|
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
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
OP
|
$468.18
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.54 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna Commercial |
$397.95
|
| Rate for Payer: Aetna Medicare |
$121.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.31
|
| Rate for Payer: BCBS Complete |
$86.66
|
| Rate for Payer: BCBS MAPPO |
$117.05
|
| Rate for Payer: BCBS Trust/PPO |
$384.89
|
| Rate for Payer: BCN Commercial |
$384.89
|
| Rate for Payer: BCN Medicare Advantage |
$117.05
|
| 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: Health Alliance Plan Medicare Advantage |
$117.05
|
| Rate for Payer: Healthscope Commercial |
$421.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.13
|
| Rate for Payer: Mclaren Medicaid |
$82.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.90
|
| Rate for Payer: Meridian Medicaid |
$86.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.75
|
| 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: PACE Senior Care Partners |
$111.19
|
| Rate for Payer: PACE SWMI |
$117.05
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: PHP Medicare Advantage |
$117.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$407.32
|
| Rate for Payer: Priority Health Medicare |
$118.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.85
|
| Rate for Payer: Railroad Medicare Medicare |
$117.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.00
|
| Rate for Payer: UHC Core |
$390.93
|
| Rate for Payer: UHC Exchange |
$117.05
|
| Rate for Payer: UHC Medicaid |
$82.54
|
| Rate for Payer: UHC Medicare Advantage |
$117.05
|
| Rate for Payer: UHCCP Medicaid |
$82.54
|
| Rate for Payer: VA VA |
$117.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.13
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
IP
|
$468.18
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
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
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Medicare |
$31.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.39
|
| Rate for Payer: BCBS Complete |
$22.15
|
| Rate for Payer: BCBS MAPPO |
$29.91
|
| Rate for Payer: BCBS Trust/PPO |
$98.36
|
| Rate for Payer: BCN Commercial |
$98.36
|
| Rate for Payer: BCN Medicare Advantage |
$29.91
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.91
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.74
|
| Rate for Payer: Mclaren Medicaid |
$21.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.41
|
| Rate for Payer: Meridian Medicaid |
$22.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PACE Senior Care Partners |
$28.42
|
| Rate for Payer: PACE SWMI |
$29.91
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: PHP Medicare Advantage |
$29.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$104.10
|
| Rate for Payer: Priority Health Medicare |
$30.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.28
|
| Rate for Payer: Railroad Medicare Medicare |
$29.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.29
|
| Rate for Payer: UHC Core |
$99.91
|
| Rate for Payer: UHC Exchange |
$29.91
|
| Rate for Payer: UHC Medicaid |
$21.09
|
| Rate for Payer: UHC Medicare Advantage |
$29.91
|
| Rate for Payer: UHCCP Medicaid |
$21.09
|
| Rate for Payer: VA VA |
$29.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.74
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: BCBS Trust/PPO |
$98.82
|
| Rate for Payer: BCN Commercial |
$98.82
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$98.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$104.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.29
|
| Rate for Payer: UHC Core |
$99.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.74
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
IP
|
$84.89
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.08 |
| Max. Negotiated Rate |
$76.40 |
| Rate for Payer: Aetna Commercial |
$72.16
|
| Rate for Payer: BCBS Trust/PPO |
$70.11
|
| Rate for Payer: BCN Commercial |
$70.11
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cofinity Commercial |
$73.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.91
|
| Rate for Payer: Healthscope Commercial |
$76.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.16
|
| Rate for Payer: Nomi Health Commercial |
$69.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.67
|
| Rate for Payer: PHP Commercial |
$72.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.70
|
| Rate for Payer: UHC Core |
$70.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.67
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
OP
|
$84.89
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$76.40 |
| Rate for Payer: Aetna Commercial |
$72.16
|
| Rate for Payer: Aetna Medicare |
$22.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.53
|
| Rate for Payer: BCBS Complete |
$15.71
|
| Rate for Payer: BCBS MAPPO |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$69.79
|
| Rate for Payer: BCN Commercial |
$69.79
|
| Rate for Payer: BCN Medicare Advantage |
$21.22
|
| Rate for Payer: Cash Price |
$67.91
|
| Rate for Payer: Cofinity Commercial |
$73.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$76.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.67
|
