|
| Rate for Payer: Nomi Health Commercial |
$989.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$905.35
|
| Rate for Payer: PHP Commercial |
$1,026.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,050.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$840.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,062.27
|
| Rate for Payer: UHC Core |
$1,007.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$905.35
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
OP
|
$1,207.13
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$212.82 |
| Max. Negotiated Rate |
$1,086.42 |
| Rate for Payer: Aetna Commercial |
$1,026.06
|
| Rate for Payer: Aetna Medicare |
$313.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$377.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$377.23
|
| Rate for Payer: BCBS Complete |
$223.44
|
| Rate for Payer: BCBS MAPPO |
$301.78
|
| Rate for Payer: BCBS Trust/PPO |
$992.38
|
| Rate for Payer: BCN Commercial |
$992.38
|
| Rate for Payer: BCN Medicare Advantage |
$301.78
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Cofinity Commercial |
$1,038.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$965.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.78
|
| Rate for Payer: Healthscope Commercial |
$1,086.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$905.35
|
| Rate for Payer: Mclaren Medicaid |
$212.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$316.87
|
| Rate for Payer: Meridian Medicaid |
$223.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$347.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$331.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.06
|
| Rate for Payer: Nomi Health Commercial |
$989.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$905.35
|
| Rate for Payer: PACE Senior Care Partners |
$286.69
|
| Rate for Payer: PACE SWMI |
$301.78
|
| Rate for Payer: PHP Commercial |
$1,026.06
|
| Rate for Payer: PHP Medicare Advantage |
$301.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,050.20
|
| Rate for Payer: Priority Health Medicare |
$304.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$840.16
|
| Rate for Payer: Railroad Medicare Medicare |
$301.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,062.27
|
| Rate for Payer: UHC Core |
$1,007.95
|
| Rate for Payer: UHC Exchange |
$301.78
|
| Rate for Payer: UHC Medicaid |
$212.82
|
| Rate for Payer: UHC Medicare Advantage |
$301.78
|
| Rate for Payer: UHCCP Medicaid |
$212.82
|
| Rate for Payer: VA VA |
$301.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$905.35
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
OP
|
$1,353.34
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$238.59 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: Aetna Medicare |
$351.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$422.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$422.92
|
| Rate for Payer: BCBS Complete |
$250.50
|
| Rate for Payer: BCBS MAPPO |
$338.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,112.58
|
| Rate for Payer: BCN Commercial |
$1,112.58
|
| Rate for Payer: BCN Medicare Advantage |
$338.33
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.33
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,015.00
|
| Rate for Payer: Mclaren Medicaid |
$238.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.25
|
| Rate for Payer: Meridian Medicaid |
$250.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$389.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$372.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,109.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,015.00
|
| Rate for Payer: PACE Senior Care Partners |
$321.42
|
| Rate for Payer: PACE SWMI |
$338.33
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: PHP Medicare Advantage |
$338.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$238.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,177.41
|
| Rate for Payer: Priority Health Medicare |
$341.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$941.92
|
| Rate for Payer: Railroad Medicare Medicare |
$338.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.94
|
| Rate for Payer: UHC Core |
$1,130.04
|
| Rate for Payer: UHC Exchange |
$338.33
|
| Rate for Payer: UHC Medicaid |
$238.59
|
| Rate for Payer: UHC Medicare Advantage |
$338.33
|
| Rate for Payer: UHCCP Medicaid |
$238.59
|
| Rate for Payer: VA VA |
$338.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,015.00
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
IP
|
$1,353.34
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$941.92 |
| Max. Negotiated Rate |
$1,218.01 |
| Rate for Payer: Aetna Commercial |
$1,150.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.72
|
| Rate for Payer: BCN Commercial |
$1,117.72
|
| Rate for Payer: Cash Price |
$1,082.67
|
| Rate for Payer: Cofinity Commercial |
$1,163.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,082.67
|
| Rate for Payer: Healthscope Commercial |
$1,218.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,015.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,150.34
|
| Rate for Payer: Nomi Health Commercial |
$1,109.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,015.00
|
| Rate for Payer: PHP Commercial |
$1,150.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,177.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$941.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,190.94
|
| Rate for Payer: UHC Core |
$1,130.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,015.00
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
OP
|
$892.35
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$157.32 |
| Max. Negotiated Rate |
$803.12 |
| Rate for Payer: Aetna Commercial |
$758.50
|
| Rate for Payer: Aetna Medicare |
$232.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$278.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$278.86
|
| Rate for Payer: BCBS Complete |
$165.17
|
| Rate for Payer: BCBS MAPPO |
$223.09
|
| Rate for Payer: BCBS Trust/PPO |
$733.60
|
| Rate for Payer: BCN Commercial |
$733.60
|
| Rate for Payer: BCN Medicare Advantage |
$223.09
|
| Rate for Payer: Cash Price |
$713.88
|
| Rate for Payer: Cofinity Commercial |
$767.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.09
|
| Rate for Payer: Healthscope Commercial |
$803.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.26
|
| Rate for Payer: Mclaren Medicaid |
$157.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.24
|
| Rate for Payer: Meridian Medicaid |
$165.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$245.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.50
|
| Rate for Payer: Nomi Health Commercial |
$731.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.26
|
| Rate for Payer: PACE Senior Care Partners |
$211.93
|
| Rate for Payer: PACE SWMI |
$223.09
|
| Rate for Payer: PHP Commercial |
$758.50
|
| Rate for Payer: PHP Medicare Advantage |
$223.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$776.34
|
| Rate for Payer: Priority Health Medicare |
$225.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.08
|
