|
HC NM GASTRIC EMPTYING
|
Facility
|
OP
|
$1,401.08
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,401.08 |
| Rate for Payer: Aetna Commercial |
$1,260.97
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,359.05
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.26
|
| Rate for Payer: BCN Commercial |
$1,086.26
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$1,120.86
|
| Rate for Payer: Cash Price |
$1,120.86
|
| Rate for Payer: Cofinity Commercial |
$1,317.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,120.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,401.08
|
| Rate for Payer: Healthscope Whirlpool |
$1,359.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,260.97
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,190.92
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$980.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,043.62
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$834.90
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,232.95
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM GE REFLUX
|
Facility
|
OP
|
$1,240.94
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,240.94 |
| Rate for Payer: Aetna Commercial |
$1,116.85
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,203.71
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$962.10
|
| Rate for Payer: BCN Commercial |
$962.10
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$992.75
|
| Rate for Payer: Cash Price |
$992.75
|
| Rate for Payer: Cofinity Commercial |
$1,166.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$992.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,240.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,203.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,116.85
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,054.80
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$788.62
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$630.90
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,092.03
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM GE REFLUX
|
Facility
|
IP
|
$1,240.94
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$868.66 |
| Max. Negotiated Rate |
$1,240.94 |
| Rate for Payer: Aetna Commercial |
$1,116.85
|
| Rate for Payer: ASR ASR |
$1,203.71
|
| Rate for Payer: BCBS Trust/PPO |
$962.10
|
| Rate for Payer: BCN Commercial |
$962.10
|
| Rate for Payer: Cash Price |
$992.75
|
| Rate for Payer: Cofinity Commercial |
$1,166.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$992.75
|
| Rate for Payer: Healthscope Commercial |
$1,240.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,203.71
|
| Rate for Payer: Mclaren Commercial |
$1,116.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,054.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,092.03
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,000.76 |
| Rate for Payer: Aetna Commercial |
$900.68
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$970.74
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$775.89
|
| Rate for Payer: BCN Commercial |
$775.89
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$940.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,000.76
|
| Rate for Payer: Healthscope Whirlpool |
$970.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$900.68
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$996.93
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$797.54
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.67
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$700.53 |
| Max. Negotiated Rate |
$1,000.76 |
| Rate for Payer: Aetna Commercial |
$900.68
|
| Rate for Payer: ASR ASR |
$970.74
|
| Rate for Payer: BCBS Trust/PPO |
$775.89
|
| Rate for Payer: BCN Commercial |
$775.89
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$940.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Healthscope Commercial |
$1,000.76
|
| Rate for Payer: Healthscope Whirlpool |
$970.74
|
| Rate for Payer: Mclaren Commercial |
$900.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.67
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
OP
|
$1,447.61
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,447.61 |
| Rate for Payer: Aetna Commercial |
$1,302.85
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,404.18
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.33
|
| Rate for Payer: BCN Commercial |
$1,122.33
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cofinity Commercial |
$1,360.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,447.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,302.85
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.47
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,106.73
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$885.38
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,273.90
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
IP
|
$1,447.61
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,013.33 |
| Max. Negotiated Rate |
$1,447.61 |
| Rate for Payer: Aetna Commercial |
$1,302.85
|
| Rate for Payer: ASR ASR |
$1,404.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.33
|
| Rate for Payer: BCN Commercial |
$1,122.33
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cofinity Commercial |
$1,360.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.09
|
| Rate for Payer: Healthscope Commercial |
$1,447.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.18
|
| Rate for Payer: Mclaren Commercial |
$1,302.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,273.90
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
IP
|
$1,447.61
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,013.33 |
| Max. Negotiated Rate |
$1,447.61 |
| Rate for Payer: Aetna Commercial |
$1,302.85
|
| Rate for Payer: ASR ASR |
$1,404.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.33
|
| Rate for Payer: BCN Commercial |
