|
HC NM GASTRIC EMPTYING
|
Facility
|
OP
|
$1,429.10
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$290.52 |
| Max. Negotiated Rate |
$1,286.19 |
| Rate for Payer: Aetna Commercial |
$1,214.73
|
| Rate for Payer: Aetna Medicare |
$371.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.59
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$357.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,174.86
|
| Rate for Payer: BCN Commercial |
$1,111.13
|
| Rate for Payer: BCN Medicare Advantage |
$357.27
|
| Rate for Payer: Cash Price |
$1,143.28
|
| Rate for Payer: Cash Price |
$1,143.28
|
| Rate for Payer: Cofinity Commercial |
$1,229.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.27
|
| Rate for Payer: Healthscope Commercial |
$1,286.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,071.83
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.14
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.73
|
| Rate for Payer: Nomi Health Commercial |
$1,171.86
|
| Rate for Payer: PACE Senior Care Partners |
$339.41
|
| Rate for Payer: PACE SWMI |
$357.27
|
| Rate for Payer: PHP Commercial |
$1,214.73
|
| Rate for Payer: PHP Medicare Advantage |
$357.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.91
|
| Rate for Payer: Priority Health HMO/PPO |
$1,243.32
|
| Rate for Payer: Priority Health Medicare |
$360.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$957.50
|
| Rate for Payer: Railroad Medicare Medicare |
$357.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,257.61
|
| Rate for Payer: UHC Core |
$1,193.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.27
|
| Rate for Payer: UHC Exchange |
$357.27
|
| Rate for Payer: UHC Medicare Advantage |
$357.27
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$357.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,071.83
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
IP
|
$1,429.10
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$928.91 |
| Max. Negotiated Rate |
$1,286.19 |
| Rate for Payer: Aetna Commercial |
$1,214.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,166.57
|
| Rate for Payer: BCN Commercial |
$1,104.41
|
| Rate for Payer: Cash Price |
$1,143.28
|
| Rate for Payer: Cofinity Commercial |
$1,229.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.28
|
| Rate for Payer: Healthscope Commercial |
$1,286.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,071.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.73
|
| Rate for Payer: Nomi Health Commercial |
$1,171.86
|
| Rate for Payer: PHP Commercial |
$1,214.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.91
|
| Rate for Payer: Priority Health HMO/PPO |
$1,243.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$957.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,257.61
|
| Rate for Payer: UHC Core |
$1,193.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,071.83
|
|
|
HC NM GE REFLUX
|
Facility
|
OP
|
$1,265.76
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$290.52 |
| Max. Negotiated Rate |
$1,139.18 |
| Rate for Payer: Aetna Commercial |
$1,075.90
|
| Rate for Payer: Aetna Medicare |
$329.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$395.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$395.55
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$316.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,040.58
|
| Rate for Payer: BCN Commercial |
$984.13
|
| Rate for Payer: BCN Medicare Advantage |
$316.44
|
| Rate for Payer: Cash Price |
$1,012.61
|
| Rate for Payer: Cash Price |
$1,012.61
|
| Rate for Payer: Cofinity Commercial |
$1,088.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.44
|
| Rate for Payer: Healthscope Commercial |
$1,139.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$949.32
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.26
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.90
|
| Rate for Payer: Nomi Health Commercial |
$1,037.92
|
| Rate for Payer: PACE Senior Care Partners |
$300.62
|
| Rate for Payer: PACE SWMI |
$316.44
|
| Rate for Payer: PHP Commercial |
$1,075.90
|
| Rate for Payer: PHP Medicare Advantage |
$316.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.74
|
| Rate for Payer: Priority Health HMO/PPO |
$1,101.21
|
| Rate for Payer: Priority Health Medicare |
$319.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$848.06
|
| Rate for Payer: Railroad Medicare Medicare |
$316.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,113.87
|
| Rate for Payer: UHC Core |
$1,056.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.44
|
| Rate for Payer: UHC Exchange |
$316.44
|
| Rate for Payer: UHC Medicare Advantage |
$316.44
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$316.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$949.32
|
|
|
HC NM GE REFLUX
|
Facility
|
IP
|
$1,265.76
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$822.74 |
| Max. Negotiated Rate |
