|
HC NM RENAL NON FLOW STUDY
|
Facility
|
IP
|
$1,360.85
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
34100044
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$884.55 |
| Max. Negotiated Rate |
$1,224.77 |
| Rate for Payer: Aetna Commercial |
$1,156.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,110.86
|
| Rate for Payer: BCN Commercial |
$1,051.66
|
| Rate for Payer: Cash Price |
$1,088.68
|
| Rate for Payer: Cofinity Commercial |
$1,170.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,088.68
|
| Rate for Payer: Healthscope Commercial |
$1,224.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,020.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,156.72
|
| Rate for Payer: Nomi Health Commercial |
$1,115.90
|
| Rate for Payer: PHP Commercial |
$1,156.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,183.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$911.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,197.55
|
| Rate for Payer: UHC Core |
$1,136.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,020.64
|
|
|
HC NM RENAL NON FLOW STUDY
|
Facility
|
OP
|
$1,360.85
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
34100044
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$290.52 |
| Max. Negotiated Rate |
$1,224.77 |
| Rate for Payer: Aetna Commercial |
$1,156.72
|
| Rate for Payer: Aetna Medicare |
$353.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$425.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$425.27
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$340.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.75
|
| Rate for Payer: BCN Commercial |
$1,058.06
|
| Rate for Payer: BCN Medicare Advantage |
$340.21
|
| Rate for Payer: Cash Price |
$1,088.68
|
| Rate for Payer: Cash Price |
$1,088.68
|
| Rate for Payer: Cofinity Commercial |
$1,170.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,088.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.21
|
| Rate for Payer: Healthscope Commercial |
$1,224.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,020.64
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$357.22
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$391.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,156.72
|
| Rate for Payer: Nomi Health Commercial |
$1,115.90
|
| Rate for Payer: PACE Senior Care Partners |
$323.20
|
| Rate for Payer: PACE SWMI |
$340.21
|
| Rate for Payer: PHP Commercial |
$1,156.72
|
| Rate for Payer: PHP Medicare Advantage |
$340.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,183.94
|
| Rate for Payer: Priority Health Medicare |
$343.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$911.77
|
| Rate for Payer: Railroad Medicare Medicare |
$340.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,197.55
|
| Rate for Payer: UHC Core |
$1,136.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$340.21
|
| Rate for Payer: UHC Exchange |
$340.21
|
| Rate for Payer: UHC Medicare Advantage |
$340.21
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$340.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,020.64
|
|
|
HC NM RENOGRAM WITH FLOW
|
Facility
|
IP
|
$1,326.66
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
34100045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$862.33 |
| Max. Negotiated Rate |
$1,193.99 |
| Rate for Payer: Aetna Commercial |
$1,127.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,082.95
|
| Rate for Payer: BCN Commercial |
$1,025.24
|
| Rate for Payer: Cash Price |
$1,061.33
|
| Rate for Payer: Cofinity Commercial |
$1,140.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.33
|
| Rate for Payer: Healthscope Commercial |
$1,193.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.66
|
| Rate for Payer: Nomi Health Commercial |
$1,087.86
|
| Rate for Payer: PHP Commercial |
$1,127.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.33
|
| Rate for Payer: Priority Health HMO/PPO |
$1,154.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$888.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,167.46
|
| Rate for Payer: UHC Core |
$1,107.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.00
|
|
|
HC NM RENOGRAM WITH FLOW
|
Facility
|
OP
|
$1,326.66
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
34100045
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$315.08 |
| Max. Negotiated Rate |
$1,193.99 |
| Rate for Payer: Aetna Commercial |
$1,127.66
|
| Rate for Payer: Aetna Medicare |
$344.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$414.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$414.58
|
| Rate for Payer: BCBS Complete |
$408.65
|
| Rate for Payer: BCBS MAPPO |
$331.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.65
|
| Rate for Payer: BCN Commercial |
$1,031.48
|
| Rate for Payer: BCN Medicare Advantage |
$331.67
|
| Rate for Payer: Cash Price |
$1,061.33
|
| Rate for Payer: Cash Price |
$1,061.33
|
| Rate for Payer: Cofinity Commercial |
$1,140.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$331.67
|
| Rate for Payer: Healthscope Commercial |
$1,193.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$995.00