| Rate for Payer: Mclaren Medicaid |
$14.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.28
|
| Rate for Payer: Meridian Medicaid |
$15.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.16
|
| Rate for Payer: Nomi Health Commercial |
$69.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.67
|
| Rate for Payer: PACE Senior Care Partners |
$20.16
|
| Rate for Payer: PACE SWMI |
$21.22
|
| Rate for Payer: PHP Commercial |
$72.16
|
| Rate for Payer: PHP Medicare Advantage |
$21.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.85
|
| Rate for Payer: Priority Health Medicare |
$21.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.08
|
| Rate for Payer: Railroad Medicare Medicare |
$21.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.70
|
| Rate for Payer: UHC Core |
$70.88
|
| Rate for Payer: UHC Exchange |
$21.22
|
| Rate for Payer: UHC Medicaid |
$14.97
|
| Rate for Payer: UHC Medicare Advantage |
$21.22
|
| Rate for Payer: UHCCP Medicaid |
$14.97
|
| Rate for Payer: VA VA |
$21.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.67
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
IP
|
$1,457.68
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,014.55 |
| Max. Negotiated Rate |
$1,311.91 |
| Rate for Payer: Aetna Commercial |
$1,239.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.90
|
| Rate for Payer: BCN Commercial |
$1,203.90
|
| Rate for Payer: Cash Price |
$1,166.14
|
| Rate for Payer: Cofinity Commercial |
$1,253.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.14
|
| Rate for Payer: Healthscope Commercial |
$1,311.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,093.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.03
|
| Rate for Payer: Nomi Health Commercial |
$1,195.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.26
|
| Rate for Payer: PHP Commercial |
$1,239.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,268.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,014.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,282.76
|
| Rate for Payer: UHC Core |
$1,217.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,093.26
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
OP
|
$1,457.68
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$256.99 |
| Max. Negotiated Rate |
$1,311.91 |
| Rate for Payer: Aetna Commercial |
$1,239.03
|
| Rate for Payer: Aetna Medicare |
$379.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$455.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$455.52
|
| Rate for Payer: BCBS Complete |
$269.82
|
| Rate for Payer: BCBS MAPPO |
$364.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,198.36
|
| Rate for Payer: BCN Commercial |
$1,198.36
|
| Rate for Payer: BCN Medicare Advantage |
$364.42
|
| Rate for Payer: Cash Price |
$1,166.14
|
| Rate for Payer: Cofinity Commercial |
$1,253.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,166.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$364.42
|
| Rate for Payer: Healthscope Commercial |
$1,311.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,093.26
|
| Rate for Payer: Mclaren Medicaid |
$256.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$382.64
|
| Rate for Payer: Meridian Medicaid |
$269.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$419.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$400.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.03
|
| Rate for Payer: Nomi Health Commercial |
$1,195.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,093.26
|
| Rate for Payer: PACE Senior Care Partners |
$346.20
|
| Rate for Payer: PACE SWMI |
$364.42
|
| Rate for Payer: PHP Commercial |
$1,239.03
|
| Rate for Payer: PHP Medicare Advantage |
$364.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,268.18
|
| Rate for Payer: Priority Health Medicare |
$368.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,014.55
|
| Rate for Payer: Railroad Medicare Medicare |
$364.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,282.76
|
| Rate for Payer: UHC Core |
$1,217.16
|
| Rate for Payer: UHC Exchange |
$364.42
|
| Rate for Payer: UHC Medicaid |
$256.99
|
| Rate for Payer: UHC Medicare Advantage |
$364.42
|
| Rate for Payer: UHCCP Medicaid |
$256.99
|
| Rate for Payer: VA VA |
$364.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,093.26
|
|
|
HC NM GE REFLUX
|
Facility
|
OP
|
$1,291.08
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$227.62 |
| Max. Negotiated Rate |
$1,161.97 |
| Rate for Payer: Aetna Commercial |
$1,097.42
|
| Rate for Payer: Aetna Medicare |
$335.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$403.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$403.46
|
| Rate for Payer: BCBS Complete |
$238.98
|
| Rate for Payer: BCBS MAPPO |
$322.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.40
|
| Rate for Payer: BCN Commercial |
$1,061.40
|
| Rate for Payer: BCN Medicare Advantage |
$322.77
|
| Rate for Payer: Cash Price |
$1,032.86
|
| Rate for Payer: Cofinity Commercial |
$1,110.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.77
|
| Rate for Payer: Healthscope Commercial |
$1,161.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$968.31
|
| Rate for Payer: Mclaren Medicaid |
$227.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.91
|
| Rate for Payer: Meridian Medicaid |