$1,139.18 |
| Rate for Payer: Aetna Commercial |
$1,075.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,033.24
|
| Rate for Payer: BCN Commercial |
$978.18
|
| Rate for Payer: Cash Price |
$1,012.61
|
| Rate for Payer: Cofinity Commercial |
$1,088.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.61
|
| Rate for Payer: Healthscope Commercial |
$1,139.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$949.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.90
|
| Rate for Payer: Nomi Health Commercial |
$1,037.92
|
| Rate for Payer: PHP Commercial |
$1,075.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.74
|
| Rate for Payer: Priority Health HMO/PPO |
$1,101.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$848.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,113.87
|
| Rate for Payer: UHC Core |
$1,056.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$949.32
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna Medicare |
$265.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$318.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$318.99
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$255.19
|
| Rate for Payer: BCBS Trust/PPO |
$839.18
|
| Rate for Payer: BCN Commercial |
$793.66
|
| Rate for Payer: BCN Medicare Advantage |
$255.19
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.19
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.95
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PACE Senior Care Partners |
$242.44
|
| Rate for Payer: PACE SWMI |
$255.19
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: PHP Medicare Advantage |
$255.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO |
$888.08
|
| Rate for Payer: Priority Health Medicare |
$257.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.92
|
| Rate for Payer: Railroad Medicare Medicare |
$255.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.19
|
| Rate for Payer: UHC Exchange |
$255.19
|
| Rate for Payer: UHC Medicare Advantage |
$255.19
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$255.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$663.51 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: BCBS Trust/PPO |
$833.26
|
| Rate for Payer: BCN Commercial |
$788.86
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO |
$888.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
IP
|
$1,476.56
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$959.76 |
| Max. Negotiated Rate |
$1,328.90 |
| Rate for Payer: Aetna Commercial |
$1,255.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,205.32
|
| Rate for Payer: BCN Commercial |
$1,141.09
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,269.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Healthscope Commercial |
$1,328.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,107.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: Nomi Health Commercial |
$1,210.78
|
| Rate for Payer: PHP Commercial |
$1,255.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: Priority Health HMO/PPO |
$1,284.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$989.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,299.37
|
| Rate for Payer: UHC Core |
$1,232.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,107.42
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
OP
|
$1,476.56
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$290.52 |
| Max. Negotiated Rate |
$1,328.90 |
| Rate for Payer: Aetna Commercial |
$1,255.08
|
| Rate for Payer: Aetna Medicare |
$383.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$461.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$461.43
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$369.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,213.88
|
| Rate for Payer: BCN Commercial |
$1,148.03
|
| Rate for Payer: BCN Medicare Advantage |
$369.14
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,269.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$369.14
|
| Rate for Payer: Healthscope Commercial |
$1,328.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,107.42
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$387.60
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$424.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: Nomi Health Commercial |
$1,210.78
|
| Rate for Payer: PACE Senior Care Partners |
$350.68
|
| Rate for Payer: PACE SWMI |
$369.14
|
| Rate for Payer: PHP Commercial |
$1,255.08
|
| Rate for Payer: PHP Medicare Advantage |
$369.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: Priority Health HMO/PPO |
$1,284.61
|
| Rate for Payer: Priority Health Medicare |
$372.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$989.30
|
| Rate for Payer: Railroad Medicare Medicare |
$369.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,299.37
|
| Rate for Payer: UHC Core |
$1,232.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$369.14
|
