|
HC NM LIVER SPLEEN
|
Facility
|
OP
|
$918.57
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
34100016
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$918.57 |
| Rate for Payer: Aetna Commercial |
$826.71
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$891.01
|
| Rate for Payer: ASR Commercial |
$891.01
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$752.22
|
| Rate for Payer: BCN Commercial |
$712.17
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| 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 |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$918.57
|
| Rate for Payer: Healthscope Whirlpool |
$891.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$826.71
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.78
|
| Rate for Payer: Nomi Health Commercial |
$753.23
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$754.87
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$603.90
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$808.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
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 |
$211.02 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Aetna Commercial |
$712.37
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$767.77
|
| Rate for Payer: ASR Commercial |
$767.77
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$648.18
|
| Rate for Payer: BCN Commercial |
$613.67
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| 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 |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$791.52
|
| Rate for Payer: Healthscope Whirlpool |
$767.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$712.37
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.79
|
| Rate for Payer: Nomi Health Commercial |
$649.05
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$652.76
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$522.21
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$696.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
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 |
$211.02 |
| Max. Negotiated Rate |
$1,288.73 |
| Rate for Payer: Aetna Commercial |
$1,159.86
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,250.07
|
| Rate for Payer: ASR Commercial |
$1,250.07
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.34
|
| Rate for Payer: BCN Commercial |
$999.15
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| 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 |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,288.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,159.86
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| 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 |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| 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 |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$903.40
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,134.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
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 |
$685.59 |
| Max. Negotiated Rate |
$1,982.57 |
| Rate for Payer: Aetna Commercial |
$1,561.49
|
| Rate for Payer: Aetna Medicare |
$1,279.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,598.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,598.85
|
| Rate for Payer: ASR ASR |
$1,682.94
|
| Rate for Payer: ASR Commercial |
$1,682.94
|
| Rate for Payer: BCBS Complete |
$719.87
|
| Rate for Payer: BCBS MAPPO |
$1,279.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,420.78
|
| Rate for Payer: BCN Commercial |
$1,345.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,279.08
|
| 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 |
$1,279.08
|
| Rate for Payer: Healthscope Commercial |
$1,734.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,682.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,279.08
|
| Rate for Payer: Mclaren Commercial |
$1,561.49
|
| Rate for Payer: Mclaren Medicaid |
$685.59
|
| Rate for Payer: Mclaren Medicare |
$1,279.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,343.03
|
| Rate for Payer: Meridian Medicaid |
$719.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,470.94
|
| 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 |
$1,215.13
|
| Rate for Payer: PACE SWMI |
$1,279.08
|
| Rate for Payer: PHP Commercial |
$1,406.99
|
| Rate for Payer: PHP Medicaid |
$685.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,279.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,796.35
|
| Rate for Payer: Priority Health Medicare |
$1,279.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,437.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,279.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,526.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,279.08
|
| Rate for Payer: UHC Exchange |
$1,982.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,279.08
|
| Rate for Payer: UHCCP DNSP |
$1,279.08
|
| Rate for Payer: UHCCP Medicaid |
$685.59
|
| Rate for Payer: VA VA |
$1,279.08
|
|
|
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 LUNG PERF DIFF FUNCT
|
Facility
|
OP
|
$833.44
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100037
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$833.44 |
| Rate for Payer: Aetna Commercial |
$750.10
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$808.44
|
| Rate for Payer: ASR Commercial |
$808.44
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$682.50
|
| Rate for Payer: BCN Commercial |
$646.17
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| 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 |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$833.44
|
| Rate for Payer: Healthscope Whirlpool |
$808.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$750.10
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.42
|
| Rate for Payer: Nomi Health Commercial |
$683.42
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| 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 |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$584.24