$238.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$371.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$355.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,097.42
|
| Rate for Payer: Nomi Health Commercial |
$1,058.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$968.31
|
| Rate for Payer: PACE Senior Care Partners |
$306.63
|
| Rate for Payer: PACE SWMI |
$322.77
|
| Rate for Payer: PHP Commercial |
$1,097.42
|
| Rate for Payer: PHP Medicare Advantage |
$322.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$227.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,123.24
|
| Rate for Payer: Priority Health Medicare |
$326.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$898.59
|
| Rate for Payer: Railroad Medicare Medicare |
$322.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,136.15
|
| Rate for Payer: UHC Core |
$1,078.05
|
| Rate for Payer: UHC Exchange |
$322.77
|
| Rate for Payer: UHC Medicaid |
$227.62
|
| Rate for Payer: UHC Medicare Advantage |
$322.77
|
| Rate for Payer: UHCCP Medicaid |
$227.62
|
| Rate for Payer: VA VA |
$322.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$968.31
|
|
|
HC NM GE REFLUX
|
Facility
|
IP
|
$1,291.08
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$898.59 |
| Max. Negotiated Rate |
$1,161.97 |
| Rate for Payer: Aetna Commercial |
$1,097.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.30
|
| Rate for Payer: BCN Commercial |
$1,066.30
|
| Rate for Payer: Cash Price |
$1,032.86
|
| Rate for Payer: Cofinity Commercial |
$1,110.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.86
|
| Rate for Payer: Healthscope Commercial |
$1,161.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$968.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,097.42
|
| Rate for Payer: Nomi Health Commercial |
$1,058.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$968.31
|
| Rate for Payer: PHP Commercial |
$1,097.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,123.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$898.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,136.15
|
| Rate for Payer: UHC Core |
$1,078.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$968.31
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
IP
|
$1,041.20
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
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 GI BLOOD LOSS
|
Facility
|
OP
|
$1,041.20
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
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 LIVER BILE TRANSPORT WO PHARM
|
Facility
|
OP
|
$1,506.09
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$1,355.48 |
| Rate for Payer: Aetna Commercial |
$1,280.18
|
| Rate for Payer: Aetna Medicare |
$391.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$470.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$470.65
|
| Rate for Payer: BCBS Complete |
$278.78
|
| Rate for Payer: BCBS MAPPO |
$376.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,238.16
|
| Rate for Payer: BCN Commercial |
$1,238.16
|
| Rate for Payer: BCN Medicare Advantage |
$376.52
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cofinity Commercial |
$1,295.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$376.52
|
| Rate for Payer: Healthscope Commercial |
$1,355.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,129.57
|
| Rate for Payer: Mclaren Medicaid |
$265.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$395.35
|
| Rate for Payer: Meridian Medicaid |
$278.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$433.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$414.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.18
|
| Rate for Payer: Nomi Health Commercial |
$1,234.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,129.57
|
| Rate for Payer: PACE Senior Care Partners |
$357.70
|
| Rate for Payer: PACE SWMI |
$376.52
|
| Rate for Payer: PHP Commercial |
$1,280.18
|
| Rate for Payer: PHP Medicare Advantage |
$376.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$265.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,310.30
|
| Rate for Payer: Priority Health Medicare |
$380.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,048.24
|
| Rate for Payer: Railroad Medicare Medicare |
$376.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,325.36
|
| Rate for Payer: UHC Core |
$1,257.59
|
| Rate for Payer: UHC Exchange |
$376.52
|
| Rate for Payer: UHC Medicaid |
$265.52
|
| Rate for Payer: UHC Medicare Advantage |
$376.52
|
| Rate for Payer: UHCCP Medicaid |
$265.52
|
| Rate for Payer: VA VA |
$376.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,129.57
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
IP
|
$1,506.09
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,048.24 |
| Max. Negotiated Rate |
$1,355.48 |
| Rate for Payer: Aetna Commercial |
$1,280.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,243.88
|
| Rate for Payer: BCN Commercial |
$1,243.88
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cofinity Commercial |
$1,295.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.87
|
| Rate for Payer: Healthscope Commercial |
$1,355.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,129.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.18
|
| Rate for Payer: Nomi Health Commercial |