$1,122.33
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cofinity Commercial |
$1,360.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.09
|
| Rate for Payer: Healthscope Commercial |
$1,447.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.18
|
| Rate for Payer: Mclaren Commercial |
$1,302.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,273.90
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
OP
|
$1,447.61
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$1,447.61 |
| Rate for Payer: Aetna Commercial |
$1,302.85
|
| Rate for Payer: Aetna Medicare |
$480.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$600.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$600.55
|
| Rate for Payer: ASR ASR |
$1,404.18
|
| Rate for Payer: BCBS Complete |
$275.96
|
| Rate for Payer: BCBS MAPPO |
$480.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,122.33
|
| Rate for Payer: BCN Commercial |
$1,122.33
|
| Rate for Payer: BCN Medicare Advantage |
$480.44
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cash Price |
$1,158.09
|
| Rate for Payer: Cofinity Commercial |
$1,360.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,158.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.44
|
| Rate for Payer: Healthscope Commercial |
$1,447.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,404.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$480.44
|
| Rate for Payer: Mclaren Commercial |
$1,302.85
|
| Rate for Payer: Mclaren Medicaid |
$262.80
|
| Rate for Payer: Mclaren Medicare |
$480.44
|
| Rate for Payer: Meridian Medicaid |
$275.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$552.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,230.47
|
| Rate for Payer: PACE Medicare |
$456.42
|
| Rate for Payer: PACE SWMI |
$480.44
|
| Rate for Payer: PHP Commercial |
$528.48
|
| Rate for Payer: PHP Medicaid |
$262.80
|
| Rate for Payer: PHP Medicare Advantage |
$480.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,013.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,106.73
|
| Rate for Payer: Priority Health Medicare |
$480.44
|
| Rate for Payer: Priority Health Narrow Network |
$885.38
|
| Rate for Payer: Railroad Medicare Medicare |
$480.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,273.90
|
| Rate for Payer: UHC Medicare Advantage |
$494.85
|
| Rate for Payer: VA VA |
$480.44
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
IP
|
$900.56
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$630.39 |
| Max. Negotiated Rate |
$900.56 |
| Rate for Payer: Aetna Commercial |
$810.50
|
| Rate for Payer: ASR ASR |
$873.54
|
| Rate for Payer: BCBS Trust/PPO |
$698.20
|
| Rate for Payer: BCN Commercial |
$698.20
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cofinity Commercial |
$846.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.45
|
| Rate for Payer: Healthscope Commercial |
$900.56
|
| Rate for Payer: Healthscope Whirlpool |
$873.54
|
| Rate for Payer: Mclaren Commercial |
$810.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$792.49
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
OP
|
$900.56
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$900.56 |
| Rate for Payer: Aetna Commercial |
$810.50
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$873.54
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$698.20
|
| Rate for Payer: BCN Commercial |
$698.20
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cofinity Commercial |
$846.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$900.56
|
| Rate for Payer: Healthscope Whirlpool |
$873.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$810.50
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.48
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$705.49
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$564.39
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$792.49
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$543.20 |
| Max. Negotiated Rate |
$776.00 |
| Rate for Payer: Aetna Commercial |
$698.40
|
| Rate for Payer: ASR ASR |
$752.72
|
| Rate for Payer: BCBS Trust/PPO |
$601.63
|
| Rate for Payer: BCN Commercial |
$601.63
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cofinity Commercial |
$729.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.80
|
| Rate for Payer: Healthscope Commercial |
$776.00
|
| Rate for Payer: Healthscope Whirlpool |
$752.72
|
| Rate for Payer: Mclaren Commercial |
$698.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$659.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.88
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$776.00 |
| Rate for Payer: Aetna Commercial |
$698.40
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$752.72
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$601.63
|
| Rate for Payer: BCN Commercial |
$601.63
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cofinity Commercial |
$729.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$620.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$776.00
|
| Rate for Payer: Healthscope Whirlpool |
$752.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$698.40
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$659.60
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$610.06
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$488.05
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$682.88
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
IP
|
$1,263.46
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$884.42 |
| Max. Negotiated Rate |
$1,263.46 |
| Rate for Payer: Aetna Commercial |
$1,137.11
|
| Rate for Payer: ASR ASR |
$1,225.56
|
| Rate for Payer: BCBS Trust/PPO |
$979.56
|
| Rate for Payer: BCN Commercial |
$979.56
|
| Rate for Payer: Cash Price |
$1,010.77
|
| Rate for Payer: Cofinity Commercial |
$1,187.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.77
|