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$733.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
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
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,020.78 |
| Rate for Payer: Aetna Commercial |
$918.70
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$990.16
|
| Rate for Payer: ASR Commercial |
$990.16
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$835.92
|
| Rate for Payer: BCN Commercial |
$791.41
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| 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 |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,020.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$918.70
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: Nomi Health Commercial |
$837.04
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$874.56
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$699.65
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM LUNG PERFUSION EG PARTICULATE
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
34100032
|
|
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 LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
OP
|
$1,314.40
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.68 |
| Max. Negotiated Rate |
$1,314.40 |
| Rate for Payer: Aetna Commercial |
$1,182.96
|
| Rate for Payer: Aetna Medicare |
$527.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.24
|
| Rate for Payer: ASR ASR |
$1,274.97
|
| Rate for Payer: ASR Commercial |
$1,274.97
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,076.36
|
| Rate for Payer: BCN Commercial |
$1,019.05
|
| Rate for Payer: BCN Medicare Advantage |
$527.39
|
| Rate for Payer: Cash Price |
$1,051.52
|
| Rate for Payer: Cash Price |
$1,051.52
|
| Rate for Payer: Cofinity Commercial |
$1,235.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.39
|
| Rate for Payer: Healthscope Commercial |
$1,314.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,274.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$527.39
|
| Rate for Payer: Mclaren Commercial |
$1,182.96
|
| Rate for Payer: Mclaren Medicaid |
$282.68
|
| Rate for Payer: Mclaren Medicare |
$527.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.76
|
| Rate for Payer: Meridian Medicaid |
$296.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.24
|
| Rate for Payer: Nomi Health Commercial |
$1,077.81
|
| Rate for Payer: PACE Medicare |
$501.02
|
| Rate for Payer: PACE SWMI |
$527.39
|
| Rate for Payer: PHP Commercial |
$580.13
|
| Rate for Payer: PHP Medicaid |
$282.68
|
| Rate for Payer: PHP Medicare Advantage |
$527.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$567.68
|
| Rate for Payer: Priority Health Medicare |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$454.14
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,156.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.39
|
| Rate for Payer: UHC Exchange |
$817.45
|
| Rate for Payer: UHC Medicare Advantage |
$527.39
|
| Rate for Payer: UHCCP DNSP |
$527.39
|
| Rate for Payer: UHCCP Medicaid |
$282.68
|
| Rate for Payer: VA VA |
$527.39
|
|
|
HC NM LYMPHATIC SENTINAL NODE IMAGING
|
Facility
|
IP
|
$1,314.40
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
34100012
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$854.36 |
| Max. Negotiated Rate |
$1,314.40 |
| Rate for Payer: Aetna Commercial |
$1,182.96
|
| Rate for Payer: ASR ASR |
$1,274.97
|
| Rate for Payer: ASR Commercial |
$1,274.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,071.10
|
| Rate for Payer: BCN Commercial |
$1,019.05
|
| Rate for Payer: Cash Price |
$1,051.52
|
| Rate for Payer: Cofinity Commercial |
$1,235.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,051.52
|
| Rate for Payer: Healthscope Commercial |
$1,314.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,274.97
|
| Rate for Payer: Mclaren Commercial |
$1,182.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.24
|
| Rate for Payer: Nomi Health Commercial |
$1,077.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,156.67
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
IP
|
$1,146.04
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$744.93 |
| Max. Negotiated Rate |
$1,146.04 |
| Rate for Payer: Aetna Commercial |
$1,031.44
|
| Rate for Payer: ASR ASR |
$1,111.66
|
| Rate for Payer: ASR Commercial |
$1,111.66
|
| Rate for Payer: BCBS Trust/PPO |
$933.91
|
| Rate for Payer: BCN Commercial |
$888.52
|
| Rate for Payer: Cash Price |
$916.83
|
| Rate for Payer: Cofinity Commercial |
$1,077.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.83
|
| Rate for Payer: Healthscope Commercial |
$1,146.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,111.66
|
| Rate for Payer: Mclaren Commercial |
$1,031.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$974.13
|
| Rate for Payer: Nomi Health Commercial |
$939.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,008.52
|
|
|
HC NM MECKELS OR ABD
|
Facility
|
OP
|
$1,146.04
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
34100021
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,146.04 |
| Rate for Payer: Aetna Commercial |
$1,031.44
|
| Rate for Payer: Aetna Medicare |
$393.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.12
|
| Rate for Payer: ASR ASR |
$1,111.66
|
| Rate for Payer: ASR Commercial |
$1,111.66
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$938.49
|
| Rate for Payer: BCN Commercial |
$888.52
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$916.83
|
| Rate for Payer: Cash Price |
$916.83
|
| Rate for Payer: Cofinity Commercial |
$1,077.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,146.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,111.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,031.44
|
| Rate for Payer: Mclaren Medicaid |
$211.02
|
| Rate for Payer: Mclaren Medicare |
$393.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.38
|
| Rate for Payer: Meridian Medicaid |