$1,234.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,129.57
|
| Rate for Payer: PHP Commercial |
$1,280.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,310.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,048.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,325.36
|
| Rate for Payer: UHC Core |
$1,257.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,129.57
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
OP
|
$1,506.09
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$265.52 |
| Max. Negotiated Rate |
$1,355.48 |
| Rate for Payer: Aetna Commercial |
$1,280.18
|
| Rate for Payer: Aetna Medicare |
$391.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$470.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$470.65
|
| Rate for Payer: BCBS Complete |
$278.78
|
| Rate for Payer: BCBS MAPPO |
$376.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,238.16
|
| Rate for Payer: BCN Commercial |
$1,238.16
|
| Rate for Payer: BCN Medicare Advantage |
$376.52
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cofinity Commercial |
$1,295.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$376.52
|
| Rate for Payer: Healthscope Commercial |
$1,355.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,129.57
|
| Rate for Payer: Mclaren Medicaid |
$265.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$395.35
|
| Rate for Payer: Meridian Medicaid |
$278.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$433.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$414.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.18
|
| Rate for Payer: Nomi Health Commercial |
$1,234.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,129.57
|
| Rate for Payer: PACE Senior Care Partners |
$357.70
|
| Rate for Payer: PACE SWMI |
$376.52
|
| Rate for Payer: PHP Commercial |
$1,280.18
|
| Rate for Payer: PHP Medicare Advantage |
$376.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$265.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,310.30
|
| Rate for Payer: Priority Health Medicare |
$380.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,048.24
|
| Rate for Payer: Railroad Medicare Medicare |
$376.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,325.36
|
| Rate for Payer: UHC Core |
$1,257.59
|
| Rate for Payer: UHC Exchange |
$376.52
|
| Rate for Payer: UHC Medicaid |
$265.52
|
| Rate for Payer: UHC Medicare Advantage |
$376.52
|
| Rate for Payer: UHCCP Medicaid |
$265.52
|
| Rate for Payer: VA VA |
$376.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,129.57
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
IP
|
$1,506.09
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,048.24 |
| Max. Negotiated Rate |
$1,355.48 |
| Rate for Payer: Aetna Commercial |
$1,280.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,243.88
|
| Rate for Payer: BCN Commercial |
$1,243.88
|
| Rate for Payer: Cash Price |
$1,204.87
|
| Rate for Payer: Cofinity Commercial |
$1,295.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,204.87
|
| Rate for Payer: Healthscope Commercial |
$1,355.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,129.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,280.18
|
| Rate for Payer: Nomi Health Commercial |
$1,234.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,129.57
|
| Rate for Payer: PHP Commercial |
$1,280.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,310.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,048.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,325.36
|
| Rate for Payer: UHC Core |
$1,257.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,129.57
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
IP
|
$936.94
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$652.11 |
| Max. Negotiated Rate |
$843.25 |
| Rate for Payer: Aetna Commercial |
$796.40
|
| Rate for Payer: BCBS Trust/PPO |
$773.82
|
| Rate for Payer: BCN Commercial |
$773.82
|
| Rate for Payer: Cash Price |
$749.55
|
| Rate for Payer: Cofinity Commercial |
$805.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.55
|
| Rate for Payer: Healthscope Commercial |
$843.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$702.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.40
|
| Rate for Payer: Nomi Health Commercial |
$768.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.71
|
| Rate for Payer: PHP Commercial |
$796.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$815.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$652.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$824.51
|
| Rate for Payer: UHC Core |
$782.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$702.71
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
OP
|
$936.94
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$165.18 |
| Max. Negotiated Rate |
$843.25 |
| Rate for Payer: Aetna Commercial |
$796.40
|
| Rate for Payer: Aetna Medicare |
$243.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$292.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$292.79
|
| Rate for Payer: BCBS Complete |
$173.43
|
| Rate for Payer: BCBS MAPPO |
$234.24
|
| Rate for Payer: BCBS Trust/PPO |
$770.26
|
| Rate for Payer: BCN Commercial |
$770.26
|
| Rate for Payer: BCN Medicare Advantage |
$234.24
|
| Rate for Payer: Cash Price |
$749.55