|
| Rate for Payer: Mclaren Medicaid |
$389.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$348.25
|
| Rate for Payer: Meridian Medicaid |
$408.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$381.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.66
|
| Rate for Payer: Nomi Health Commercial |
$1,087.86
|
| Rate for Payer: PACE Senior Care Partners |
$315.08
|
| Rate for Payer: PACE SWMI |
$331.67
|
| Rate for Payer: PHP Commercial |
$1,127.66
|
| Rate for Payer: PHP Medicare Advantage |
$331.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.33
|
| Rate for Payer: Priority Health HMO/PPO |
$1,154.19
|
| Rate for Payer: Priority Health Medicare |
$334.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$888.86
|
| Rate for Payer: Railroad Medicare Medicare |
$331.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,167.46
|
| Rate for Payer: UHC Core |
$1,107.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$331.67
|
| Rate for Payer: UHC Exchange |
$331.67
|
| Rate for Payer: UHC Medicare Advantage |
$331.67
|
| Rate for Payer: UHCCP Medicaid |
$389.17
|
| Rate for Payer: VA VA |
$331.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$995.00
|
|
|
HC NM RENOGRAM WITH PHARM INTERVENTION
|
Facility
|
OP
|
$1,684.15
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
34100046
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$389.17 |
| Max. Negotiated Rate |
$1,515.73 |
| Rate for Payer: Aetna Commercial |
$1,431.53
|
| Rate for Payer: Aetna Medicare |
$437.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$526.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$526.30
|
| Rate for Payer: BCBS Complete |
$408.65
|
| Rate for Payer: BCBS MAPPO |
$421.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,384.54
|
| Rate for Payer: BCN Commercial |
$1,309.43
|
| Rate for Payer: BCN Medicare Advantage |
$421.04
|
| Rate for Payer: Cash Price |
$1,347.32
|
| Rate for Payer: Cash Price |
$1,347.32
|
| Rate for Payer: Cofinity Commercial |
$1,448.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.04
|
| Rate for Payer: Healthscope Commercial |
$1,515.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.11
|
| Rate for Payer: Mclaren Medicaid |
$389.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.09
|
| Rate for Payer: Meridian Medicaid |
$408.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$484.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,431.53
|
| Rate for Payer: Nomi Health Commercial |
$1,381.00
|
| Rate for Payer: PACE Senior Care Partners |
$399.99
|
| Rate for Payer: PACE SWMI |
$421.04
|
| Rate for Payer: PHP Commercial |
$1,431.53
|
| Rate for Payer: PHP Medicare Advantage |
$421.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,094.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,465.21
|
| Rate for Payer: Priority Health Medicare |
$425.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,128.38
|
| Rate for Payer: Railroad Medicare Medicare |
$421.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,482.05
|
| Rate for Payer: UHC Core |
$1,406.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.04
|
| Rate for Payer: UHC Exchange |
$421.04
|
| Rate for Payer: UHC Medicare Advantage |
$421.04
|
| Rate for Payer: UHCCP Medicaid |
$389.17
|
| Rate for Payer: VA VA |
$421.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.11
|
|
|
HC NM RENOGRAM WITH PHARM INTERVENTION
|
Facility
|
IP
|
$1,684.15
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
34100046
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,094.70 |
| Max. Negotiated Rate |
$1,515.73 |
| Rate for Payer: Aetna Commercial |
$1,431.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,374.77
|
| Rate for Payer: BCN Commercial |
$1,301.51
|
| Rate for Payer: Cash Price |
$1,347.32
|
| Rate for Payer: Cofinity Commercial |
$1,448.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.32
|
| Rate for Payer: Healthscope Commercial |
$1,515.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,431.53
|
| Rate for Payer: Nomi Health Commercial |
$1,381.00
|
| Rate for Payer: PHP Commercial |
$1,431.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,094.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,465.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,128.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,482.05
|
| Rate for Payer: UHC Core |
$1,406.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.11
|
|
|
HC NM SENTINEL NODE INJECTION NON IMAGE BIL
|
Facility
|
IP
|
$801.11
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100622
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$520.72 |
| Max. Negotiated Rate |
$721.00 |
| Rate for Payer: Aetna Commercial |
$680.94
|
| Rate for Payer: BCBS Trust/PPO |
$653.95
|
| Rate for Payer: BCN Commercial |
$619.10
|
| Rate for Payer: Cash Price |
$640.89
|
| Rate for Payer: Cofinity Commercial |
$688.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.89
|
| Rate for Payer: Healthscope Commercial |
$721.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$600.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.94
|
| Rate for Payer: Nomi Health Commercial |
