|
HC NMDA-R AB CBA, SERUM
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$298.35 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$413.10
|
| Rate for Payer: ASR ASR |
$445.23
|
| Rate for Payer: ASR Commercial |
$445.23
|
| Rate for Payer: BCBS Trust/PPO |
$374.04
|
| Rate for Payer: BCN Commercial |
$355.86
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$431.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Healthscope Whirlpool |
$445.23
|
| Rate for Payer: Mclaren Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.92
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: ASR Commercial |
$113.78
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$96.06
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.78
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$82.23
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna Commercial |
$105.57
|
| Rate for Payer: ASR ASR |
$113.78
|
| Rate for Payer: ASR Commercial |
$113.78
|
| Rate for Payer: BCBS Trust/PPO |
$95.59
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$110.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$117.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.78
|
| Rate for Payer: Mclaren Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.22
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| Rate for Payer: ASR ASR |
$80.73
|
| Rate for Payer: ASR Commercial |
$80.73
|
| Rate for Payer: BCBS Trust/PPO |
$67.82
|
| Rate for Payer: BCN Commercial |
$64.53
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$78.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$83.23
|
| Rate for Payer: Healthscope Whirlpool |
$80.73
|
| Rate for Payer: Mclaren Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.24
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$83.23 |
| Rate for Payer: Aetna Commercial |
$74.91
|
| Rate for Payer: Aetna Medicare |
$24.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: ASR ASR |
$80.73
|
| Rate for Payer: ASR Commercial |
$80.73
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$68.16
|
| Rate for Payer: BCN Commercial |
$64.53
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$78.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$83.23
|
| Rate for Payer: Healthscope Whirlpool |
$80.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.09
|
| Rate for Payer: Mclaren Commercial |
$74.91
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$13.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$26.50
|
| Rate for Payer: PHP Medicaid |
$12.91
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.93
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$58.34
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$37.34
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: UHCCP DNSP |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$12.91
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
OP
|
$1,429.10
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,429.10 |
| Rate for Payer: Aetna Commercial |
$1,286.19
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,386.23
|
| Rate for Payer: ASR Commercial |
$1,386.23
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,170.29
|
| Rate for Payer: BCN Commercial |
$1,107.98
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$1,143.28
|
| Rate for Payer: Cash Price |
$1,143.28
|
| Rate for Payer: Cofinity Commercial |
$1,343.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,429.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,386.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,286.19
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.73
|
| Rate for Payer: Nomi Health Commercial |
$1,171.86
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,252.18
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,001.80
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,257.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
IP
|
$1,429.10
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$928.91 |
| Max. Negotiated Rate |
$1,429.10 |
| Rate for Payer: Aetna Commercial |
$1,286.19
|
| Rate for Payer: ASR ASR |
$1,386.23
|
| Rate for Payer: ASR Commercial |
$1,386.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.57
|
| Rate for Payer: BCN Commercial |
$1,107.98
|
| Rate for Payer: Cash Price |
$1,143.28
|
| Rate for Payer: Cofinity Commercial |
$1,343.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.28
|
| Rate for Payer: Healthscope Commercial |
$1,429.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,386.23
|
| Rate for Payer: Mclaren Commercial |
$1,286.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.73
|
| Rate for Payer: Nomi Health Commercial |
$1,171.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,257.61
|
|
|
HC NM GE REFLUX
|
Facility
|
IP
|
$1,265.76
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$822.74 |
| Max. Negotiated Rate |
$1,265.76 |
| Rate for Payer: Aetna Commercial |
$1,139.18
|
| Rate for Payer: ASR ASR |
$1,227.79
|
| Rate for Payer: ASR Commercial |
$1,227.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,031.47
|
| Rate for Payer: BCN Commercial |
$981.34
|
| Rate for Payer: Cash Price |
$1,012.61
|
| Rate for Payer: Cofinity Commercial |
$1,189.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.61
|
| Rate for Payer: Healthscope Commercial |
$1,265.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,227.79
|
| Rate for Payer: Mclaren Commercial |
$1,139.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.90
|
| Rate for Payer: Nomi Health Commercial |
$1,037.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,113.87
|
|
|
HC NM GE REFLUX
|
Facility
|
OP
|
$1,265.76
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,265.76 |
| Rate for Payer: Aetna Commercial |
$1,139.18
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,227.79
|
| Rate for Payer: ASR Commercial |
$1,227.79
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,036.53
|
