|
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
|
|
|
HC NM MYOCARD PERF SPECT EF WM MU
|
Facility
|
OP
|
$5,128.21
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
34100029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$943.86 |
| Max. Negotiated Rate |
$4,615.39 |
| Rate for Payer: Aetna Commercial |
$4,358.98
|
| Rate for Payer: Aetna Medicare |
$1,333.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,602.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,602.57
|
| Rate for Payer: BCBS Complete |
$991.12
|
| Rate for Payer: BCBS MAPPO |
$1,282.05
|
| Rate for Payer: BCBS Trust/PPO |
$4,215.90
|
| Rate for Payer: BCN Commercial |
$3,987.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,282.05
|
| Rate for Payer: Cash Price |
$4,102.57
|
| Rate for Payer: Cash Price |
$4,102.57
|
| Rate for Payer: Cofinity Commercial |
$4,410.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,102.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,282.05
|
| Rate for Payer: Healthscope Commercial |
$4,615.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,846.16
|
| Rate for Payer: Mclaren Medicaid |
$943.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,346.16
|
| Rate for Payer: Meridian Medicaid |
$991.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,474.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,358.98
|
| Rate for Payer: Nomi Health Commercial |
$4,205.13
|
| Rate for Payer: PACE Senior Care Partners |
$1,217.95
|
| Rate for Payer: PACE SWMI |
$1,282.05
|
| Rate for Payer: PHP Commercial |
$4,358.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,282.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$943.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,333.34
|
| Rate for Payer: Priority Health HMO/PPO |
$4,461.54
|
| Rate for Payer: Priority Health Medicare |
$1,294.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,435.90
|
| Rate for Payer: Railroad Medicare Medicare |
$1,282.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,512.82
|
| Rate for Payer: UHC Core |
$4,282.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,282.05
|
| Rate for Payer: UHC Exchange |
$1,282.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,282.05
|
| Rate for Payer: UHCCP Medicaid |
$943.86
|
| Rate for Payer: VA VA |
$1,282.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,846.16
|
|
|
HC NM MYOCARD PERF SPECT EF WM MU
|
Facility
|
IP
|
$5,128.21
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
34100029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,333.34 |
| Max. Negotiated Rate |
$4,615.39 |
| Rate for Payer: Aetna Commercial |
$4,358.98
|
| Rate for Payer: BCBS Trust/PPO |
$4,186.16
|
| Rate for Payer: BCN Commercial |
$3,963.08
|
| Rate for Payer: Cash Price |
$4,102.57
|
| Rate for Payer: Cofinity Commercial |
$4,410.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,102.57
|
| Rate for Payer: Healthscope Commercial |
$4,615.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,846.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,358.98
|
| Rate for Payer: Nomi Health Commercial |
$4,205.13
|
| Rate for Payer: PHP Commercial |
$4,358.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,333.34
|
| Rate for Payer: Priority Health HMO/PPO |
$4,461.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,435.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,512.82
|
| Rate for Payer: UHC Core |
$4,282.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,846.16
|
|
|
HC NM MYOCARD PERF SPECT EF WM SI
|
Facility
|
OP
|
$1,831.50
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
34100067
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$434.98 |
| Max. Negotiated Rate |
$1,648.35 |
| Rate for Payer: Aetna Commercial |
$1,556.78
|
| Rate for Payer: Aetna Medicare |
$476.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$572.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$572.34
|
| Rate for Payer: BCBS Complete |
$991.12
|
| Rate for Payer: BCBS MAPPO |
$457.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,505.68
|
| Rate for Payer: BCN Commercial |
$1,423.99
|
| Rate for Payer: BCN Medicare Advantage |
$457.88
|
| Rate for Payer: Cash Price |
$1,465.20
|
| Rate for Payer: Cash Price |
$1,465.20
|
| Rate for Payer: Cofinity Commercial |
$1,575.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$457.88
|
| Rate for Payer: Healthscope Commercial |
$1,648.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,373.62
|
| Rate for Payer: Mclaren Medicaid |
$943.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$480.77
|
| Rate for Payer: Meridian Medicaid |
$991.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$526.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,556.78
|
| Rate for Payer: Nomi Health Commercial |
$1,501.83
|
| Rate for Payer: PACE Senior Care Partners |
$434.98
|
| Rate for Payer: PACE SWMI |
$457.88
|
| Rate for Payer: PHP Commercial |
$1,556.78
|
| Rate for Payer: PHP Medicare Advantage |
$457.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$943.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.47
|
| Rate for Payer: Priority Health HMO/PPO |
$1,593.40
|
| Rate for Payer: Priority Health Medicare |