| Rate for Payer: Healthscope Commercial |
$1,263.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,225.56
|
| Rate for Payer: Mclaren Commercial |
$1,137.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,073.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,111.84
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
OP
|
$1,263.46
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,263.46 |
| Rate for Payer: Aetna Commercial |
$1,137.11
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,225.56
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$979.56
|
| Rate for Payer: BCN Commercial |
$979.56
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$1,010.77
|
| Rate for Payer: Cash Price |
$1,010.77
|
| Rate for Payer: Cofinity Commercial |
$1,187.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,263.46
|
| Rate for Payer: Healthscope Whirlpool |
$1,225.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,137.11
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,073.94
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,149.75
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$897.06
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,111.84
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
OP
|
$1,700.97
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$690.41 |
| Max. Negotiated Rate |
$1,700.97 |
| Rate for Payer: Aetna Commercial |
$1,530.87
|
| Rate for Payer: Aetna Medicare |
$1,262.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,577.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,577.72
|
| Rate for Payer: ASR ASR |
$1,649.94
|
| Rate for Payer: BCBS Complete |
$725.00
|
| Rate for Payer: BCBS MAPPO |
$1,262.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,318.76
|
| Rate for Payer: BCN Commercial |
$1,318.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,262.18
|
| Rate for Payer: Cash Price |
$1,360.78
|
| Rate for Payer: Cash Price |
$1,360.78
|
| Rate for Payer: Cofinity Commercial |
$1,598.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,262.18
|
| Rate for Payer: Healthscope Commercial |
$1,700.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,649.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,262.18
|
| Rate for Payer: Mclaren Commercial |
$1,530.87
|
| Rate for Payer: Mclaren Medicaid |
$690.41
|
| Rate for Payer: Mclaren Medicare |
$1,262.18
|
| Rate for Payer: Meridian Medicaid |
$725.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,325.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,451.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,445.82
|
| Rate for Payer: PACE Medicare |
$1,199.07
|
| Rate for Payer: PACE SWMI |
$1,262.18
|
| Rate for Payer: PHP Commercial |
$1,388.40
|
| Rate for Payer: PHP Medicaid |
$690.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,262.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$690.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,678.83
|
| Rate for Payer: Priority Health Medicare |
$1,262.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,343.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,262.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,496.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,300.05
|
| Rate for Payer: VA VA |
$1,262.18
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
IP
|
$1,700.97
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,190.68 |
| Max. Negotiated Rate |
$1,700.97 |
| Rate for Payer: Aetna Commercial |
$1,530.87
|
| Rate for Payer: ASR ASR |
$1,649.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,318.76
|
| Rate for Payer: BCN Commercial |
$1,318.76
|
| Rate for Payer: Cash Price |
$1,360.78
|
| Rate for Payer: Cofinity Commercial |
$1,598.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.78
|
| Rate for Payer: Healthscope Commercial |
$1,700.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,649.94
|
| Rate for Payer: Mclaren Commercial |
$1,530.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,445.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,496.85
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
IP
|
$817.10
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.97 |
| Max. Negotiated Rate |
$817.10 |
| Rate for Payer: Aetna Commercial |
$735.39
|
| Rate for Payer: ASR ASR |
$792.59
|
| Rate for Payer: BCBS Trust/PPO |
$633.50
|
| Rate for Payer: BCN Commercial |
$633.50
|
| Rate for Payer: Cash Price |
$653.68
|
| Rate for Payer: Cofinity Commercial |
$768.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.68
|
| Rate for Payer: Healthscope Commercial |
$817.10
|
| Rate for Payer: Healthscope Whirlpool |
$792.59
|
| Rate for Payer: Mclaren Commercial |
$735.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$694.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$719.05
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
OP
|
$817.10
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$817.10 |
| Rate for Payer: Aetna Commercial |
$735.39
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$792.59
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$633.50
|
| Rate for Payer: BCN Commercial |
$633.50
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$653.68
|
| Rate for Payer: Cash Price |
$653.68
|
| Rate for Payer: Cofinity Commercial |
$768.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$653.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$817.10
|
| Rate for Payer: Healthscope Whirlpool |
$792.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$735.39
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$694.54
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$743.56
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$580.14
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$719.05
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
OP
|
$1,000.76
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,000.76 |