$656.91
|
| Rate for Payer: PHP Commercial |
$680.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.72
|
| Rate for Payer: Priority Health HMO/PPO |
$696.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$536.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$704.98
|
| Rate for Payer: UHC Core |
$668.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$600.83
|
|
|
HC NM SENTINEL NODE INJECTION NON IMAGE BIL
|
Facility
|
OP
|
$801.11
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100622
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$190.26 |
| Max. Negotiated Rate |
$721.00 |
| Rate for Payer: Aetna Commercial |
$680.94
|
| Rate for Payer: Aetna Medicare |
$208.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$250.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$250.35
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$200.28
|
| Rate for Payer: BCBS Trust/PPO |
$658.59
|
| Rate for Payer: BCN Commercial |
$622.86
|
| Rate for Payer: BCN Medicare Advantage |
$200.28
|
| Rate for Payer: Cash Price |
$640.89
|
| Rate for Payer: Cash Price |
$640.89
|
| Rate for Payer: Cofinity Commercial |
$688.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.28
|
| Rate for Payer: Healthscope Commercial |
$721.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$600.83
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.29
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.94
|
| Rate for Payer: Nomi Health Commercial |
$656.91
|
| Rate for Payer: PACE Senior Care Partners |
$190.26
|
| Rate for Payer: PACE SWMI |
$200.28
|
| Rate for Payer: PHP Commercial |
$680.94
|
| Rate for Payer: PHP Medicare Advantage |
$200.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.72
|
| Rate for Payer: Priority Health HMO/PPO |
$696.97
|
| Rate for Payer: Priority Health Medicare |
$202.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$536.74
|
| Rate for Payer: Railroad Medicare Medicare |
$200.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$704.98
|
| Rate for Payer: UHC Core |
$668.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.28
|
| Rate for Payer: UHC Exchange |
$200.28
|
| Rate for Payer: UHC Medicare Advantage |
$200.28
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$200.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$600.83
|
|
|
HC NM SENTINEL NODE INJ NON-IMAGI
|
Facility
|
OP
|
$991.36
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$235.45 |
| Max. Negotiated Rate |
$892.22 |
| Rate for Payer: Aetna Commercial |
$842.66
|
| Rate for Payer: Aetna Medicare |
$257.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$309.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$309.80
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$247.84
|
| Rate for Payer: BCBS Trust/PPO |
$815.00
|
| Rate for Payer: BCN Commercial |
$770.78
|
| Rate for Payer: BCN Medicare Advantage |
$247.84
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cofinity Commercial |
$852.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.84
|
| Rate for Payer: Healthscope Commercial |
$892.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.52
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.23
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.66
|
| Rate for Payer: Nomi Health Commercial |
$812.92
|
| Rate for Payer: PACE Senior Care Partners |
$235.45
|
| Rate for Payer: PACE SWMI |
$247.84
|
| Rate for Payer: PHP Commercial |
$842.66
|
| Rate for Payer: PHP Medicare Advantage |
$247.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.38
|
| Rate for Payer: Priority Health HMO/PPO |
$862.48
|
| Rate for Payer: Priority Health Medicare |
$250.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$664.21
|
| Rate for Payer: Railroad Medicare Medicare |
$247.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.40
|
| Rate for Payer: UHC Core |
$827.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$247.84
|
| Rate for Payer: UHC Exchange |
$247.84
|
| Rate for Payer: UHC Medicare Advantage |
$247.84
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$247.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.52
|
|
|
HC NM SENTINEL NODE INJ NON-IMAGI
|
Facility
|
IP
|
$991.36
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
36100187
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$644.38 |
| Max. Negotiated Rate |
$892.22 |
| Rate for Payer: Aetna Commercial |
$842.66
|
| Rate for Payer: BCBS Trust/PPO |
$809.25
|
| Rate for Payer: BCN Commercial |
$766.12
|
| Rate for Payer: Cash Price |
$793.09
|
| Rate for Payer: Cofinity Commercial |
$852.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.09
|
| Rate for Payer: Healthscope Commercial |
$892.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.66
|
| Rate for Payer: Nomi Health Commercial |
$812.92
|
| Rate for Payer: PHP Commercial |
$842.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.38
|
| Rate for Payer: Priority Health HMO/PPO |
$862.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$664.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$872.40
|
| Rate for Payer: UHC Core |