| Rate for Payer: BCN Commercial |
$981.34
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$1,012.61
|
| Rate for Payer: Cash Price |
$1,012.61
|
| Rate for Payer: Cofinity Commercial |
$1,189.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,265.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,227.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,139.18
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.90
|
| Rate for Payer: Nomi Health Commercial |
$1,037.92
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,109.06
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$887.30
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,113.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$663.51 |
| Max. Negotiated Rate |
$1,020.78 |
| Rate for Payer: Aetna Commercial |
$918.70
|
| Rate for Payer: ASR ASR |
$990.16
|
| Rate for Payer: ASR Commercial |
$990.16
|
| Rate for Payer: BCBS Trust/PPO |
$831.83
|
| Rate for Payer: BCN Commercial |
$791.41
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$959.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$1,020.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.16
|
| Rate for Payer: Mclaren Commercial |
$918.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.29
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,020.78 |
| Rate for Payer: Aetna Commercial |
$918.70
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$990.16
|
| Rate for Payer: ASR Commercial |
$990.16
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$835.92
|
| Rate for Payer: BCN Commercial |
$791.41
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$959.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,020.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$918.70
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$894.41
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$715.57
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
OP
|
$1,476.56
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,476.56 |
| Rate for Payer: Aetna Commercial |
$1,328.90
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,432.26
|
| Rate for Payer: ASR Commercial |
$1,432.26
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,209.15
|
| Rate for Payer: BCN Commercial |
$1,144.78
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,387.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,476.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,432.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,328.90
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: Nomi Health Commercial |
$1,210.78
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,293.76
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,035.07
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,299.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
IP
|
$1,476.56
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$959.76 |
| Max. Negotiated Rate |
$1,476.56 |
| Rate for Payer: Aetna Commercial |
$1,328.90
|
| Rate for Payer: ASR ASR |
$1,432.26
|
| Rate for Payer: ASR Commercial |
$1,432.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.25
|
| Rate for Payer: BCN Commercial |
$1,144.78
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,387.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Healthscope Commercial |
$1,476.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,432.26
|
| Rate for Payer: Mclaren Commercial |
$1,328.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: Nomi Health Commercial |
$1,210.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,299.37
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
IP
|
$1,476.56
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$959.76 |
| Max. Negotiated Rate |
$1,476.56 |
| Rate for Payer: Aetna Commercial |
$1,328.90
|
| Rate for Payer: ASR ASR |
$1,432.26
|
| Rate for Payer: ASR Commercial |
$1,432.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.25
|
| Rate for Payer: BCN Commercial |
$1,144.78
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,387.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Healthscope Commercial |
$1,476.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,432.26
|
| Rate for Payer: Mclaren Commercial |
$1,328.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: Nomi Health Commercial |
$1,210.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,299.37
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
OP
|
$1,476.56
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.38 |
| Max. Negotiated Rate |
$1,476.56 |
| Rate for Payer: Aetna Commercial |
$1,328.90
|
| Rate for Payer: Aetna Medicare |
$524.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.20
|
| Rate for Payer: ASR ASR |
$1,432.26
|
| Rate for Payer: ASR Commercial |
$1,432.26
|
| Rate for Payer: BCBS Complete |
$295.45
|
| Rate for Payer: BCBS MAPPO |
$524.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,209.15
|
| Rate for Payer: BCN Commercial |
$1,144.78
|
| Rate for Payer: BCN Medicare Advantage |
$524.96
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,387.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.96
|
| Rate for Payer: Healthscope Commercial |
$1,476.56
|
| Rate for Payer: Healthscope Whirlpool |
$1,432.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$524.96
|
| Rate for Payer: Mclaren Commercial |
$1,328.90
|
| Rate for Payer: Mclaren Medicaid |
$281.38
|
| Rate for Payer: Mclaren Medicare |
$524.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.21
|
| Rate for Payer: Meridian Medicaid |
$295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: Nomi Health Commercial |
$1,210.78
|
| Rate for Payer: PACE Medicare |
$498.71
|
| Rate for Payer: PACE SWMI |
$524.96
|
| Rate for Payer: PHP Commercial |
$577.46
|
| Rate for Payer: PHP Medicaid |
$281.38
|
| Rate for Payer: PHP Medicare Advantage |
$524.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,293.76
|