$221.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$974.13
|
| Rate for Payer: Nomi Health Commercial |
$939.75
|
| Rate for Payer: PACE Medicare |
$374.02
|
| Rate for Payer: PACE SWMI |
$393.70
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: PHP Medicaid |
$211.02
|
| Rate for Payer: PHP Medicare Advantage |
$393.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,016.77
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$813.42
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,008.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.70
|
| Rate for Payer: UHC Exchange |
$610.24
|
| Rate for Payer: UHC Medicare Advantage |
$393.70
|
| Rate for Payer: UHCCP DNSP |
$393.70
|
| Rate for Payer: UHCCP Medicaid |
$211.02
|
| Rate for Payer: VA VA |
$393.70
|
|
|
HC NM MYOCARD PERF SPECT EF WM MU
|
Facility
|
OP
|
$5,128.21
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
34100029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$685.59 |
| Max. Negotiated Rate |
$5,128.21 |
| Rate for Payer: Aetna Commercial |
$4,615.39
|
| Rate for Payer: Aetna Medicare |
$1,279.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,598.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,598.85
|
| Rate for Payer: ASR ASR |
$4,974.36
|
| Rate for Payer: ASR Commercial |
$4,974.36
|
| Rate for Payer: BCBS Complete |
$719.87
|
| Rate for Payer: BCBS MAPPO |
$1,279.08
|
| Rate for Payer: BCBS Trust/PPO |
$4,199.49
|
| Rate for Payer: BCN Commercial |
$3,975.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,279.08
|
| Rate for Payer: Cash Price |
$4,102.57
|
| Rate for Payer: Cash Price |
$4,102.57
|
| Rate for Payer: Cofinity Commercial |
$4,820.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,102.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,279.08
|
| Rate for Payer: Healthscope Commercial |
$5,128.21
|
| Rate for Payer: Healthscope Whirlpool |
$4,974.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,279.08
|
| Rate for Payer: Mclaren Commercial |
$4,615.39
|
| Rate for Payer: Mclaren Medicaid |
$685.59
|
| Rate for Payer: Mclaren Medicare |
$1,279.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,343.03
|
| Rate for Payer: Meridian Medicaid |
$719.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,470.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,358.98
|
| Rate for Payer: Nomi Health Commercial |
$4,205.13
|
| Rate for Payer: PACE Medicare |
$1,215.13
|
| Rate for Payer: PACE SWMI |
$1,279.08
|
| Rate for Payer: PHP Commercial |
$1,406.99
|
| Rate for Payer: PHP Medicaid |
$685.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,279.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,333.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,885.02
|
| Rate for Payer: Priority Health Medicare |
$1,279.08
|
| Rate for Payer: Priority Health Narrow Network |
$2,308.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,279.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,512.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,279.08
|
| Rate for Payer: UHC Exchange |
$1,982.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,279.08
|
| Rate for Payer: UHCCP DNSP |
$1,279.08
|
| Rate for Payer: UHCCP Medicaid |
$685.59
|
| Rate for Payer: VA VA |
$1,279.08
|
|
|
HC NM MYOCARD PERF SPECT EF WM MU
|
Facility
|
IP
|
$5,128.21
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
34100029
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,333.34 |
| Max. Negotiated Rate |
$5,128.21 |
| Rate for Payer: Aetna Commercial |
$4,615.39
|
| Rate for Payer: ASR ASR |
$4,974.36
|
| Rate for Payer: ASR Commercial |
$4,974.36
|
| Rate for Payer: BCBS Trust/PPO |
$4,178.98
|
| Rate for Payer: BCN Commercial |
$3,975.90
|
| Rate for Payer: Cash Price |
$4,102.57
|
| Rate for Payer: Cofinity Commercial |
$4,820.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,102.57
|
| Rate for Payer: Healthscope Commercial |
$5,128.21
|
| Rate for Payer: Healthscope Whirlpool |
$4,974.36
|
| Rate for Payer: Mclaren Commercial |
$4,615.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,358.98
|
| Rate for Payer: Nomi Health Commercial |
$4,205.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,333.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,512.82
|
|
|
HC NM MYOCARD PERF SPECT EF WM SI
|
Facility
|
IP
|
$1,831.50
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
34100067
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,190.48 |
| Max. Negotiated Rate |
$1,831.50 |
| Rate for Payer: Aetna Commercial |
$1,648.35
|
| Rate for Payer: ASR ASR |
$1,776.56
|
| Rate for Payer: ASR Commercial |
$1,776.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,492.49
|
| Rate for Payer: BCN Commercial |
$1,419.96
|
| Rate for Payer: Cash Price |
$1,465.20
|
| Rate for Payer: Cofinity Commercial |
$1,721.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.20
|
| Rate for Payer: Healthscope Commercial |
$1,831.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,776.56
|
| Rate for Payer: Mclaren Commercial |
$1,648.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,556.78
|
| Rate for Payer: Nomi Health Commercial |
$1,501.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,611.72
|
|
|
HC NM MYOCARD PERF SPECT EF WM SI
|
Facility
|
OP
|
$1,831.50
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
34100067
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$685.59 |
| Max. Negotiated Rate |
$1,982.57 |
| Rate for Payer: Aetna Commercial |
$1,648.35
|
| Rate for Payer: Aetna Medicare |
$1,279.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,598.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,598.85
|
| Rate for Payer: ASR ASR |
$1,776.56
|
| Rate for Payer: ASR Commercial |
$1,776.56
|
| Rate for Payer: BCBS Complete |
$719.87
|
| Rate for Payer: BCBS MAPPO |
$1,279.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,499.82
|
| Rate for Payer: BCN Commercial |
$1,419.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,279.08
|
| Rate for Payer: Cash Price |
$1,465.20
|
| Rate for Payer: Cash Price |
$1,465.20
|