| Rate for Payer: UHC Exchange |
$369.14
|
| Rate for Payer: UHC Medicare Advantage |
$369.14
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$369.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,107.42
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
OP
|
$1,476.56
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$350.68 |
| Max. Negotiated Rate |
$1,328.90 |
| Rate for Payer: Aetna Commercial |
$1,255.08
|
| Rate for Payer: Aetna Medicare |
$383.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$461.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$461.43
|
| Rate for Payer: BCBS Complete |
$408.65
|
| Rate for Payer: BCBS MAPPO |
$369.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,213.88
|
| Rate for Payer: BCN Commercial |
$1,148.03
|
| Rate for Payer: BCN Medicare Advantage |
$369.14
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,269.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$369.14
|
| Rate for Payer: Healthscope Commercial |
$1,328.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,107.42
|
| Rate for Payer: Mclaren Medicaid |
$389.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$387.60
|
| Rate for Payer: Meridian Medicaid |
$408.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$424.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: Nomi Health Commercial |
$1,210.78
|
| Rate for Payer: PACE Senior Care Partners |
$350.68
|
| Rate for Payer: PACE SWMI |
$369.14
|
| Rate for Payer: PHP Commercial |
$1,255.08
|
| Rate for Payer: PHP Medicare Advantage |
$369.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: Priority Health HMO/PPO |
$1,284.61
|
| Rate for Payer: Priority Health Medicare |
$372.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$989.30
|
| Rate for Payer: Railroad Medicare Medicare |
$369.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,299.37
|
| Rate for Payer: UHC Core |
$1,232.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$369.14
|
| Rate for Payer: UHC Exchange |
$369.14
|
| Rate for Payer: UHC Medicare Advantage |
$369.14
|
| Rate for Payer: UHCCP Medicaid |
$389.17
|
| Rate for Payer: VA VA |
$369.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,107.42
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
IP
|
$1,476.56
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$959.76 |
| Max. Negotiated Rate |
$1,328.90 |
| Rate for Payer: Aetna Commercial |
$1,255.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,205.32
|
| Rate for Payer: BCN Commercial |
$1,141.09
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,269.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Healthscope Commercial |
$1,328.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,107.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: Nomi Health Commercial |
$1,210.78
|
| Rate for Payer: PHP Commercial |
$1,255.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: Priority Health HMO/PPO |
$1,284.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$989.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,299.37
|
| Rate for Payer: UHC Core |
$1,232.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,107.42
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
OP
|
$918.57
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$218.16 |
| Max. Negotiated Rate |
$826.71 |
| Rate for Payer: Aetna Commercial |
$780.78
|
| Rate for Payer: Aetna Medicare |
$238.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$287.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$287.05
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$229.64
|
| Rate for Payer: BCBS Trust/PPO |
$755.16
|
| Rate for Payer: BCN Commercial |
$714.19
|
| Rate for Payer: BCN Medicare Advantage |
$229.64
|
| Rate for Payer: Cash Price |
$734.86
|
| Rate for Payer: Cash Price |
$734.86
|
| Rate for Payer: Cofinity Commercial |
$789.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.64
|
| Rate for Payer: Healthscope Commercial |
$826.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$688.93
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.12
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$264.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.78
|
| Rate for Payer: Nomi Health Commercial |
$753.23
|
| Rate for Payer: PACE Senior Care Partners |
$218.16
|
| Rate for Payer: PACE SWMI |
$229.64
|
| Rate for Payer: PHP Commercial |
$780.78
|
| Rate for Payer: PHP Medicare Advantage |
$229.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.07
|
| Rate for Payer: Priority Health HMO/PPO |
$799.16
|
| Rate for Payer: Priority Health Medicare |
$231.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$615.44
|
| Rate for Payer: Railroad Medicare Medicare |
$229.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.34
|
| Rate for Payer: UHC Core |
$767.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.64
|
| Rate for Payer: UHC Exchange |
$229.64
|