$462.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,227.11
|
| Rate for Payer: Railroad Medicare Medicare |
$457.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,611.72
|
| Rate for Payer: UHC Core |
$1,529.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$457.88
|
| Rate for Payer: UHC Exchange |
$457.88
|
| Rate for Payer: UHC Medicare Advantage |
$457.88
|
| Rate for Payer: UHCCP Medicaid |
$943.86
|
| Rate for Payer: VA VA |
$457.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,373.62
|
|
|
HC NM MYOCARD PERF SPECT EF WM SI
|
Facility
|
IP
|
$1,831.50
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
34100067
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,190.47 |
| Max. Negotiated Rate |
$1,648.35 |
| Rate for Payer: Aetna Commercial |
$1,556.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,495.05
|
| Rate for Payer: BCN Commercial |
$1,415.38
|
| Rate for Payer: Cash Price |
$1,465.20
|
| Rate for Payer: Cofinity Commercial |
$1,575.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.20
|
| Rate for Payer: Healthscope Commercial |
$1,648.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,373.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,556.78
|
| Rate for Payer: Nomi Health Commercial |
$1,501.83
|
| Rate for Payer: PHP Commercial |
$1,556.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.47
|
| Rate for Payer: Priority Health HMO/PPO |
$1,593.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,227.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,611.72
|
| Rate for Payer: UHC Core |
$1,529.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,373.62
|
|
|
HC NMO/AQP4 FACS TITER SERUM
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.88
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$83.85
|
| Rate for Payer: BCN Commercial |
$79.31
|
| Rate for Payer: BCN Medicare Advantage |
$25.50
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.50
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.77
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: PACE Senior Care Partners |
$24.23
|
| Rate for Payer: PACE SWMI |
$25.50
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$25.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO |
$88.74
|
| Rate for Payer: Priority Health Medicare |
$25.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.34
|
| Rate for Payer: Railroad Medicare Medicare |
$25.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.50
|
| Rate for Payer: UHC Exchange |
$25.50
|
| Rate for Payer: UHC Medicare Advantage |
$25.50
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$25.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC NMO/AQP4 FACS TITER SERUM
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: BCBS Trust/PPO |
$83.26
|
| Rate for Payer: BCN Commercial |
$78.83
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO |
$88.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.76
|
| Rate for Payer: UHC Core |
$85.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.50
|
|
|
HC NMO/AQP4-IGG CBA, S
|
Facility
|
IP
|
$351.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$228.74 |
| Max. Negotiated Rate |
$316.71 |
| Rate for Payer: Aetna Commercial |
$299.12
|
| Rate for Payer: BCBS Trust/PPO |
$287.26
|
| Rate for Payer: BCN Commercial |
$271.95
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cofinity Commercial |
$302.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.52
|
| Rate for Payer: Healthscope Commercial |
$316.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.12
|
| Rate for Payer: Nomi Health Commercial |
$288.56
|
| Rate for Payer: PHP Commercial |
$299.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.74
|
| Rate for Payer: Priority Health HMO/PPO |
$306.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.67
|
| Rate for Payer: UHC Core |
$293.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.93
|
|
|
HC NMO/AQP4-IGG CBA, S
|
Facility
|
OP
|
$351.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$316.71 |
| Rate for Payer: Aetna Commercial |
$299.12
|
| Rate for Payer: Aetna Medicare |
$91.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.97
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$87.97
|
| Rate for Payer: BCBS Trust/PPO |
$289.30
|
| Rate for Payer: BCN Commercial |
$273.60
|
| Rate for Payer: BCN Medicare Advantage |
$87.97
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cofinity Commercial |
$302.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.97
|
| Rate for Payer: Healthscope Commercial |
$316.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.93
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.37
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.12
|
| Rate for Payer: Nomi Health Commercial |
$288.56
|
| Rate for Payer: PACE Senior Care Partners |
$83.58
|
| Rate for Payer: PACE SWMI |
$87.97
|
| Rate for Payer: PHP Commercial |
$299.12
|
| Rate for Payer: PHP Medicare Advantage |
$87.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.74
|
| Rate for Payer: Priority Health HMO/PPO |
$306.15
|
| Rate for Payer: Priority Health Medicare |
$88.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.77
|
| Rate for Payer: Railroad Medicare Medicare |