| Rate for Payer: Cofinity Commercial |
$1,721.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,465.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,279.08
|
| Rate for Payer: Healthscope Commercial |
$1,831.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,776.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,279.08
|
| Rate for Payer: Mclaren Commercial |
$1,648.35
|
| Rate for Payer: Mclaren Medicaid |
$685.59
|
| Rate for Payer: Mclaren Medicare |
$1,279.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,343.03
|
| Rate for Payer: Meridian Medicaid |
$719.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,470.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,556.78
|
| Rate for Payer: Nomi Health Commercial |
$1,501.83
|
| Rate for Payer: PACE Medicare |
$1,215.13
|
| Rate for Payer: PACE SWMI |
$1,279.08
|
| Rate for Payer: PHP Commercial |
$1,406.99
|
| Rate for Payer: PHP Medicaid |
$685.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,279.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,668.98
|
| Rate for Payer: Priority Health Medicare |
$1,279.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,335.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,279.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,611.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,279.08
|
| Rate for Payer: UHC Exchange |
$1,982.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,279.08
|
| Rate for Payer: UHCCP DNSP |
$1,279.08
|
| Rate for Payer: UHCCP Medicaid |
$685.59
|
| Rate for Payer: VA VA |
$1,279.08
|
|
|
HC NMO/AQP4 FACS TITER SERUM
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: ASR ASR |
$98.94
|
| Rate for Payer: ASR Commercial |
$98.94
|
| Rate for Payer: BCBS Trust/PPO |
$83.12
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$95.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$98.94
|
| Rate for Payer: Mclaren Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.76
|
|
|
HC NMO/AQP4 FACS TITER SERUM
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200395
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$193.25 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| 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 |
$98.94
|
| Rate for Payer: ASR Commercial |
$98.94
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$83.53
|
| Rate for Payer: BCN Commercial |
$79.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$95.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$102.00
|
| Rate for Payer: Healthscope Whirlpool |
$98.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$91.80
|
| 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 |
$86.70
|
| Rate for Payer: Nomi Health Commercial |
$83.64
|
| 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 |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.25
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$154.60
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.76
|
| 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 NMO/AQP4-IGG CBA, S
|
Facility
|
IP
|
$351.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$228.74 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Aetna Commercial |
$316.71
|
| Rate for Payer: ASR ASR |
$341.34
|
| Rate for Payer: ASR Commercial |
$341.34
|
| Rate for Payer: BCBS Trust/PPO |
$286.76
|
| Rate for Payer: BCN Commercial |
$272.83
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cofinity Commercial |
$330.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.52
|
| Rate for Payer: Healthscope Commercial |
$351.90
|
| Rate for Payer: Healthscope Whirlpool |
$341.34
|
| Rate for Payer: Mclaren Commercial |
$316.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.12
|
| Rate for Payer: Nomi Health Commercial |
$288.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.67
|
|
|
HC NMO/AQP4-IGG CBA, S
|
Facility
|
OP
|
$351.90
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$351.90 |
| Rate for Payer: Aetna Commercial |
$316.71
|
| 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 |
$341.34
|
| Rate for Payer: ASR Commercial |
$341.34
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$288.17
|
| Rate for Payer: BCN Commercial |
$272.83
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cash Price |
$281.52
|
| Rate for Payer: Cofinity Commercial |
$330.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$351.90
|
| Rate for Payer: Healthscope Whirlpool |
$341.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$316.71
|
| 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 |
$299.12
|
| Rate for Payer: Nomi Health Commercial |
$288.56
|
| 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 |
$228.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.29
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$181.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$309.67
|
| 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 NMO/AQUAPO 4 IGG CBA
|
Facility
|
OP
|
$350.88
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200394
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$350.88 |
| Rate for Payer: Aetna Commercial |
$315.79
|
| 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 |
$340.35
|
| Rate for Payer: ASR Commercial |
$340.35
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$287.34
|
| Rate for Payer: BCN Commercial |
$272.04
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: Cash Price |
$280.70
|
| Rate for Payer: Cofinity Commercial |
$329.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$350.88
|
| Rate for Payer: Healthscope Whirlpool |
$340.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$315.79
|
| 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 |
$298.25
|
| Rate for Payer: Nomi Health Commercial |
$287.72
|
| 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 |
$228.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.29
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$181.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.77
|
| 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
|
|