$827.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.52
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
IP
|
$1,106.96
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$719.52 |
| Max. Negotiated Rate |
$996.26 |
| Rate for Payer: Aetna Commercial |
$940.92
|
| Rate for Payer: BCBS Trust/PPO |
$903.61
|
| Rate for Payer: BCN Commercial |
$855.46
|
| Rate for Payer: Cash Price |
$885.57
|
| Rate for Payer: Cofinity Commercial |
$951.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.57
|
| Rate for Payer: Healthscope Commercial |
$996.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$830.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.92
|
| Rate for Payer: Nomi Health Commercial |
$907.71
|
| Rate for Payer: PHP Commercial |
$940.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.52
|
| Rate for Payer: Priority Health HMO/PPO |
$963.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$741.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.12
|
| Rate for Payer: UHC Core |
$924.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$830.22
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
OP
|
$1,106.96
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$262.90 |
| Max. Negotiated Rate |
$996.26 |
| Rate for Payer: Aetna Commercial |
$940.92
|
| Rate for Payer: Aetna Medicare |
$287.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$345.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$345.93
|
| Rate for Payer: BCBS Complete |
$442.78
|
| Rate for Payer: BCBS MAPPO |
$276.74
|
| Rate for Payer: BCBS Trust/PPO |
$910.03
|
| Rate for Payer: BCN Commercial |
$860.66
|
| Rate for Payer: BCN Medicare Advantage |
$276.74
|
| Rate for Payer: Cash Price |
$885.57
|
| Rate for Payer: Cofinity Commercial |
$951.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.74
|
| Rate for Payer: Healthscope Commercial |
$996.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$830.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$290.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.92
|
| Rate for Payer: Nomi Health Commercial |
$907.71
|
| Rate for Payer: PACE Senior Care Partners |
$262.90
|
| Rate for Payer: PACE SWMI |
$276.74
|
| Rate for Payer: PHP Commercial |
$940.92
|
| Rate for Payer: PHP Medicare Advantage |
$276.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.52
|
| Rate for Payer: Priority Health HMO/PPO |
$963.06
|
| Rate for Payer: Priority Health Medicare |
$279.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$741.66
|
| Rate for Payer: Railroad Medicare Medicare |
$276.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.12
|
| Rate for Payer: UHC Core |
$924.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.74
|
| Rate for Payer: UHC Exchange |
$276.74
|
| Rate for Payer: UHC Medicare Advantage |
$276.74
|
| Rate for Payer: VA VA |
$276.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$830.22
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
IP
|
$1,263.44
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$821.24 |
| Max. Negotiated Rate |
$1,137.10 |
| Rate for Payer: Aetna Commercial |
$1,073.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,031.35
|
| Rate for Payer: BCN Commercial |
$976.39
|
| Rate for Payer: Cash Price |
$1,010.75
|
| Rate for Payer: Cofinity Commercial |
$1,086.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.75
|
| Rate for Payer: Healthscope Commercial |
$1,137.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$947.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,073.92
|
| Rate for Payer: Nomi Health Commercial |
$1,036.02
|
| Rate for Payer: PHP Commercial |
$1,073.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.24
|
| Rate for Payer: Priority Health HMO/PPO |
$1,099.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$846.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,111.83
|
| Rate for Payer: UHC Core |
$1,054.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$947.58
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
OP
|
$1,263.44
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$300.07 |
| Max. Negotiated Rate |
$1,137.10 |
| Rate for Payer: Aetna Commercial |
$1,073.92
|
| Rate for Payer: Aetna Medicare |
$328.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$394.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$394.82
|
| Rate for Payer: BCBS Complete |
$408.65
|
| Rate for Payer: BCBS MAPPO |
$315.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,038.67
|
| Rate for Payer: BCN Commercial |
$982.32
|
| Rate for Payer: BCN Medicare Advantage |
$315.86
|
| Rate for Payer: Cash Price |
$1,010.75
|
| Rate for Payer: Cash Price |
$1,010.75
|
| Rate for Payer: Cofinity Commercial |
$1,086.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.86
|
| Rate for Payer: Healthscope Commercial |
$1,137.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$947.58
|
| Rate for Payer: Mclaren Medicaid |
$389.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.65
|
| Rate for Payer: Meridian Medicaid |
$408.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,073.92
|
| Rate for Payer: Nomi Health Commercial |
