|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
IP
|
$1,129.10
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$496.80 |
| Max. Negotiated Rate |
$1,016.19 |
| Rate for Payer: Aetna American Axle |
$733.91
|
| Rate for Payer: Aetna Commercial |
$959.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.91
|
| Rate for Payer: Cash Price |
$903.28
|
| Rate for Payer: Cofinity Advantage |
$790.37
|
| Rate for Payer: Cofinity Commercial |
$971.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.28
|
| Rate for Payer: Healthscope Commercial |
$1,016.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$790.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$846.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$846.83
|
| Rate for Payer: PHP Commercial |
$959.74
|
| Rate for Payer: Priority Health SBD |
$711.33
|
| Rate for Payer: UMR Bronson Commercial |
$496.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.83
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
IP
|
$1,288.71
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$567.03 |
| Max. Negotiated Rate |
$1,159.84 |
| Rate for Payer: Aetna American Axle |
$837.66
|
| Rate for Payer: Aetna Commercial |
$1,095.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.66
|
| Rate for Payer: Cash Price |
$1,030.97
|
| Rate for Payer: Cofinity Advantage |
$902.10
|
| Rate for Payer: Cofinity Commercial |
$1,108.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.97
|
| Rate for Payer: Healthscope Commercial |
$1,159.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.53
|
| Rate for Payer: PHP Commercial |
$1,095.40
|
| Rate for Payer: Priority Health SBD |
$811.89
|
| Rate for Payer: UMR Bronson Commercial |
$567.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.53
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
OP
|
$1,288.71
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna American Axle |
$837.66
|
| Rate for Payer: Aetna Commercial |
$1,095.40
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$593.51
|
| Rate for Payer: BCN Commercial |
$593.51
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,030.97
|
| Rate for Payer: Cash Price |
$1,030.97
|
| Rate for Payer: Cofinity Advantage |
$902.10
|
| Rate for Payer: Cofinity Commercial |
$1,108.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,159.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$902.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.53
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.40
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$966.53
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,095.40
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$811.89
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$837.66
|
| Rate for Payer: UHC Core |
$671.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$506.46
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: UMR Bronson Commercial |
$476.82
|
| Rate for Payer: VA VA |
$541.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.53
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
OP
|
$2,025.10
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$674.66 |
| Max. Negotiated Rate |
$4,171.73 |
| Rate for Payer: Aetna American Axle |
$1,316.32
|
| Rate for Payer: Aetna Commercial |
$1,721.34
|
| Rate for Payer: Aetna Medicare |
$1,341.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,316.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,612.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,612.49
|
| Rate for Payer: BCBS Complete |
$708.46
|
| Rate for Payer: BCBS MAPPO |
$1,289.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,351.20
|
| Rate for Payer: BCN Commercial |
$1,351.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,289.99
|
| Rate for Payer: Cash Price |
$1,620.08
|
| Rate for Payer: Cash Price |
$1,620.08
|
| Rate for Payer: Cofinity Advantage |
$1,417.57
|
| Rate for Payer: Cofinity Commercial |
$1,741.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,620.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,289.99
|
| Rate for Payer: Healthscope Commercial |
$1,822.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,417.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,518.83
|
| Rate for Payer: Mclaren Medicaid |
$1,289.99
|
| Rate for Payer: Mclaren Medicare |
$1,289.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,354.49
|
| Rate for Payer: Meridian Medicaid |
$1,354.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,483.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,418.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,721.34
|
| Rate for Payer: Nomi Health Commercial |
$3,869.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,518.83
|
| Rate for Payer: PACE Medicare |
$1,225.49
|
| Rate for Payer: PACE SWMI |
$1,289.99
|
| Rate for Payer: PHP Commercial |
$1,721.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,289.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,171.73
|
| Rate for Payer: Priority Health Medicare |
$1,289.99
|
| Rate for Payer: Priority Health SBD |
$1,275.81
|
| Rate for Payer: Priority Health Tiered Network |
$3,337.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,289.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,316.32
|
| Rate for Payer: UHC Core |
$1,055.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,289.99
|
| Rate for Payer: UHC Exchange |
$795.86
|
| Rate for Payer: UHC Medicaid |
$674.66
|
| Rate for Payer: UHCCP Medicaid |
$674.66
|
| Rate for Payer: UMR Bronson Commercial |
$749.29
|
| Rate for Payer: VA VA |
$1,289.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,518.83
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
IP
|
$2,025.10
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$891.04 |
| Max. Negotiated Rate |
$1,822.59 |
| Rate for Payer: Aetna American Axle |
$1,316.32
|
| Rate for Payer: Aetna Commercial |
$1,721.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,316.32
|
| Rate for Payer: Cash Price |
$1,620.08
|
| Rate for Payer: Cofinity Advantage |
$1,417.57
|
| Rate for Payer: Cofinity Commercial |
$1,741.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,620.08
|
| Rate for Payer: Healthscope Commercial |