|
| Rate for Payer: Cofinity Commercial |
$805.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.24
|
| Rate for Payer: Healthscope Commercial |
$843.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$702.71
|
| Rate for Payer: Mclaren Medicaid |
$165.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.95
|
| Rate for Payer: Meridian Medicaid |
$173.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$257.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.40
|
| Rate for Payer: Nomi Health Commercial |
$768.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$702.71
|
| Rate for Payer: PACE Senior Care Partners |
$222.52
|
| Rate for Payer: PACE SWMI |
$234.24
|
| Rate for Payer: PHP Commercial |
$796.40
|
| Rate for Payer: PHP Medicare Advantage |
$234.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$815.14
|
| Rate for Payer: Priority Health Medicare |
$236.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$652.11
|
| Rate for Payer: Railroad Medicare Medicare |
$234.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$824.51
|
| Rate for Payer: UHC Core |
$782.34
|
| Rate for Payer: UHC Exchange |
$234.24
|
| Rate for Payer: UHC Medicaid |
$165.18
|
| Rate for Payer: UHC Medicare Advantage |
$234.24
|
| Rate for Payer: UHCCP Medicaid |
$165.18
|
| Rate for Payer: VA VA |
$234.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$702.71
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
OP
|
$807.35
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$142.34 |
| Max. Negotiated Rate |
$726.62 |
| Rate for Payer: Aetna Commercial |
$686.25
|
| Rate for Payer: Aetna Medicare |
$209.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$252.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$252.30
|
| Rate for Payer: BCBS Complete |
$149.44
|
| Rate for Payer: BCBS MAPPO |
$201.84
|
| Rate for Payer: BCBS Trust/PPO |
$663.72
|
| Rate for Payer: BCN Commercial |
$663.72
|
| Rate for Payer: BCN Medicare Advantage |
$201.84
|
| Rate for Payer: Cash Price |
$645.88
|
| Rate for Payer: Cofinity Commercial |
$694.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.84
|
| Rate for Payer: Healthscope Commercial |
$726.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$605.51
|
| Rate for Payer: Mclaren Medicaid |
$142.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.93
|
| Rate for Payer: Meridian Medicaid |
$149.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$222.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.25
|
| Rate for Payer: Nomi Health Commercial |
$662.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$605.51
|
| Rate for Payer: PACE Senior Care Partners |
$191.75
|
| Rate for Payer: PACE SWMI |
$201.84
|
| Rate for Payer: PHP Commercial |
$686.25
|
| Rate for Payer: PHP Medicare Advantage |
$201.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$702.39
|
| Rate for Payer: Priority Health Medicare |
$203.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$561.92
|
| Rate for Payer: Railroad Medicare Medicare |
$201.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.47
|
| Rate for Payer: UHC Core |
$674.14
|
| Rate for Payer: UHC Exchange |
$201.84
|
| Rate for Payer: UHC Medicaid |
$142.34
|
| Rate for Payer: UHC Medicare Advantage |
$201.84
|
| Rate for Payer: UHCCP Medicaid |
$142.34
|
| Rate for Payer: VA VA |
$201.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$605.51
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
IP
|
$807.35
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$561.92 |
| Max. Negotiated Rate |
$726.62 |
| Rate for Payer: Aetna Commercial |
$686.25
|
| Rate for Payer: BCBS Trust/PPO |
$666.79
|
| Rate for Payer: BCN Commercial |
$666.79
|
| Rate for Payer: Cash Price |
$645.88
|
| Rate for Payer: Cofinity Commercial |
$694.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.88
|
| Rate for Payer: Healthscope Commercial |
$726.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$605.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.25
|
| Rate for Payer: Nomi Health Commercial |
$662.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$605.51
|
| Rate for Payer: PHP Commercial |
$686.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$702.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$561.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.47
|
| Rate for Payer: UHC Core |
$674.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$605.51
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
OP
|
$1,314.50
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$1,183.05 |
| Rate for Payer: Aetna Commercial |
$1,117.33
|
| Rate for Payer: Aetna Medicare |
$341.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.78
|
| Rate for Payer: BCBS Complete |
$243.31
|
| Rate for Payer: BCBS MAPPO |
$328.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,080.65
|
| Rate for Payer: BCN Commercial |
$1,080.65
|
| Rate for Payer: BCN Medicare Advantage |
$328.62
|
| Rate for Payer: Cash Price |
$1,051.60
|
| Rate for Payer: Cofinity Commercial |
$1,130.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.62
|
| Rate for Payer: Healthscope Commercial |
$1,183.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$985.88
|
| Rate for Payer: Mclaren Medicaid |
$231.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.06