$87.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.67
|
| Rate for Payer: UHC Core |
$293.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.97
|
| Rate for Payer: UHC Exchange |
$87.97
|
| Rate for Payer: UHC Medicare Advantage |
$87.97
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$87.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.93
|
|
|
HC NMO/AQUAPO 4 IGG CBA
|
Facility
|
IP
|
$350.88
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$228.07 |
| Max. Negotiated Rate |
$315.79 |
| Rate for Payer: Aetna Commercial |
$298.25
|
| Rate for Payer: BCBS Trust/PPO |
$286.42
|
| Rate for Payer: BCN Commercial |
$271.16
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.70
|
| Rate for Payer: Healthscope Commercial |
$315.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.25
|
| Rate for Payer: Nomi Health Commercial |
$287.72
|
| Rate for Payer: PHP Commercial |
$298.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.07
|
| Rate for Payer: Priority Health HMO/PPO |
$305.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.77
|
| Rate for Payer: UHC Core |
$292.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.16
|
|
|
HC NMO/AQUAPO 4 IGG CBA
|
Facility
|
OP
|
$350.88
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$315.79 |
| Rate for Payer: Aetna Commercial |
$298.25
|
| Rate for Payer: Aetna Medicare |
$91.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.65
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$87.72
|
| Rate for Payer: BCBS Trust/PPO |
$288.46
|
| Rate for Payer: BCN Commercial |
$272.81
|
| Rate for Payer: BCN Medicare Advantage |
$87.72
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: Cofinity Commercial |
$301.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.72
|
| Rate for Payer: Healthscope Commercial |
$315.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.16
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.11
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.25
|
| Rate for Payer: Nomi Health Commercial |
$287.72
|
| Rate for Payer: PACE Senior Care Partners |
$83.33
|
| Rate for Payer: PACE SWMI |
$87.72
|
| Rate for Payer: PHP Commercial |
$298.25
|
| Rate for Payer: PHP Medicare Advantage |
$87.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.07
|
| Rate for Payer: Priority Health HMO/PPO |
$305.27
|
| Rate for Payer: Priority Health Medicare |
$88.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.09
|
| Rate for Payer: Railroad Medicare Medicare |
$87.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.77
|
| Rate for Payer: UHC Core |
$292.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.72
|
| Rate for Payer: UHC Exchange |
$87.72
|
| Rate for Payer: UHC Medicare Advantage |
$87.72
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$87.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.16
|
|
|
HC NM PARATHYROID SCAN
|
Facility
|
IP
|
$918.71
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
34100007
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$597.16 |
| Max. Negotiated Rate |
$826.84 |
| Rate for Payer: Aetna Commercial |
$780.90
|
| Rate for Payer: BCBS Trust/PPO |
$749.94
|
| Rate for Payer: BCN Commercial |
$709.98
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cofinity Commercial |
$790.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.97
|
| Rate for Payer: Healthscope Commercial |
$826.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.90
|
| Rate for Payer: Nomi Health Commercial |
$753.34
|
| Rate for Payer: PHP Commercial |
$780.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.16
|
| Rate for Payer: Priority Health HMO/PPO |
$799.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$615.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.46
|
| Rate for Payer: UHC Core |
$767.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.03
|
|
|
HC NM PARATHYROID SCAN
|
Facility
|
OP
|
$918.71
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
34100007
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$218.19 |
| Max. Negotiated Rate |
$826.84 |
| Rate for Payer: Aetna Commercial |
$780.90
|
| Rate for Payer: Aetna Medicare |
$238.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$287.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$287.10
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$229.68
|
| Rate for Payer: BCBS Trust/PPO |
$755.27
|
| Rate for Payer: BCN Commercial |
$714.30
|
| Rate for Payer: BCN Medicare Advantage |
$229.68
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cash Price |
$734.97
|
| Rate for Payer: Cofinity Commercial |
$790.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.68
|
| Rate for Payer: Healthscope Commercial |
$826.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.03
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.16
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$264.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.90
|
| Rate for Payer: Nomi Health Commercial |
$753.34
|
| Rate for Payer: PACE Senior Care Partners |
$218.19
|
| Rate for Payer: PACE SWMI |
$229.68
|
| Rate for Payer: PHP Commercial |
$780.90
|
| Rate for Payer: PHP Medicare Advantage |