$1,822.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,417.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,518.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,721.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,518.83
|
| Rate for Payer: PHP Commercial |
$1,721.34
|
| Rate for Payer: Priority Health SBD |
$1,275.81
|
| Rate for Payer: UMR Bronson Commercial |
$891.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,518.83
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
IP
|
$2,015.23
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$886.70 |
| Max. Negotiated Rate |
$1,813.71 |
| Rate for Payer: Aetna American Axle |
$1,309.90
|
| Rate for Payer: Aetna Commercial |
$1,712.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,309.90
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cofinity Advantage |
$1,410.66
|
| Rate for Payer: Cofinity Commercial |
$1,733.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.18
|
| Rate for Payer: Healthscope Commercial |
$1,813.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,410.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,511.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,511.42
|
| Rate for Payer: PHP Commercial |
$1,712.95
|
| Rate for Payer: Priority Health SBD |
$1,269.59
|
| Rate for Payer: UMR Bronson Commercial |
$886.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,511.42
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
OP
|
$2,015.23
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,813.71 |
| Rate for Payer: Aetna American Axle |
$1,309.90
|
| Rate for Payer: Aetna Commercial |
$1,712.95
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,309.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$710.89
|
| Rate for Payer: BCN Commercial |
$710.89
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cash Price |
$1,612.18
|
| Rate for Payer: Cofinity Advantage |
$1,410.66
|
| Rate for Payer: Cofinity Commercial |
$1,733.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,612.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,813.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,410.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,511.42
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,712.95
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,511.42
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,712.95
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$1,269.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,309.90
|
| Rate for Payer: UHC Core |
$1,049.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$791.99
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: UMR Bronson Commercial |
$745.64
|
| Rate for Payer: VA VA |
$541.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,511.42
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
IP
|
$1,792.32
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$788.62 |
| Max. Negotiated Rate |
$1,613.09 |
| Rate for Payer: Aetna American Axle |
$1,165.01
|
| Rate for Payer: Aetna Commercial |
$1,523.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.01
|
| Rate for Payer: Cash Price |
$1,433.86
|
| Rate for Payer: Cofinity Advantage |
$1,254.62
|
| Rate for Payer: Cofinity Commercial |
$1,541.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.86
|
| Rate for Payer: Healthscope Commercial |
$1,613.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,254.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.24
|
| Rate for Payer: PHP Commercial |
$1,523.47
|
| Rate for Payer: Priority Health SBD |
$1,129.16
|
| Rate for Payer: UMR Bronson Commercial |
$788.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.24
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
OP
|
$1,792.32
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$663.16 |
| Max. Negotiated Rate |
$19,480.40 |
| Rate for Payer: Aetna American Axle |
$1,165.01
|
| Rate for Payer: Aetna Commercial |
$1,523.47
|
| Rate for Payer: Aetna Medicare |
$6,264.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,738.06
|
| Rate for Payer: BCN Commercial |
$4,738.06
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Cash Price |
$1,433.86
|
| Rate for Payer: Cash Price |
$1,433.86
|
| Rate for Payer: Cash Price |
$1,433.86
|
| Rate for Payer: Cofinity Advantage |
$1,254.62
|
| Rate for Payer: Cofinity Commercial |
$1,541.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Healthscope Commercial |
$1,613.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,254.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.24
|
| Rate for Payer: Mclaren Medicaid |
$6,023.79
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$6,324.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.47
|
| Rate for Payer: Nomi Health Commercial |
$18,071.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.24
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Commercial |
$1,523.47
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,480.40
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health SBD |
$1,129.16
|
| Rate for Payer: Priority Health Tiered Network |
$15,584.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,023.79
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: UMR Bronson Commercial |
$663.16
|
| Rate for Payer: VA VA |
$6,023.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.24
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
IP
|
$1,699.68
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$747.86 |
| Max. Negotiated Rate |
$1,529.71 |
| Rate for Payer: Aetna American Axle |
$1,104.79
|
| Rate for Payer: Aetna Commercial |
$1,444.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,104.79
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cofinity Advantage |
$1,189.78
|
| Rate for Payer: Cofinity Commercial |
$1,461.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,359.74
|
| Rate for Payer: Healthscope Commercial |
$1,529.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,189.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,274.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,444.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,274.76
|
| Rate for Payer: PHP Commercial |
$1,444.73
|
| Rate for Payer: Priority Health SBD |