| Rate for Payer: UHC Medicare Advantage |
$229.64
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$229.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$688.93
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
IP
|
$918.57
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$597.07 |
| Max. Negotiated Rate |
$826.71 |
| Rate for Payer: Aetna Commercial |
$780.78
|
| Rate for Payer: BCBS Trust/PPO |
$749.83
|
| Rate for Payer: BCN Commercial |
$709.87
|
| Rate for Payer: Cash Price |
$734.86
|
| Rate for Payer: Cofinity Commercial |
$789.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.86
|
| Rate for Payer: Healthscope Commercial |
$826.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$688.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.78
|
| Rate for Payer: Nomi Health Commercial |
$753.23
|
| Rate for Payer: PHP Commercial |
$780.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.07
|
| Rate for Payer: Priority Health HMO/PPO |
$799.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$615.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.34
|
| Rate for Payer: UHC Core |
$767.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$688.93
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
OP
|
$791.52
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$187.99 |
| Max. Negotiated Rate |
$712.37 |
| Rate for Payer: Aetna Commercial |
$672.79
|
| Rate for Payer: Aetna Medicare |
$205.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.35
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$197.88
|
| Rate for Payer: BCBS Trust/PPO |
$650.71
|
| Rate for Payer: BCN Commercial |
$615.41
|
| Rate for Payer: BCN Medicare Advantage |
$197.88
|
| Rate for Payer: Cash Price |
$633.22
|
| Rate for Payer: Cash Price |
$633.22
|
| Rate for Payer: Cofinity Commercial |
$680.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.88
|
| Rate for Payer: Healthscope Commercial |
$712.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.64
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.77
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.79
|
| Rate for Payer: Nomi Health Commercial |
$649.05
|
| Rate for Payer: PACE Senior Care Partners |
$187.99
|
| Rate for Payer: PACE SWMI |
$197.88
|
| Rate for Payer: PHP Commercial |
$672.79
|
| Rate for Payer: PHP Medicare Advantage |
$197.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.49
|
| Rate for Payer: Priority Health HMO/PPO |
$688.62
|
| Rate for Payer: Priority Health Medicare |
$199.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$530.32
|
| Rate for Payer: Railroad Medicare Medicare |
$197.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$696.54
|
| Rate for Payer: UHC Core |
$660.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.88
|
| Rate for Payer: UHC Exchange |
$197.88
|
| Rate for Payer: UHC Medicare Advantage |
$197.88
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$197.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.64
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
IP
|
$791.52
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$514.49 |
| Max. Negotiated Rate |
$712.37 |
| Rate for Payer: Aetna Commercial |
$672.79
|
| Rate for Payer: BCBS Trust/PPO |
$646.12
|
| Rate for Payer: BCN Commercial |
$611.69
|
| Rate for Payer: Cash Price |
$633.22
|
| Rate for Payer: Cofinity Commercial |
$680.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.22
|
| Rate for Payer: Healthscope Commercial |
$712.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$593.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.79
|
| Rate for Payer: Nomi Health Commercial |
$649.05
|
| Rate for Payer: PHP Commercial |
$672.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.49
|
| Rate for Payer: Priority Health HMO/PPO |
$688.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$530.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$696.54
|
| Rate for Payer: UHC Core |
$660.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$593.64
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
IP
|
$1,288.73
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$837.67 |
| Max. Negotiated Rate |
$1,159.86 |
| Rate for Payer: Aetna Commercial |
$1,095.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,051.99
|
| Rate for Payer: BCN Commercial |
$995.93
|
| Rate for Payer: Cash Price |
$1,030.98
|
| Rate for Payer: Cofinity Commercial |
$1,108.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.98
|
| Rate for Payer: Healthscope Commercial |
$1,159.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.42
|
| Rate for Payer: Nomi Health Commercial |
$1,056.76
|
| Rate for Payer: PHP Commercial |
$1,095.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.67
|
| Rate for Payer: Priority Health HMO/PPO |
$1,121.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$863.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,134.08
|
| Rate for Payer: UHC Core |