$229.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.16
|
| Rate for Payer: Priority Health HMO/PPO |
$799.28
|
| Rate for Payer: Priority Health Medicare |
$231.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$615.54
|
| Rate for Payer: Railroad Medicare Medicare |
$229.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.46
|
| Rate for Payer: UHC Core |
$767.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.68
|
| Rate for Payer: UHC Exchange |
$229.68
|
| Rate for Payer: UHC Medicare Advantage |
$229.68
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$229.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.03
|
|
|
HC NM PARATHYROID SESTAMIBI INJ O
|
Facility
|
IP
|
$408.20
|
|
|
Service Code
|
CPT 78808
|
| Hospital Charge Code |
34100060
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$265.33 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna Commercial |
$346.97
|
| Rate for Payer: BCBS Trust/PPO |
$333.21
|
| Rate for Payer: BCN Commercial |
$315.46
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$351.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Healthscope Commercial |
$367.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: PHP Commercial |
$346.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health HMO/PPO |
$355.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.22
|
| Rate for Payer: UHC Core |
$340.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.15
|
|
|
HC NM PARATHYROID SESTAMIBI INJ O
|
Facility
|
OP
|
$408.20
|
|
|
Service Code
|
CPT 78808
|
| Hospital Charge Code |
34100060
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$96.95 |
| Max. Negotiated Rate |
$367.38 |
| Rate for Payer: Aetna Commercial |
$346.97
|
| Rate for Payer: Aetna Medicare |
$106.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.56
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$102.05
|
| Rate for Payer: BCBS Trust/PPO |
$335.58
|
| Rate for Payer: BCN Commercial |
$317.38
|
| Rate for Payer: BCN Medicare Advantage |
$102.05
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cash Price |
$326.56
|
| Rate for Payer: Cofinity Commercial |
$351.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.05
|
| Rate for Payer: Healthscope Commercial |
$367.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.15
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.15
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$346.97
|
| Rate for Payer: Nomi Health Commercial |
$334.72
|
| Rate for Payer: PACE Senior Care Partners |
$96.95
|
| Rate for Payer: PACE SWMI |
$102.05
|
| Rate for Payer: PHP Commercial |
$346.97
|
| Rate for Payer: PHP Medicare Advantage |
$102.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.33
|
| Rate for Payer: Priority Health HMO/PPO |
$355.13
|
| Rate for Payer: Priority Health Medicare |
$103.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.49
|
| Rate for Payer: Railroad Medicare Medicare |
$102.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.22
|
| Rate for Payer: UHC Core |
$340.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.05
|
| Rate for Payer: UHC Exchange |
$102.05
|
| Rate for Payer: UHC Medicare Advantage |
$102.05
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$102.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.15
|
|
|
HC NM PARATHYROID SPECT SCAN
|
Facility
|
OP
|
$1,032.12
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
34100077
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$245.13 |
| Max. Negotiated Rate |
$928.91 |
| Rate for Payer: Aetna Commercial |
$877.30
|
| Rate for Payer: Aetna Medicare |
$268.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$322.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$322.54
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$258.03
|
| Rate for Payer: BCBS Trust/PPO |
$848.51
|
| Rate for Payer: BCN Commercial |
$802.47
|
| Rate for Payer: BCN Medicare Advantage |
$258.03
|
| Rate for Payer: Cash Price |
$825.70
|
| Rate for Payer: Cash Price |
$825.70
|
| Rate for Payer: Cofinity Commercial |
$887.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.03
|
| Rate for Payer: Healthscope Commercial |
$928.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$774.09
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.93
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.30
|
| Rate for Payer: Nomi Health Commercial |
$846.34
|
| Rate for Payer: PACE Senior Care Partners |
$245.13
|
| Rate for Payer: PACE SWMI |
$258.03
|
| Rate for Payer: PHP Commercial |
$877.30
|
| Rate for Payer: PHP Medicare Advantage |
$258.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.88
|
| Rate for Payer: Priority Health HMO/PPO |
$897.94
|
| Rate for Payer: Priority Health Medicare |
$260.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$691.52
|
| Rate for Payer: Railroad Medicare Medicare |
$258.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$908.27
|
| Rate for Payer: UHC Core |
$861.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.03
|
| Rate for Payer: UHC Exchange |
$258.03
|
| Rate for Payer: UHC Medicare Advantage |
$258.03
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$258.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$774.09
|
|
|