| Rate for Payer: Railroad Medicare Medicare |
$223.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$785.27
|
| Rate for Payer: UHC Core |
$745.11
|
| Rate for Payer: UHC Exchange |
$223.09
|
| Rate for Payer: UHC Medicaid |
$157.32
|
| Rate for Payer: UHC Medicare Advantage |
$223.09
|
| Rate for Payer: UHCCP Medicaid |
$157.32
|
| Rate for Payer: VA VA |
$223.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.26
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
IP
|
$892.35
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$621.08 |
| Max. Negotiated Rate |
$803.12 |
| Rate for Payer: Aetna Commercial |
$758.50
|
| Rate for Payer: BCBS Trust/PPO |
$736.99
|
| Rate for Payer: BCN Commercial |
$736.99
|
| Rate for Payer: Cash Price |
$713.88
|
| Rate for Payer: Cofinity Commercial |
$767.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$713.88
|
| Rate for Payer: Healthscope Commercial |
$803.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$758.50
|
| Rate for Payer: Nomi Health Commercial |
$731.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$669.26
|
| Rate for Payer: PHP Commercial |
$758.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$776.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$621.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$785.27
|
| Rate for Payer: UHC Core |
$745.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.26
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$183.56 |
| Max. Negotiated Rate |
$937.08 |
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: Aetna Medicare |
$270.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.38
|
| Rate for Payer: BCBS Complete |
$192.73
|
| Rate for Payer: BCBS MAPPO |
$260.30
|
| Rate for Payer: BCBS Trust/PPO |
$855.97
|
| Rate for Payer: BCN Commercial |
$855.97
|
| Rate for Payer: BCN Medicare Advantage |
$260.30
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.30
|
| Rate for Payer: Healthscope Commercial |
$937.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.90
|
| Rate for Payer: Mclaren Medicaid |
$183.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.31
|
| Rate for Payer: Meridian Medicaid |
$192.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$286.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PACE Senior Care Partners |
$247.28
|
| Rate for Payer: PACE SWMI |
$260.30
|
| Rate for Payer: PHP Commercial |
$885.02
|
| Rate for Payer: PHP Medicare Advantage |
$260.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$905.84
|
| Rate for Payer: Priority Health Medicare |
$262.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.68
|
| Rate for Payer: Railroad Medicare Medicare |
$260.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$916.26
|
| Rate for Payer: UHC Core |
$869.40
|
| Rate for Payer: UHC Exchange |
$260.30
|
| Rate for Payer: UHC Medicaid |
$183.56
|
| Rate for Payer: UHC Medicare Advantage |
$260.30
|
| Rate for Payer: UHCCP Medicaid |
$183.56
|
| Rate for Payer: VA VA |
$260.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.90
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
IP
|
$1,041.20
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$724.68 |
| Max. Negotiated Rate |
$937.08 |
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: BCBS Trust/PPO |
$859.93
|
| Rate for Payer: BCN Commercial |
$859.93
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Healthscope Commercial |
$937.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PHP Commercial |
$885.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$905.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$916.26
|
| Rate for Payer: UHC Core |
$869.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.90
|
|
|
HC NM CSF LEAK
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$183.56 |
| Max. Negotiated Rate |
$937.08 |
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: Aetna Medicare |
$270.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.38
|
| Rate for Payer: BCBS Complete |
$192.73
|
| Rate for Payer: BCBS MAPPO |
$260.30
|
| Rate for Payer: BCBS Trust/PPO |
$855.97
|
| Rate for Payer: BCN Commercial |
$855.97
|
| Rate for Payer: BCN Medicare Advantage |
$260.30
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.30
|
| Rate for Payer: Healthscope Commercial |
$937.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.90
|
| Rate for Payer: Mclaren Medicaid |
$183.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.31
|
| Rate for Payer: Meridian Medicaid |
$192.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$286.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PACE Senior Care Partners |
$247.28
|
| Rate for Payer: PACE SWMI |
$260.30
|
| Rate for Payer: PHP Commercial |
$885.02
|
| Rate for Payer: PHP Medicare Advantage |
$260.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$905.84
|
| Rate for Payer: Priority Health Medicare |
$262.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.68
|
| Rate for Payer: Railroad Medicare Medicare |
$260.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$916.26
|
| Rate for Payer: UHC Core |
$869.40
|
| Rate for Payer: UHC Exchange |
$260.30
|
| Rate for Payer: UHC Medicaid |
$183.56
|
| Rate for Payer: UHC Medicare Advantage |
$260.30
|
| Rate for Payer: UHCCP Medicaid |
$183.56
|
| Rate for Payer: VA VA |
$260.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.90
|
|
|
HC NM CSF LEAK
|
Facility
|
IP
|
$1,041.20
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$724.68 |
| Max. Negotiated Rate |
$937.08 |
| Rate for Payer: Aetna Commercial |
$885.02
|
| Rate for Payer: BCBS Trust/PPO |
$859.93
|
| Rate for Payer: BCN Commercial |
$859.93
|
| Rate for Payer: Cash Price |
$832.96
|
| Rate for Payer: Cofinity Commercial |
$895.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.96
|
| Rate for Payer: Healthscope Commercial |
$937.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$780.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.02
|
| Rate for Payer: Nomi Health Commercial |
$853.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.90
|
| Rate for Payer: PHP Commercial |
$885.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$905.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$724.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$916.26
|
| Rate for Payer: UHC Core |
$869.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$780.90
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
IP
|
$468.18
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$325.85 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: BCBS Trust/PPO |
$386.67
|
| Rate for Payer: BCN Commercial |
$386.67
|
| Rate for Payer: Cash Price |
$374.54
|
| Rate for Payer: Cofinity Commercial |
$402.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.54
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.95
|
| Rate for Payer: Nomi Health Commercial |
$383.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.13
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$407.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.00
|
| Rate for Payer: UHC Core |
$390.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