| Rate for Payer: Aetna Commercial |
$900.68
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$970.74
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$775.89
|
| Rate for Payer: BCN Commercial |
$775.89
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$940.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,000.76
|
| Rate for Payer: Healthscope Whirlpool |
$970.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$900.68
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.35
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$653.88
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.67
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
IP
|
$1,000.76
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$700.53 |
| Max. Negotiated Rate |
$1,000.76 |
| Rate for Payer: Aetna Commercial |
$900.68
|
| Rate for Payer: ASR ASR |
$970.74
|
| Rate for Payer: BCBS Trust/PPO |
$775.89
|
| Rate for Payer: BCN Commercial |
$775.89
|
| Rate for Payer: Cash Price |
$800.61
|
| Rate for Payer: Cofinity Commercial |
$940.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$800.61
|
| Rate for Payer: Healthscope Commercial |
$1,000.76
|
| Rate for Payer: Healthscope Whirlpool |
$970.74
|
| Rate for Payer: Mclaren Commercial |
$900.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$850.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$880.67
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
OP
|
$1,288.63
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$1,288.63 |
| Rate for Payer: Aetna Commercial |
$1,159.77
|
| Rate for Payer: Aetna Medicare |
$480.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$600.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$600.55
|
| Rate for Payer: ASR ASR |
$1,249.97
|
| Rate for Payer: BCBS Complete |
$275.96
|
| Rate for Payer: BCBS MAPPO |
$480.44
|
| Rate for Payer: BCBS Trust/PPO |
$999.07
|
| Rate for Payer: BCN Commercial |
$999.07
|
| Rate for Payer: BCN Medicare Advantage |
$480.44
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Cofinity Commercial |
$1,211.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.44
|
| Rate for Payer: Healthscope Commercial |
$1,288.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,249.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$480.44
|
| Rate for Payer: Mclaren Commercial |
$1,159.77
|
| Rate for Payer: Mclaren Medicaid |
$262.80
|
| Rate for Payer: Mclaren Medicare |
$480.44
|
| Rate for Payer: Meridian Medicaid |
$275.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$504.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$552.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,095.34
|
| Rate for Payer: PACE Medicare |
$456.42
|
| Rate for Payer: PACE SWMI |
$480.44
|
| Rate for Payer: PHP Commercial |
$528.48
|
| Rate for Payer: PHP Medicaid |
$262.80
|
| Rate for Payer: PHP Medicare Advantage |
$480.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$530.54
|
| Rate for Payer: Priority Health Medicare |
$480.44
|
| Rate for Payer: Priority Health Narrow Network |
$424.43
|
| Rate for Payer: Railroad Medicare Medicare |
$480.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,133.99
|
| Rate for Payer: UHC Medicare Advantage |
$494.85
|
| Rate for Payer: VA VA |
$480.44
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
IP
|
$1,288.63
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$902.04 |
| Max. Negotiated Rate |
$1,288.63 |
| Rate for Payer: Aetna Commercial |
$1,159.77
|
| Rate for Payer: ASR ASR |
$1,249.97
|
| Rate for Payer: BCBS Trust/PPO |
$999.07
|
| Rate for Payer: BCN Commercial |
$999.07
|
| Rate for Payer: Cash Price |
$1,030.90
|
| Rate for Payer: Cofinity Commercial |
$1,211.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.90
|
| Rate for Payer: Healthscope Commercial |
$1,288.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,249.97
|
| Rate for Payer: Mclaren Commercial |
$1,159.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,095.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$902.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,133.99
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
IP
|
$1,123.57
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$786.50 |
| Max. Negotiated Rate |
$1,123.57 |
| Rate for Payer: Aetna Commercial |
$1,011.21
|
| Rate for Payer: ASR ASR |
$1,089.86
|
| Rate for Payer: BCBS Trust/PPO |
$871.10
|
| Rate for Payer: BCN Commercial |
$871.10
|
| Rate for Payer: Cash Price |
$898.86
|
| Rate for Payer: Cofinity Commercial |
$1,056.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.86
|
| Rate for Payer: Healthscope Commercial |
$1,123.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,089.86
|
| Rate for Payer: Mclaren Commercial |
$1,011.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$955.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$988.74
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
OP
|
$1,123.57
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,123.57 |
| Rate for Payer: Aetna Commercial |
$1,011.21
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,089.86
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$871.10
|
| Rate for Payer: BCN Commercial |
$871.10
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$898.86
|
| Rate for Payer: Cash Price |
$898.86
|
| Rate for Payer: Cofinity Commercial |
$1,056.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$898.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,123.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,089.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,011.21
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$955.03
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$950.25
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$760.20
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$988.74
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