HC NM PARATHYROID SPECT SCAN
|
Facility
|
IP
|
$1,032.12
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
34100077
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$670.88 |
| Max. Negotiated Rate |
$928.91 |
| Rate for Payer: Aetna Commercial |
$877.30
|
| Rate for Payer: BCBS Trust/PPO |
$842.52
|
| Rate for Payer: BCN Commercial |
$797.62
|
| Rate for Payer: Cash Price |
$825.70
|
| Rate for Payer: Cofinity Commercial |
$887.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$825.70
|
| Rate for Payer: Healthscope Commercial |
$928.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$774.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.30
|
| Rate for Payer: Nomi Health Commercial |
$846.34
|
| Rate for Payer: PHP Commercial |
$877.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.88
|
| Rate for Payer: Priority Health HMO/PPO |
$897.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$691.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$908.27
|
| Rate for Payer: UHC Core |
$861.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$774.09
|
|
|
HC NM PERFUSION QUANTITATIVE DIFF
|
Facility
|
IP
|
$1,219.18
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
34100069
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$792.47 |
| Max. Negotiated Rate |
$1,097.26 |
| Rate for Payer: Aetna Commercial |
$1,036.30
|
| Rate for Payer: BCBS Trust/PPO |
$995.22
|
| Rate for Payer: BCN Commercial |
$942.18
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cofinity Commercial |
$1,048.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$975.34
|
| Rate for Payer: Healthscope Commercial |
$1,097.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$914.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,036.30
|
| Rate for Payer: Nomi Health Commercial |
$999.73
|
| Rate for Payer: PHP Commercial |
$1,036.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.47
|
| Rate for Payer: Priority Health HMO/PPO |
$1,060.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$816.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,072.88
|
| Rate for Payer: UHC Core |
$1,018.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$914.38
|
|
|
HC NM PERFUSION QUANTITATIVE DIFF
|
Facility
|
OP
|
$1,219.18
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
34100069
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$289.56 |
| Max. Negotiated Rate |
$1,097.26 |
| Rate for Payer: Aetna Commercial |
$1,036.30
|
| Rate for Payer: Aetna Medicare |
$316.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$380.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$380.99
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$304.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,002.29
|
| Rate for Payer: BCN Commercial |
$947.91
|
| Rate for Payer: BCN Medicare Advantage |
$304.80
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cofinity Commercial |
$1,048.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$975.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.80
|
| Rate for Payer: Healthscope Commercial |
$1,097.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$914.38
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.03
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,036.30
|
| Rate for Payer: Nomi Health Commercial |
$999.73
|
| Rate for Payer: PACE Senior Care Partners |
$289.56
|
| Rate for Payer: PACE SWMI |
$304.80
|
| Rate for Payer: PHP Commercial |
$1,036.30
|
| Rate for Payer: PHP Medicare Advantage |
$304.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.47
|
| Rate for Payer: Priority Health HMO/PPO |
$1,060.69
|
| Rate for Payer: Priority Health Medicare |
$307.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$816.85
|
| Rate for Payer: Railroad Medicare Medicare |
$304.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,072.88
|
| Rate for Payer: UHC Core |
$1,018.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$304.80
|
| Rate for Payer: UHC Exchange |
$304.80
|
| Rate for Payer: UHC Medicare Advantage |
$304.80
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$304.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$914.38
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$162.05 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna Medicare |
$202.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.03
|
| Rate for Payer: BCBS Complete |
$170.16
|
| Rate for Payer: BCBS MAPPO |
$194.43
|
| Rate for Payer: BCBS Trust/PPO |
$639.36
|
| Rate for Payer: BCN Commercial |
$604.67
|
| Rate for Payer: BCN Medicare Advantage |
$194.43
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.43
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Mclaren Medicaid |
$162.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.15
|
| Rate for Payer: Meridian Medicaid |
$170.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: PACE Senior Care Partners |
$184.71
|
| Rate for Payer: PACE SWMI |
$194.43
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: PHP Medicare Advantage |
$194.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO |
$676.61
|
| Rate for Payer: Priority Health Medicare |
$196.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.07
|