$1,036.02
|
| Rate for Payer: PACE Senior Care Partners |
$300.07
|
| Rate for Payer: PACE SWMI |
$315.86
|
| Rate for Payer: PHP Commercial |
$1,073.92
|
| Rate for Payer: PHP Medicare Advantage |
$315.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.24
|
| Rate for Payer: Priority Health HMO/PPO |
$1,099.19
|
| Rate for Payer: Priority Health Medicare |
$319.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$846.50
|
| Rate for Payer: Railroad Medicare Medicare |
$315.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,111.83
|
| Rate for Payer: UHC Core |
$1,054.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.86
|
| Rate for Payer: UHC Exchange |
$315.86
|
| Rate for Payer: UHC Medicare Advantage |
$315.86
|
| Rate for Payer: UHCCP Medicaid |
$389.17
|
| Rate for Payer: VA VA |
$315.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$947.58
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
IP
|
$1,985.39
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,290.50 |
| Max. Negotiated Rate |
$1,786.85 |
| Rate for Payer: Aetna Commercial |
$1,687.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,620.67
|
| Rate for Payer: BCN Commercial |
$1,534.31
|
| Rate for Payer: Cash Price |
$1,588.31
|
| Rate for Payer: Cofinity Commercial |
$1,707.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,588.31
|
| Rate for Payer: Healthscope Commercial |
$1,786.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,489.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,687.58
|
| Rate for Payer: Nomi Health Commercial |
$1,628.02
|
| Rate for Payer: PHP Commercial |
$1,687.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,727.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,330.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,747.14
|
| Rate for Payer: UHC Core |
$1,657.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,489.04
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
OP
|
$1,985.39
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$471.53 |
| Max. Negotiated Rate |
$1,786.85 |
| Rate for Payer: Aetna Commercial |
$1,687.58
|
| Rate for Payer: Aetna Medicare |
$516.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$620.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$620.43
|
| Rate for Payer: BCBS Complete |
$991.12
|
| Rate for Payer: BCBS MAPPO |
$496.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,632.19
|
| Rate for Payer: BCN Commercial |
$1,543.64
|
| Rate for Payer: BCN Medicare Advantage |
$496.35
|
| Rate for Payer: Cash Price |
$1,588.31
|
| Rate for Payer: Cash Price |
$1,588.31
|
| Rate for Payer: Cofinity Commercial |
$1,707.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,588.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.35
|
| Rate for Payer: Healthscope Commercial |
$1,786.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,489.04
|
| Rate for Payer: Mclaren Medicaid |
$943.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$521.16
|
| Rate for Payer: Meridian Medicaid |
$991.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$570.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,687.58
|
| Rate for Payer: Nomi Health Commercial |
$1,628.02
|
| Rate for Payer: PACE Senior Care Partners |
$471.53
|
| Rate for Payer: PACE SWMI |
$496.35
|
| Rate for Payer: PHP Commercial |
$1,687.58
|
| Rate for Payer: PHP Medicare Advantage |
$496.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$943.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,727.29
|
| Rate for Payer: Priority Health Medicare |
$501.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,330.21
|
| Rate for Payer: Railroad Medicare Medicare |
$496.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,747.14
|
| Rate for Payer: UHC Core |
$1,657.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.35
|
| Rate for Payer: UHC Exchange |
$496.35
|
| Rate for Payer: UHC Medicare Advantage |
$496.35
|
| Rate for Payer: UHCCP Medicaid |
$943.86
|
| Rate for Payer: VA VA |
$496.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,489.04
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
IP
|
$1,975.72
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,284.22 |
| Max. Negotiated Rate |
$1,778.15 |
| Rate for Payer: Aetna Commercial |
$1,679.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,612.78
|
| Rate for Payer: BCN Commercial |
$1,526.84
|
| Rate for Payer: Cash Price |
$1,580.58
|
| Rate for Payer: Cofinity Commercial |
$1,699.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.58
|
| Rate for Payer: Healthscope Commercial |
$1,778.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,481.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,679.36
|
| Rate for Payer: Nomi Health Commercial |
$1,620.09
|
| Rate for Payer: PHP Commercial |
$1,679.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.22
|
| Rate for Payer: Priority Health HMO/PPO |
$1,718.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,323.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,738.63
|
| Rate for Payer: UHC Core |
$1,649.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,481.79