$1,070.80
|
| Rate for Payer: UMR Bronson Commercial |
$747.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,274.76
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
OP
|
$1,699.68
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna American Axle |
$1,104.79
|
| Rate for Payer: Aetna Commercial |
$1,444.73
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,104.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$609.11
|
| Rate for Payer: BCN Commercial |
$609.11
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cofinity Advantage |
$1,189.78
|
| Rate for Payer: Cofinity Commercial |
$1,461.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,359.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,529.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,189.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,274.76
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,444.73
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,274.76
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,444.73
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$1,070.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,104.79
|
| Rate for Payer: UHC Core |
$885.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$667.97
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: UMR Bronson Commercial |
$628.88
|
| Rate for Payer: VA VA |
$541.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,274.76
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
OP
|
$1,243.56
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$808.31
|
| Rate for Payer: Aetna Commercial |
$1,057.03
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$360.37
|
| Rate for Payer: BCN Commercial |
$360.37
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$994.85
|
| Rate for Payer: Cash Price |
$994.85
|
| Rate for Payer: Cofinity Advantage |
$870.49
|
| Rate for Payer: Cofinity Commercial |
$1,069.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,119.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$870.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$932.67
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,057.03
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$932.67
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,057.03
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$783.44
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.31
|
| Rate for Payer: UHC Core |
$647.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$488.72
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$460.12
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$932.67
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
IP
|
$1,243.56
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$547.17 |
| Max. Negotiated Rate |
$1,119.20 |
| Rate for Payer: Aetna American Axle |
$808.31
|
| Rate for Payer: Aetna Commercial |
$1,057.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.31
|
| Rate for Payer: Cash Price |
$994.85
|
| Rate for Payer: Cofinity Advantage |
$870.49
|
| Rate for Payer: Cofinity Commercial |
$1,069.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$994.85
|
| Rate for Payer: Healthscope Commercial |
$1,119.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$870.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$932.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,057.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$932.67
|
| Rate for Payer: PHP Commercial |
$1,057.03
|
| Rate for Payer: Priority Health SBD |
$783.44
|
| Rate for Payer: UMR Bronson Commercial |
$547.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$932.67
|
|
|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
OP
|
$1,699.68
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna American Axle |
$1,104.79
|
| Rate for Payer: Aetna Commercial |
$1,444.73
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,104.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$568.06
|
| Rate for Payer: BCN Commercial |
$568.06
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cofinity Advantage |
$1,189.78
|
| Rate for Payer: Cofinity Commercial |
$1,461.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,359.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,529.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,189.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,274.76
|
| Rate for Payer: Mclaren Medicaid |
$541.02
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,444.73
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,274.76
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,444.73
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$1,070.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,104.79
|
| Rate for Payer: UHC Core |
$885.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$667.97
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: UMR Bronson Commercial |
$628.88
|
| Rate for Payer: VA VA |
$541.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,274.76
|
|
|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
IP
|
$1,699.68
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$747.86 |
| Max. Negotiated Rate |
$1,529.71 |
| Rate for Payer: Aetna American Axle |
$1,104.79
|
| Rate for Payer: Aetna Commercial |
$1,444.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,104.79
|
| Rate for Payer: Cash Price |
$1,359.74
|
| Rate for Payer: Cofinity Advantage |
$1,189.78
|
| Rate for Payer: Cofinity Commercial |
$1,461.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,359.74
|
| Rate for Payer: Healthscope Commercial |
$1,529.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,189.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,274.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,444.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,274.76
|
| Rate for Payer: PHP Commercial |
$1,444.73
|
| Rate for Payer: Priority Health SBD |
$1,070.80
|
| Rate for Payer: UMR Bronson Commercial |
$747.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,274.76
|
|
|
HC NM VOID CYSTO
|
Facility
|
IP
|
$1,090.67
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$479.89 |
| Max. Negotiated Rate |
$981.60 |
| Rate for Payer: Aetna American Axle |
$708.94
|