$1,076.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.55
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
OP
|
$1,288.73
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$290.52 |
| Max. Negotiated Rate |
$1,159.86 |
| Rate for Payer: Aetna Commercial |
$1,095.42
|
| Rate for Payer: Aetna Medicare |
$335.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$402.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$402.73
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$322.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.46
|
| Rate for Payer: BCN Commercial |
$1,001.99
|
| Rate for Payer: BCN Medicare Advantage |
$322.18
|
| Rate for Payer: Cash Price |
$1,030.98
|
| Rate for Payer: Cash Price |
$1,030.98
|
| Rate for Payer: Cofinity Commercial |
$1,108.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.18
|
| Rate for Payer: Healthscope Commercial |
$1,159.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.55
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.29
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.42
|
| Rate for Payer: Nomi Health Commercial |
$1,056.76
|
| Rate for Payer: PACE Senior Care Partners |
$306.07
|
| Rate for Payer: PACE SWMI |
$322.18
|
| Rate for Payer: PHP Commercial |
$1,095.42
|
| Rate for Payer: PHP Medicare Advantage |
$322.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.67
|
| Rate for Payer: Priority Health HMO/PPO |
$1,121.20
|
| Rate for Payer: Priority Health Medicare |
$325.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$863.45
|
| Rate for Payer: Railroad Medicare Medicare |
$322.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,134.08
|
| Rate for Payer: UHC Core |
$1,076.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.18
|
| Rate for Payer: UHC Exchange |
$322.18
|
| Rate for Payer: UHC Medicare Advantage |
$322.18
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$322.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.55
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
IP
|
$1,734.99
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,127.74 |
| Max. Negotiated Rate |
$1,561.49 |
| Rate for Payer: Aetna Commercial |
$1,474.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,416.27
|
| Rate for Payer: BCN Commercial |
$1,340.80
|
| Rate for Payer: Cash Price |
$1,387.99
|
| Rate for Payer: Cofinity Commercial |
$1,492.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,387.99
|
| Rate for Payer: Healthscope Commercial |
$1,561.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,301.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.74
|
| Rate for Payer: Nomi Health Commercial |
$1,422.69
|
| Rate for Payer: PHP Commercial |
$1,474.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.74
|
| Rate for Payer: Priority Health HMO/PPO |
$1,509.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,162.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,526.79
|
| Rate for Payer: UHC Core |
$1,448.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,301.24
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
OP
|
$1,734.99
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$412.06 |
| Max. Negotiated Rate |
$1,561.49 |
| Rate for Payer: Aetna Commercial |
$1,474.74
|
| Rate for Payer: Aetna Medicare |
$451.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$542.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$542.18
|
| Rate for Payer: BCBS Complete |
$991.12
|
| Rate for Payer: BCBS MAPPO |
$433.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,426.34
|
| Rate for Payer: BCN Commercial |
$1,348.95
|
| Rate for Payer: BCN Medicare Advantage |
$433.75
|
| Rate for Payer: Cash Price |
$1,387.99
|
| Rate for Payer: Cash Price |
$1,387.99
|
| Rate for Payer: Cofinity Commercial |
$1,492.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,387.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.75
|
| Rate for Payer: Healthscope Commercial |
$1,561.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,301.24
|
| Rate for Payer: Mclaren Medicaid |
$943.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.43
|
| Rate for Payer: Meridian Medicaid |
$991.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$498.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.74
|
| Rate for Payer: Nomi Health Commercial |
$1,422.69
|
| Rate for Payer: PACE Senior Care Partners |
$412.06
|
| Rate for Payer: PACE SWMI |
$433.75
|
| Rate for Payer: PHP Commercial |
$1,474.74
|
| Rate for Payer: PHP Medicare Advantage |
$433.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$943.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.74
|
| Rate for Payer: Priority Health HMO/PPO |
$1,509.44
|
| Rate for Payer: Priority Health Medicare |
$438.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,162.44
|
| Rate for Payer: Railroad Medicare Medicare |
$433.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,526.79
|