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
OP
|
$1,975.72
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$469.23 |
| Max. Negotiated Rate |
$1,778.15 |
| Rate for Payer: Aetna Commercial |
$1,679.36
|
| Rate for Payer: Aetna Medicare |
$513.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$617.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$617.41
|
| Rate for Payer: BCBS Complete |
$991.12
|
| Rate for Payer: BCBS MAPPO |
$493.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,624.24
|
| Rate for Payer: BCN Commercial |
$1,536.12
|
| Rate for Payer: BCN Medicare Advantage |
$493.93
|
| Rate for Payer: Cash Price |
$1,580.58
|
| Rate for Payer: Cash Price |
$1,580.58
|
| Rate for Payer: Cofinity Commercial |
$1,699.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.93
|
| Rate for Payer: Healthscope Commercial |
$1,778.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,481.79
|
| Rate for Payer: Mclaren Medicaid |
$943.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$518.63
|
| Rate for Payer: Meridian Medicaid |
$991.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$568.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,679.36
|
| Rate for Payer: Nomi Health Commercial |
$1,620.09
|
| Rate for Payer: PACE Senior Care Partners |
$469.23
|
| Rate for Payer: PACE SWMI |
$493.93
|
| Rate for Payer: PHP Commercial |
$1,679.36
|
| Rate for Payer: PHP Medicare Advantage |
$493.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$943.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.22
|
| Rate for Payer: Priority Health HMO/PPO |
$1,718.88
|
| Rate for Payer: Priority Health Medicare |
$498.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,323.73
|
| Rate for Payer: Railroad Medicare Medicare |
$493.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,738.63
|
| Rate for Payer: UHC Core |
$1,649.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$493.93
|
| Rate for Payer: UHC Exchange |
$493.93
|
| Rate for Payer: UHC Medicare Advantage |
$493.93
|
| Rate for Payer: UHCCP Medicaid |
$943.86
|
| Rate for Payer: VA VA |
$493.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,481.79
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
OP
|
$1,757.18
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$417.33 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: Aetna Commercial |
$1,493.60
|
| Rate for Payer: Aetna Medicare |
$456.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$549.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$549.12
|
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: BCBS MAPPO |
$439.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,444.58
|
| Rate for Payer: BCN Commercial |
$1,366.21
|
| Rate for Payer: BCN Medicare Advantage |
$439.30
|
| Rate for Payer: Cash Price |
$1,405.74
|
| Rate for Payer: Cash Price |
$1,405.74
|
| Rate for Payer: Cofinity Commercial |
$1,511.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.30
|
| Rate for Payer: Healthscope Commercial |
$1,581.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.88
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.26
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.60
|
| Rate for Payer: Nomi Health Commercial |
$1,440.89
|
| Rate for Payer: PACE Senior Care Partners |
$417.33
|
| Rate for Payer: PACE SWMI |
$439.30
|
| Rate for Payer: PHP Commercial |
$1,493.60
|
| Rate for Payer: PHP Medicare Advantage |
$439.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,528.75
|
| Rate for Payer: Priority Health Medicare |
$443.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,177.31
|
| Rate for Payer: Railroad Medicare Medicare |
$439.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,546.32
|
| Rate for Payer: UHC Core |
$1,467.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.30
|
| Rate for Payer: UHC Exchange |
$439.30
|
| Rate for Payer: UHC Medicare Advantage |
$439.30
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
| Rate for Payer: VA VA |
$439.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.88
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
IP
|
$1,757.18
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,142.17 |
| Max. Negotiated Rate |
$1,581.46 |
| Rate for Payer: Aetna Commercial |
$1,493.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,434.39
|
| Rate for Payer: BCN Commercial |
$1,357.95
|
| Rate for Payer: Cash Price |
$1,405.74
|
| Rate for Payer: Cofinity Commercial |
$1,511.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.74
|
| Rate for Payer: Healthscope Commercial |
$1,581.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,317.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.60
|
| Rate for Payer: Nomi Health Commercial |
$1,440.89
|
| Rate for Payer: PHP Commercial |
$1,493.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.17
|
| Rate for Payer: Priority Health HMO/PPO |
$1,528.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,177.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,546.32
|
| Rate for Payer: UHC Core |
$1,467.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,317.88