| Rate for Payer: Aetna Commercial |
$927.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.94
|
| Rate for Payer: Cash Price |
$872.54
|
| Rate for Payer: Cofinity Advantage |
$763.47
|
| Rate for Payer: Cofinity Commercial |
$937.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.54
|
| Rate for Payer: Healthscope Commercial |
$981.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$763.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$818.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.00
|
| Rate for Payer: PHP Commercial |
$927.07
|
| Rate for Payer: Priority Health SBD |
$687.12
|
| Rate for Payer: UMR Bronson Commercial |
$479.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$818.00
|
|
|
HC NM VOID CYSTO
|
Facility
|
OP
|
$1,090.67
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna American Axle |
$708.94
|
| Rate for Payer: Aetna Commercial |
$927.07
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$449.03
|
| Rate for Payer: BCN Commercial |
$449.03
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$872.54
|
| Rate for Payer: Cash Price |
$872.54
|
| Rate for Payer: Cofinity Advantage |
$763.47
|
| Rate for Payer: Cofinity Commercial |
$937.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$981.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$763.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$818.00
|
| Rate for Payer: Mclaren Medicaid |
$398.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.07
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.00
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$927.07
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$687.12
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$708.94
|
| Rate for Payer: UHC Core |
$568.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$428.63
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: UMR Bronson Commercial |
$403.55
|
| Rate for Payer: VA VA |
$398.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$818.00
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
OP
|
$1,978.67
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$121.60 |
| Max. Negotiated Rate |
$1,780.80 |
| Rate for Payer: Aetna American Axle |
$1,286.14
|
| Rate for Payer: Aetna Commercial |
$1,681.87
|
| Rate for Payer: Aetna Medicare |
$241.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,286.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$290.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$290.62
|
| Rate for Payer: BCBS Complete |
$127.69
|
| Rate for Payer: BCBS MAPPO |
$232.50
|
| Rate for Payer: BCBS Trust/PPO |
$201.12
|
| Rate for Payer: BCN Commercial |
$201.12
|
| Rate for Payer: BCN Medicare Advantage |
$232.50
|
| Rate for Payer: Cash Price |
$1,582.94
|
| Rate for Payer: Cash Price |
$1,582.94
|
| Rate for Payer: Cofinity Advantage |
$1,385.07
|
| Rate for Payer: Cofinity Commercial |
$1,701.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.50
|
| Rate for Payer: Healthscope Commercial |
$1,780.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,385.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,484.00
|
| Rate for Payer: Mclaren Medicaid |
$232.50
|
| Rate for Payer: Mclaren Medicare |
$232.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.12
|
| Rate for Payer: Meridian Medicaid |
$244.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$267.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$255.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.87
|
| Rate for Payer: Nomi Health Commercial |
$697.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,484.00
|
| Rate for Payer: PACE Medicare |
$220.88
|
| Rate for Payer: PACE SWMI |
$232.50
|
| Rate for Payer: PHP Commercial |
$1,681.87
|
| Rate for Payer: PHP Medicare Advantage |
$232.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$751.88
|
| Rate for Payer: Priority Health Medicare |
$232.50
|
| Rate for Payer: Priority Health SBD |
$1,246.56
|
| Rate for Payer: Priority Health Tiered Network |
$601.50
|
| Rate for Payer: Railroad Medicare Medicare |
$232.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,286.14
|
| Rate for Payer: UHC Core |
$1,030.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$232.50
|
| Rate for Payer: UHC Exchange |
$777.62
|
| Rate for Payer: UHC Medicaid |
$121.60
|
| Rate for Payer: UHCCP Medicaid |
$121.60
|
| Rate for Payer: UMR Bronson Commercial |
$732.11
|
| Rate for Payer: VA VA |
$232.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,484.00
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
IP
|
$1,978.67
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$870.61 |
| Max. Negotiated Rate |
$1,780.80 |
| Rate for Payer: Aetna American Axle |
$1,286.14
|
| Rate for Payer: Aetna Commercial |
$1,681.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,286.14
|
| Rate for Payer: Cash Price |
$1,582.94
|
| Rate for Payer: Cofinity Advantage |
$1,385.07
|
| Rate for Payer: Cofinity Commercial |
$1,701.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.94
|
| Rate for Payer: Healthscope Commercial |
$1,780.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,385.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,484.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,484.00
|
| Rate for Payer: PHP Commercial |
$1,681.87
|
| Rate for Payer: Priority Health SBD |
$1,246.56
|
| Rate for Payer: UMR Bronson Commercial |
$870.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,484.00
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
IP
|
$1.04
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna American Axle |
$0.68
|
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Advantage |
$0.73
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.78
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: Priority Health SBD |
$0.66
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.78
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna American Axle |
$0.68
|
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.42
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Cofinity Advantage |
$0.73
|
| Rate for Payer: Cofinity Commercial |
$0.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.83
|
| Rate for Payer: Healthscope Commercial |