| Rate for Payer: UHC Core |
$1,448.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.75
|
| Rate for Payer: UHC Exchange |
$433.75
|
| Rate for Payer: UHC Medicare Advantage |
$433.75
|
| Rate for Payer: UHCCP Medicaid |
$943.86
|
| Rate for Payer: VA VA |
$433.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,301.24
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
OP
|
$833.44
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$197.94 |
| Max. Negotiated Rate |
$750.10 |
| Rate for Payer: Aetna Commercial |
$708.42
|
| Rate for Payer: Aetna Medicare |
$216.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$260.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$260.45
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$208.36
|
| Rate for Payer: BCBS Trust/PPO |
$685.17
|
| Rate for Payer: BCN Commercial |
$648.00
|
| Rate for Payer: BCN Medicare Advantage |
$208.36
|
| Rate for Payer: Cash Price |
$666.75
|
| Rate for Payer: Cash Price |
$666.75
|
| Rate for Payer: Cofinity Commercial |
$716.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.36
|
| Rate for Payer: Healthscope Commercial |
$750.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$625.08
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$218.78
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.42
|
| Rate for Payer: Nomi Health Commercial |
$683.42
|
| Rate for Payer: PACE Senior Care Partners |
$197.94
|
| Rate for Payer: PACE SWMI |
$208.36
|
| Rate for Payer: PHP Commercial |
$708.42
|
| Rate for Payer: PHP Medicare Advantage |
$208.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.74
|
| Rate for Payer: Priority Health HMO/PPO |
$725.09
|
| Rate for Payer: Priority Health Medicare |
$210.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$558.40
|
| Rate for Payer: Railroad Medicare Medicare |
$208.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$733.43
|
| Rate for Payer: UHC Core |
$695.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$208.36
|
| Rate for Payer: UHC Exchange |
$208.36
|
| Rate for Payer: UHC Medicare Advantage |
$208.36
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$208.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$625.08
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
IP
|
$833.44
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$541.74 |
| Max. Negotiated Rate |
$750.10 |
| Rate for Payer: Aetna Commercial |
$708.42
|
| Rate for Payer: BCBS Trust/PPO |
$680.34
|
| Rate for Payer: BCN Commercial |
$644.08
|
| Rate for Payer: Cash Price |
$666.75
|
| Rate for Payer: Cofinity Commercial |
$716.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.75
|
| Rate for Payer: Healthscope Commercial |
$750.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$625.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.42
|
| Rate for Payer: Nomi Health Commercial |
$683.42
|
| Rate for Payer: PHP Commercial |
$708.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.74
|
| Rate for Payer: Priority Health HMO/PPO |
$725.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$558.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$733.43
|
| Rate for Payer: UHC Core |
$695.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$625.08
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna Medicare |
$265.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$318.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$318.99
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$255.19
|
| Rate for Payer: BCBS Trust/PPO |
$839.18
|
| Rate for Payer: BCN Commercial |
$793.66
|
| Rate for Payer: BCN Medicare Advantage |
$255.19
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.19
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.95
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PACE Senior Care Partners |
$242.44
|
| Rate for Payer: PACE SWMI |
$255.19
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: PHP Medicare Advantage |
$255.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO |
$888.08
|
| Rate for Payer: Priority Health Medicare |
$257.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.92
|
| Rate for Payer: Railroad Medicare Medicare |
$255.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.19
|
| Rate for Payer: UHC Exchange |
$255.19
|
| Rate for Payer: UHC Medicare Advantage |
$255.19
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$255.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$663.51 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: BCBS Trust/PPO |
$833.26
|
| Rate for Payer: BCN Commercial |
$788.86
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$765.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO |
$888.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$683.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.29
|
| Rate for Payer: UHC Core |
$852.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$765.59