| Rate for Payer: Priority Health Medicare |
$524.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,035.07
|
| Rate for Payer: Railroad Medicare Medicare |
$524.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,299.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.96
|
| Rate for Payer: UHC Exchange |
$813.69
|
| Rate for Payer: UHC Medicare Advantage |
$524.96
|
| Rate for Payer: UHCCP DNSP |
$524.96
|
| Rate for Payer: UHCCP Medicaid |
$281.38
|
| Rate for Payer: VA VA |
$524.96
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
OP
|
$918.57
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$918.57 |
| Rate for Payer: Aetna Commercial |
$826.71
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$891.01
|
| Rate for Payer: ASR Commercial |
$891.01
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$752.22
|
| Rate for Payer: BCN Commercial |
$712.17
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$734.86
|
| Rate for Payer: Cash Price |
$734.86
|
| Rate for Payer: Cofinity Commercial |
$863.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$918.57
|
| Rate for Payer: Healthscope Whirlpool |
$891.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$826.71
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.78
|
| Rate for Payer: Nomi Health Commercial |
$753.23
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$804.85
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$643.92
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM LIVER SPLEEN
|
Facility
|
IP
|
$918.57
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$597.07 |
| Max. Negotiated Rate |
$918.57 |
| Rate for Payer: Aetna Commercial |
$826.71
|
| Rate for Payer: ASR ASR |
$891.01
|
| Rate for Payer: ASR Commercial |
$891.01
|
| Rate for Payer: BCBS Trust/PPO |
$748.54
|
| Rate for Payer: BCN Commercial |
$712.17
|
| Rate for Payer: Cash Price |
$734.86
|
| Rate for Payer: Cofinity Commercial |
$863.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$734.86
|
| Rate for Payer: Healthscope Commercial |
$918.57
|
| Rate for Payer: Healthscope Whirlpool |
$891.01
|
| Rate for Payer: Mclaren Commercial |
$826.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.78
|
| Rate for Payer: Nomi Health Commercial |
$753.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.34
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
OP
|
$791.52
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Aetna Commercial |
$712.37
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$767.77
|
| Rate for Payer: ASR Commercial |
$767.77
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$648.18
|
| Rate for Payer: BCN Commercial |
$613.67
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$633.22
|
| Rate for Payer: Cash Price |
$633.22
|
| Rate for Payer: Cofinity Commercial |
$744.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$791.52
|
| Rate for Payer: Healthscope Whirlpool |
$767.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$712.37
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.79
|
| Rate for Payer: Nomi Health Commercial |
$649.05
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$693.53
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$554.86
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$696.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM LOCALIZATION TUMOR LMTD AREA
|
Facility
|
IP
|
$791.52
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100052
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$514.49 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Aetna Commercial |
$712.37
|
| Rate for Payer: ASR ASR |
$767.77
|
| Rate for Payer: ASR Commercial |
$767.77
|
| Rate for Payer: BCBS Trust/PPO |
$645.01
|
| Rate for Payer: BCN Commercial |
$613.67
|
| Rate for Payer: Cash Price |
$633.22
|
| Rate for Payer: Cofinity Commercial |
$744.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.22
|
| Rate for Payer: Healthscope Commercial |
$791.52
|
| Rate for Payer: Healthscope Whirlpool |
$767.77
|
| Rate for Payer: Mclaren Commercial |
$712.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.79
|
| Rate for Payer: Nomi Health Commercial |
$649.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$696.54
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
IP
|
$1,288.73
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$837.67 |
| Max. Negotiated Rate |
$1,288.73 |
| Rate for Payer: Aetna Commercial |
$1,159.86
|
| Rate for Payer: ASR ASR |
$1,250.07
|
| Rate for Payer: ASR Commercial |
$1,250.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,050.19
|
| Rate for Payer: BCN Commercial |
$999.15
|
| Rate for Payer: Cash Price |
$1,030.98
|
| Rate for Payer: Cofinity Commercial |
$1,211.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.98
|
| Rate for Payer: Healthscope Commercial |
$1,288.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.07
|
| Rate for Payer: Mclaren Commercial |
$1,159.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.42
|
| Rate for Payer: Nomi Health Commercial |
$1,056.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,134.08
|
|
|
HC NM LOCALIZATION TUMOR MULTI AREA
|
Facility
|
OP
|
$1,288.73
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
34100054
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,288.73 |
| Rate for Payer: Aetna Commercial |
$1,159.86
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$1,250.07
|
| Rate for Payer: ASR Commercial |
$1,250.07
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.34
|
| Rate for Payer: BCN Commercial |
$999.15
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$1,030.98
|
| Rate for Payer: Cash Price |
$1,030.98
|
| Rate for Payer: Cofinity Commercial |
$1,211.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,030.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,288.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$1,159.86
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.42