$0.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.78
|
| Rate for Payer: PHP Commercial |
$0.88
|
| Rate for Payer: Priority Health SBD |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.68
|
| Rate for Payer: UHC Core |
$0.54
|
| Rate for Payer: UHC Exchange |
$0.41
|
| Rate for Payer: UMR Bronson Commercial |
$0.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.78
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
IP
|
$89.05
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$39.18 |
| Max. Negotiated Rate |
$80.14 |
| Rate for Payer: Aetna American Axle |
$57.88
|
| Rate for Payer: Aetna Commercial |
$75.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.88
|
| Rate for Payer: Cash Price |
$71.24
|
| Rate for Payer: Cofinity Advantage |
$62.34
|
| Rate for Payer: Cofinity Commercial |
$76.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.24
|
| Rate for Payer: Healthscope Commercial |
$80.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.79
|
| Rate for Payer: PHP Commercial |
$75.69
|
| Rate for Payer: Priority Health SBD |
$56.10
|
| Rate for Payer: UMR Bronson Commercial |
$39.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.79
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
OP
|
$89.05
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$120.34 |
| Rate for Payer: Aetna American Axle |
$57.88
|
| Rate for Payer: Aetna Commercial |
$75.69
|
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$97.89
|
| Rate for Payer: BCN Commercial |
$97.89
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$71.24
|
| Rate for Payer: Cash Price |
$71.24
|
| Rate for Payer: Cofinity Advantage |
$62.34
|
| Rate for Payer: Cofinity Commercial |
$76.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$80.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.79
|
| Rate for Payer: Mclaren Medicaid |
$37.22
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$39.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.69
|
| Rate for Payer: Nomi Health Commercial |
$111.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.79
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$75.69
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.34
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health SBD |
$56.10
|
| Rate for Payer: Priority Health Tiered Network |
$96.27
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.88
|
| Rate for Payer: UHC Core |
$58.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$58.88
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: UMR Bronson Commercial |
$32.95
|
| Rate for Payer: VA VA |
$37.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.79
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
IP
|
$2,519.13
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,108.42 |
| Max. Negotiated Rate |
$2,267.22 |
| Rate for Payer: Aetna American Axle |
$1,637.43
|
| Rate for Payer: Aetna Commercial |
$2,141.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,637.43
|
| Rate for Payer: Cash Price |
$2,015.30
|
| Rate for Payer: Cofinity Advantage |
$1,763.39
|
| Rate for Payer: Cofinity Commercial |
$2,166.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,015.30
|
| Rate for Payer: Healthscope Commercial |
$2,267.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,763.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,889.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,141.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,889.35
|
| Rate for Payer: PHP Commercial |
$2,141.26
|
| Rate for Payer: Priority Health SBD |
$1,587.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,108.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,889.35
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
OP
|
$2,519.13
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$345.19 |
| Max. Negotiated Rate |
$3,923.26 |
| Rate for Payer: Aetna American Axle |
$1,637.43
|
| Rate for Payer: Aetna Commercial |
$2,141.26
|
| Rate for Payer: Aetna Medicare |
$1,261.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,637.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,516.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,516.45
|
| Rate for Payer: BCBS Complete |
$666.27
|
| Rate for Payer: BCBS MAPPO |
$1,213.16
|
| Rate for Payer: BCBS Trust/PPO |
$345.19
|
| Rate for Payer: BCN Commercial |
$345.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,213.16
|
| Rate for Payer: Cash Price |
$2,015.30
|
| Rate for Payer: Cash Price |
$2,015.30
|
| Rate for Payer: Cofinity Advantage |
$1,763.39
|
| Rate for Payer: Cofinity Commercial |
$2,166.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,015.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,213.16
|
| Rate for Payer: Healthscope Commercial |
$2,267.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,763.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,889.35
|
| Rate for Payer: Mclaren Medicaid |
$1,213.16
|
| Rate for Payer: Mclaren Medicare |
$1,213.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,273.82
|
| Rate for Payer: Meridian Medicaid |
$1,273.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,395.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,334.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,141.26
|
| Rate for Payer: Nomi Health Commercial |
$3,639.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,889.35
|
| Rate for Payer: PACE Medicare |
$1,152.50
|
| Rate for Payer: PACE SWMI |
$1,213.16
|
| Rate for Payer: PHP Commercial |
$2,141.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,213.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$634.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,923.26
|
| Rate for Payer: Priority Health Medicare |
$1,213.16
|
| Rate for Payer: Priority Health SBD |
$1,587.05
|
| Rate for Payer: Priority Health Tiered Network |
$3,138.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,213.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,213.16
|
| Rate for Payer: UHC Medicaid |
$634.48
|
| Rate for Payer: UHCCP Medicaid |
$634.48
|
| Rate for Payer: UMR Bronson Commercial |
$932.08
|
| Rate for Payer: VA VA |
$1,213.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,889.35
|
|