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
IP
|
$1,314.40
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$854.36 |
| Max. Negotiated Rate |
$1,182.96 |
| Rate for Payer: Aetna Commercial |
$1,117.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.94
|
| Rate for Payer: BCN Commercial |
$1,015.77
|
| Rate for Payer: Cash Price |
$1,051.52
|
| Rate for Payer: Cofinity Commercial |
$1,130.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.52
|
| Rate for Payer: Healthscope Commercial |
$1,182.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$985.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.24
|
| Rate for Payer: Nomi Health Commercial |
$1,077.81
|
| Rate for Payer: PHP Commercial |
$1,117.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1,143.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$880.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,156.67
|
| Rate for Payer: UHC Core |
$1,097.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$985.80
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
OP
|
$1,314.40
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$312.17 |
| Max. Negotiated Rate |
$1,182.96 |
| Rate for Payer: Aetna Commercial |
$1,117.24
|
| Rate for Payer: Aetna Medicare |
$341.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.75
|
| Rate for Payer: BCBS Complete |
$408.65
|
| Rate for Payer: BCBS MAPPO |
$328.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,080.57
|
| Rate for Payer: BCN Commercial |
$1,021.95
|
| Rate for Payer: BCN Medicare Advantage |
$328.60
|
| Rate for Payer: Cash Price |
$1,051.52
|
| Rate for Payer: Cash Price |
$1,051.52
|
| Rate for Payer: Cofinity Commercial |
$1,130.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.60
|
| Rate for Payer: Healthscope Commercial |
$1,182.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$985.80
|
| Rate for Payer: Mclaren Medicaid |
$389.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.03
|
| Rate for Payer: Meridian Medicaid |
$408.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$377.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.24
|
| Rate for Payer: Nomi Health Commercial |
$1,077.81
|
| Rate for Payer: PACE Senior Care Partners |
$312.17
|
| Rate for Payer: PACE SWMI |
$328.60
|
| Rate for Payer: PHP Commercial |
$1,117.24
|
| Rate for Payer: PHP Medicare Advantage |
$328.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.36
|
| Rate for Payer: Priority Health HMO/PPO |
$1,143.53
|
| Rate for Payer: Priority Health Medicare |
$331.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$880.65
|
| Rate for Payer: Railroad Medicare Medicare |
$328.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,156.67
|
| Rate for Payer: UHC Core |
$1,097.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$328.60
|
| Rate for Payer: UHC Exchange |
$328.60
|
| Rate for Payer: UHC Medicare Advantage |
$328.60
|
| Rate for Payer: UHCCP Medicaid |
$389.17
|
| Rate for Payer: VA VA |
$328.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$985.80
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
OP
|
$1,146.04
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$272.18 |
| Max. Negotiated Rate |
$1,031.44 |
| Rate for Payer: Aetna Commercial |
$974.13
|
| Rate for Payer: Aetna Medicare |
$297.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$358.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$358.14
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$286.51
|
| Rate for Payer: BCBS Trust/PPO |
$942.16
|
| Rate for Payer: BCN Commercial |
$891.05
|
| Rate for Payer: BCN Medicare Advantage |
$286.51
|
| Rate for Payer: Cash Price |
$916.83
|
| Rate for Payer: Cash Price |
$916.83
|
| Rate for Payer: Cofinity Commercial |
$985.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.51
|
| Rate for Payer: Healthscope Commercial |
$1,031.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$859.53
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$300.84
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$974.13
|
| Rate for Payer: Nomi Health Commercial |
$939.75
|
| Rate for Payer: PACE Senior Care Partners |
$272.18
|
| Rate for Payer: PACE SWMI |
$286.51
|
| Rate for Payer: PHP Commercial |
$974.13
|
| Rate for Payer: PHP Medicare Advantage |
$286.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.93
|
| Rate for Payer: Priority Health HMO/PPO |
$997.05
|
| Rate for Payer: Priority Health Medicare |
$289.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$767.85
|
| Rate for Payer: Railroad Medicare Medicare |
$286.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,008.52
|
| Rate for Payer: UHC Core |
$956.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.51
|
| Rate for Payer: UHC Exchange |
$286.51
|
| Rate for Payer: UHC Medicare Advantage |
$286.51
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$286.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$859.53
|
|