|
| Rate for Payer: Meridian Medicaid |
$243.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$361.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.33
|
| Rate for Payer: Nomi Health Commercial |
$1,077.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$985.88
|
| Rate for Payer: PACE Senior Care Partners |
$312.19
|
| Rate for Payer: PACE SWMI |
$328.62
|
| Rate for Payer: PHP Commercial |
$1,117.33
|
| Rate for Payer: PHP Medicare Advantage |
$328.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,143.62
|
| Rate for Payer: Priority Health Medicare |
$331.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$914.89
|
| Rate for Payer: Railroad Medicare Medicare |
$328.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,156.76
|
| Rate for Payer: UHC Core |
$1,097.61
|
| Rate for Payer: UHC Exchange |
$328.62
|
| Rate for Payer: UHC Medicaid |
$231.75
|
| Rate for Payer: UHC Medicare Advantage |
$328.62
|
| Rate for Payer: UHCCP Medicaid |
$231.75
|
| Rate for Payer: VA VA |
$328.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$985.88
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
IP
|
$1,314.50
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$914.89 |
| Max. Negotiated Rate |
$1,183.05 |
| Rate for Payer: Aetna Commercial |
$1,117.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.65
|
| Rate for Payer: BCN Commercial |
$1,085.65
|
| Rate for Payer: Cash Price |
$1,051.60
|
| Rate for Payer: Cofinity Commercial |
$1,130.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.60
|
| Rate for Payer: Healthscope Commercial |
$1,183.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$985.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.33
|
| Rate for Payer: Nomi Health Commercial |
$1,077.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$985.88
|
| Rate for Payer: PHP Commercial |
$1,117.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,143.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$914.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,156.76
|
| Rate for Payer: UHC Core |
$1,097.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$985.88
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
OP
|
$1,769.69
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$1,592.72 |
| Rate for Payer: Aetna Commercial |
$1,504.24
|
| Rate for Payer: Aetna Medicare |
$460.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$553.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$553.03
|
| Rate for Payer: BCBS Complete |
$327.57
|
| Rate for Payer: BCBS MAPPO |
$442.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,454.86
|
| Rate for Payer: BCN Commercial |
$1,454.86
|
| Rate for Payer: BCN Medicare Advantage |
$442.42
|
| Rate for Payer: Cash Price |
$1,415.75
|
| Rate for Payer: Cofinity Commercial |
$1,521.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.42
|
| Rate for Payer: Healthscope Commercial |
$1,592.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,327.27
|
| Rate for Payer: Mclaren Medicaid |
$312.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$464.54
|
| Rate for Payer: Meridian Medicaid |
$327.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$508.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$486.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,504.24
|
| Rate for Payer: Nomi Health Commercial |
$1,451.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,327.27
|
| Rate for Payer: PACE Senior Care Partners |
$420.30
|
| Rate for Payer: PACE SWMI |
$442.42
|
| Rate for Payer: PHP Commercial |
$1,504.24
|
| Rate for Payer: PHP Medicare Advantage |
$442.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,539.63
|
| Rate for Payer: Priority Health Medicare |
$446.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,231.70
|
| Rate for Payer: Railroad Medicare Medicare |
$442.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,557.33
|
| Rate for Payer: UHC Core |
$1,477.69
|
| Rate for Payer: UHC Exchange |
$442.42
|
| Rate for Payer: UHC Medicaid |
$312.00
|
| Rate for Payer: UHC Medicare Advantage |
$442.42
|
| Rate for Payer: UHCCP Medicaid |
$312.00
|
| Rate for Payer: VA VA |
$442.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,327.27
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
IP
|
$1,769.69
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,231.70 |
| Max. Negotiated Rate |
$1,592.72 |
| Rate for Payer: Aetna Commercial |
$1,504.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,461.59
|
| Rate for Payer: BCN Commercial |
$1,461.59
|
| Rate for Payer: Cash Price |
$1,415.75
|
| Rate for Payer: Cofinity Commercial |
$1,521.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,415.75
|
| Rate for Payer: Healthscope Commercial |
$1,592.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,327.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,504.24
|
| Rate for Payer: Nomi Health Commercial |
$1,451.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,327.27
|
| Rate for Payer: PHP Commercial |
$1,504.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,539.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,231.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,557.33
|
| Rate for Payer: UHC Core |
$1,477.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,327.27
|
|