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
IP
|
$1,666.35
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,083.13 |
| Max. Negotiated Rate |
$1,499.71 |
| Rate for Payer: Aetna Commercial |
$1,416.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,360.24
|
| Rate for Payer: BCN Commercial |
$1,287.76
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cofinity Commercial |
$1,433.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.08
|
| Rate for Payer: Healthscope Commercial |
$1,499.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,249.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,416.40
|
| Rate for Payer: Nomi Health Commercial |
$1,366.41
|
| Rate for Payer: PHP Commercial |
$1,416.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,449.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,116.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,466.39
|
| Rate for Payer: UHC Core |
$1,391.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,249.76
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
OP
|
$1,666.35
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$389.17 |
| Max. Negotiated Rate |
$1,499.71 |
| Rate for Payer: Aetna Commercial |
$1,416.40
|
| Rate for Payer: Aetna Medicare |
$433.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.73
|
| Rate for Payer: BCBS Complete |
$408.65
|
| Rate for Payer: BCBS MAPPO |
$416.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,369.91
|
| Rate for Payer: BCN Commercial |
$1,295.59
|
| Rate for Payer: BCN Medicare Advantage |
$416.59
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cofinity Commercial |
$1,433.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.59
|
| Rate for Payer: Healthscope Commercial |
$1,499.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,249.76
|
| Rate for Payer: Mclaren Medicaid |
$389.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.42
|
| Rate for Payer: Meridian Medicaid |
$408.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,416.40
|
| Rate for Payer: Nomi Health Commercial |
$1,366.41
|
| Rate for Payer: PACE Senior Care Partners |
$395.76
|
| Rate for Payer: PACE SWMI |
$416.59
|
| Rate for Payer: PHP Commercial |
$1,416.40
|
| Rate for Payer: PHP Medicare Advantage |
$416.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,449.72
|
| Rate for Payer: Priority Health Medicare |
$420.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,116.45
|
| Rate for Payer: Railroad Medicare Medicare |
$416.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,466.39
|
| Rate for Payer: UHC Core |
$1,391.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.59
|
| Rate for Payer: UHC Exchange |
$416.59
|
| Rate for Payer: UHC Medicare Advantage |
$416.59
|
| Rate for Payer: UHCCP Medicaid |
$389.17
|
| Rate for Payer: VA VA |
$416.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,249.76
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
OP
|
$1,219.18
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
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 VENTILATION AEROSOL OR GAS
|
Facility
|
IP
|
$1,219.18
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
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 VENTILATION PERFUS QUANT DIFF
|
Facility
|
OP
|
$1,666.35
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$389.17 |
| Max. Negotiated Rate |
$1,499.71 |
| Rate for Payer: Aetna Commercial |
$1,416.40
|
| Rate for Payer: Aetna Medicare |
$433.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.73
|
| Rate for Payer: BCBS Complete |
$408.65
|
| Rate for Payer: BCBS MAPPO |
$416.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,369.91
|
| Rate for Payer: BCN Commercial |
$1,295.59
|
| Rate for Payer: BCN Medicare Advantage |
$416.59
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cofinity Commercial |
$1,433.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.59
|
| Rate for Payer: Healthscope Commercial |
$1,499.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,249.76
|
| Rate for Payer: Mclaren Medicaid |
$389.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.42
|
| Rate for Payer: Meridian Medicaid |
$408.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,416.40
|
| Rate for Payer: Nomi Health Commercial |
$1,366.41
|
| Rate for Payer: PACE Senior Care Partners |
$395.76
|
| Rate for Payer: PACE SWMI |
$416.59
|
| Rate for Payer: PHP Commercial |
$1,416.40
|
| Rate for Payer: PHP Medicare Advantage |
$416.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.13
|
| Rate for Payer: Priority Health HMO/PPO |
$1,449.72
|
| Rate for Payer: Priority Health Medicare |
$420.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,116.45
|
| Rate for Payer: Railroad Medicare Medicare |
$416.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,466.39
|
| Rate for Payer: UHC Core |
$1,391.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.59
|
| Rate for Payer: UHC Exchange |
$416.59
|
| Rate for Payer: UHC Medicare Advantage |
$416.59
|
| Rate for Payer: UHCCP Medicaid |
$389.17
|
| Rate for Payer: VA VA |
$416.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,249.76
|
|