| Rate for Payer: Railroad Medicare Medicare |
$194.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.38
|
| Rate for Payer: UHC Core |
$649.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.43
|
| Rate for Payer: UHC Exchange |
$194.43
|
| Rate for Payer: UHC Medicare Advantage |
$194.43
|
| Rate for Payer: UHCCP Medicaid |
$162.05
|
| Rate for Payer: VA VA |
$194.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC NM RADIOPHARM INTRACAVITARY AD
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 79200
|
| Hospital Charge Code |
34100064
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$505.51 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: BCBS Trust/PPO |
$634.84
|
| Rate for Payer: BCN Commercial |
$601.01
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO |
$676.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.38
|
| Rate for Payer: UHC Core |
$649.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$162.05 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna Medicare |
$202.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.03
|
| Rate for Payer: BCBS Complete |
$170.16
|
| Rate for Payer: BCBS MAPPO |
$194.43
|
| Rate for Payer: BCBS Trust/PPO |
$639.36
|
| Rate for Payer: BCN Commercial |
$604.67
|
| Rate for Payer: BCN Medicare Advantage |
$194.43
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.43
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Mclaren Medicaid |
$162.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.15
|
| Rate for Payer: Meridian Medicaid |
$170.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: PACE Senior Care Partners |
$184.71
|
| Rate for Payer: PACE SWMI |
$194.43
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: PHP Medicare Advantage |
$194.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO |
$676.61
|
| Rate for Payer: Priority Health Medicare |
$196.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.07
|
| Rate for Payer: Railroad Medicare Medicare |
$194.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.38
|
| Rate for Payer: UHC Core |
$649.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.43
|
| Rate for Payer: UHC Exchange |
$194.43
|
| Rate for Payer: UHC Medicare Advantage |
$194.43
|
| Rate for Payer: UHCCP Medicaid |
$162.05
|
| Rate for Payer: VA VA |
$194.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC NM RADIOPHARM IV ADMIN
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
34100063
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$505.51 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: BCBS Trust/PPO |
$634.84
|
| Rate for Payer: BCN Commercial |
$601.01
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO |
$676.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.38
|
| Rate for Payer: UHC Core |
$649.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
IP
|
$777.71
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$505.51 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: BCBS Trust/PPO |
$634.84
|
| Rate for Payer: BCN Commercial |
$601.01
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO |
$676.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.38
|
| Rate for Payer: UHC Core |
$649.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
|
HC NM RADIOPHARM ORAL ADMIN
|
Facility
|
OP
|
$777.71
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
34100062
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$162.05 |
| Max. Negotiated Rate |
$699.94 |
| Rate for Payer: Aetna Commercial |
$661.05
|
| Rate for Payer: Aetna Medicare |
$202.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.03
|
| Rate for Payer: BCBS Complete |
$170.16
|
| Rate for Payer: BCBS MAPPO |
$194.43
|
| Rate for Payer: BCBS Trust/PPO |
$639.36
|
| Rate for Payer: BCN Commercial |
$604.67
|
| Rate for Payer: BCN Medicare Advantage |
$194.43
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cash Price |
$622.17
|
| Rate for Payer: Cofinity Commercial |
$668.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.43
|
| Rate for Payer: Healthscope Commercial |
$699.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.28
|
| Rate for Payer: Mclaren Medicaid |
$162.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.15
|
| Rate for Payer: Meridian Medicaid |
$170.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.05
|
| Rate for Payer: Nomi Health Commercial |
$637.72
|
| Rate for Payer: PACE Senior Care Partners |
$184.71
|
| Rate for Payer: PACE SWMI |
$194.43
|
| Rate for Payer: PHP Commercial |
$661.05
|
| Rate for Payer: PHP Medicare Advantage |
$194.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.51
|
| Rate for Payer: Priority Health HMO/PPO |
$676.61
|
| Rate for Payer: Priority Health Medicare |
$196.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.07
|
| Rate for Payer: Railroad Medicare Medicare |
$194.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.38
|
| Rate for Payer: UHC Core |
$649.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.43
|
| Rate for Payer: UHC Exchange |
$194.43
|
| Rate for Payer: UHC Medicare Advantage |
$194.43
|
| Rate for Payer: UHCCP Medicaid |
$162.05
|
| Rate for Payer: VA VA |
$194.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.28
|
|