|
| Rate for Payer: Nomi Health Commercial |
$1,056.76
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$837.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,129.19
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$903.40
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,134.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
IP
|
$1,734.99
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,127.74 |
| Max. Negotiated Rate |
$1,734.99 |
| Rate for Payer: Aetna Commercial |
$1,561.49
|
| Rate for Payer: ASR ASR |
$1,682.94
|
| Rate for Payer: ASR Commercial |
$1,682.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,413.84
|
| Rate for Payer: BCN Commercial |
$1,345.14
|
| Rate for Payer: Cash Price |
$1,387.99
|
| Rate for Payer: Cofinity Commercial |
$1,630.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,387.99
|
| Rate for Payer: Healthscope Commercial |
$1,734.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,682.94
|
| Rate for Payer: Mclaren Commercial |
$1,561.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.74
|
| Rate for Payer: Nomi Health Commercial |
$1,422.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,526.79
|
|
|
HC NM LOCALIZATION TUMOR WHOLE BODY
|
Facility
|
OP
|
$1,734.99
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
34100055
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$682.44 |
| Max. Negotiated Rate |
$1,973.48 |
| Rate for Payer: Aetna Commercial |
$1,561.49
|
| Rate for Payer: Aetna Medicare |
$1,273.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,591.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,591.51
|
| Rate for Payer: ASR ASR |
$1,682.94
|
| Rate for Payer: ASR Commercial |
$1,682.94
|
| Rate for Payer: BCBS Complete |
$716.56
|
| Rate for Payer: BCBS MAPPO |
$1,273.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,420.78
|
| Rate for Payer: BCN Commercial |
$1,345.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,273.21
|
| Rate for Payer: Cash Price |
$1,387.99
|
| Rate for Payer: Cash Price |
$1,387.99
|
| Rate for Payer: Cofinity Commercial |
$1,630.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,387.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,273.21
|
| Rate for Payer: Healthscope Commercial |
$1,734.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,682.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,273.21
|
| Rate for Payer: Mclaren Commercial |
$1,561.49
|
| Rate for Payer: Mclaren Medicaid |
$682.44
|
| Rate for Payer: Mclaren Medicare |
$1,273.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,336.87
|
| Rate for Payer: Meridian Medicaid |
$716.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,464.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.74
|
| Rate for Payer: Nomi Health Commercial |
$1,422.69
|
| Rate for Payer: PACE Medicare |
$1,209.55
|
| Rate for Payer: PACE SWMI |
$1,273.21
|
| Rate for Payer: PHP Commercial |
$1,400.53
|
| Rate for Payer: PHP Medicaid |
$682.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,273.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,520.20
|
| Rate for Payer: Priority Health Medicare |
$1,273.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,216.23
|
| Rate for Payer: Railroad Medicare Medicare |
$1,273.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,526.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,273.21
|
| Rate for Payer: UHC Exchange |
$1,973.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,273.21
|
| Rate for Payer: UHCCP DNSP |
$1,273.21
|
| Rate for Payer: UHCCP Medicaid |
$682.44
|
| Rate for Payer: VA VA |
$1,273.21
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
OP
|
$833.44
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$833.44 |
| Rate for Payer: Aetna Commercial |
$750.10
|
| Rate for Payer: Aetna Medicare |
$391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: ASR ASR |
$808.44
|
| Rate for Payer: ASR Commercial |
$808.44
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCBS Trust/PPO |
$682.50
|
| Rate for Payer: BCN Commercial |
$646.17
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$666.75
|
| Rate for Payer: Cash Price |
$666.75
|
| Rate for Payer: Cofinity Commercial |
$783.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$833.44
|
| Rate for Payer: Healthscope Whirlpool |
$808.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.90
|
| Rate for Payer: Mclaren Commercial |
$750.10
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.42
|
| Rate for Payer: Nomi Health Commercial |
$683.42
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$431.09
|
| Rate for Payer: PHP Medicaid |
$210.06
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$730.26
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health Narrow Network |
$584.24
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$733.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$607.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP DNSP |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$210.06
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM LUNG PERF DIFF FUNCT
|
Facility
|
IP
|
$833.44
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$541.74 |
| Max. Negotiated Rate |
$833.44 |
| Rate for Payer: Aetna Commercial |
$750.10
|
| Rate for Payer: ASR ASR |
$808.44
|
| Rate for Payer: ASR Commercial |
$808.44
|
| Rate for Payer: BCBS Trust/PPO |
$679.17
|
| Rate for Payer: BCN Commercial |
$646.17
|
| Rate for Payer: Cash Price |
$666.75
|
| Rate for Payer: Cofinity Commercial |
$783.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.75
|
| Rate for Payer: Healthscope Commercial |
$833.44
|
| Rate for Payer: Healthscope Whirlpool |
$808.44
|
| Rate for Payer: Mclaren Commercial |
$750.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.42
|
| Rate for Payer: Nomi Health Commercial |
$683.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$733.43
|
|
