|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
IP
|
$1,106.96
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$719.52 |
| Max. Negotiated Rate |
$1,106.96 |
| Rate for Payer: Aetna Commercial |
$996.26
|
| Rate for Payer: ASR ASR |
$1,073.75
|
| Rate for Payer: ASR Commercial |
$1,073.75
|
| Rate for Payer: BCBS Trust/PPO |
$902.06
|
| Rate for Payer: BCN Commercial |
$858.23
|
| Rate for Payer: Cash Price |
$885.57
|
| Rate for Payer: Cofinity Commercial |
$1,040.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.57
|
| Rate for Payer: Healthscope Commercial |
$1,106.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.75
|
| Rate for Payer: Mclaren Commercial |
$996.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.92
|
| Rate for Payer: Nomi Health Commercial |
$907.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$974.12
|
|
|
HC NM TC 99M TILMANOCEPT DX PER 0.5 MCI
|
Facility
|
OP
|
$1,106.96
|
|
|
Service Code
|
HCPCS A9520
|
| Hospital Charge Code |
34300033
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$442.78 |
| Max. Negotiated Rate |
$1,106.96 |
| Rate for Payer: Aetna Commercial |
$996.26
|
| Rate for Payer: Aetna Medicare |
$553.48
|
| Rate for Payer: ASR ASR |
$1,073.75
|
| Rate for Payer: ASR Commercial |
$1,073.75
|
| Rate for Payer: BCBS Complete |
$442.78
|
| Rate for Payer: BCBS Trust/PPO |
$906.49
|
| Rate for Payer: BCN Commercial |
$858.23
|
| Rate for Payer: Cash Price |
$885.57
|
| Rate for Payer: Cash Price |
$885.57
|
| Rate for Payer: Cofinity Commercial |
$1,040.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$885.57
|
| Rate for Payer: Healthscope Commercial |
$1,106.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.75
|
| Rate for Payer: Mclaren Commercial |
$996.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$940.92
|
| Rate for Payer: Nomi Health Commercial |
$907.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$674.81
|
| Rate for Payer: Priority Health Narrow Network |
$539.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$974.12
|
|
|
HC NM THYROID CA METS IMGI131 TOTAL
|
Facility
|
OP
|
$1,263.44
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.68 |
| Max. Negotiated Rate |
$1,263.44 |
| Rate for Payer: Aetna Commercial |
$1,137.10
|
| 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 |
$1,225.54
|
| Rate for Payer: ASR Commercial |
$1,225.54
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.63
|
| Rate for Payer: BCN Commercial |
$979.55
|
| Rate for Payer: BCN Medicare Advantage |
$527.39
|
| Rate for Payer: Cash Price |
$1,010.75
|
| Rate for Payer: Cash Price |
$1,010.75
|
| Rate for Payer: Cofinity Commercial |
$1,187.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.39
|
| Rate for Payer: Healthscope Commercial |
$1,263.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,225.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$527.39
|
| Rate for Payer: Mclaren Commercial |
$1,137.10
|
| 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 |
$1,073.92
|
| Rate for Payer: Nomi Health Commercial |
$1,036.02
|
| 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 |
$821.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,107.03
|
| Rate for Payer: Priority Health Medicare |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$885.67
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,111.83
|
| 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 THYROID CA METS IMGI131 TOTAL
|
Facility
|
IP
|
$1,263.44
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
34100006
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$821.24 |
| Max. Negotiated Rate |
$1,263.44 |
| Rate for Payer: Aetna Commercial |
$1,137.10
|
| Rate for Payer: ASR ASR |
$1,225.54
|
| Rate for Payer: ASR Commercial |
$1,225.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,029.58
|
| Rate for Payer: BCN Commercial |
$979.55
|
| Rate for Payer: Cash Price |
$1,010.75
|
| Rate for Payer: Cofinity Commercial |
$1,187.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,010.75
|
| Rate for Payer: Healthscope Commercial |
$1,263.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,225.54
|
| Rate for Payer: Mclaren Commercial |
$1,137.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,073.92
|
| Rate for Payer: Nomi Health Commercial |
$1,036.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,111.83
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
IP
|
$1,985.39
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,290.50 |
| Max. Negotiated Rate |
$1,985.39 |
| Rate for Payer: Aetna Commercial |
$1,786.85
|
| Rate for Payer: ASR ASR |
$1,925.83
|
| Rate for Payer: ASR Commercial |
$1,925.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,617.89
|
| Rate for Payer: BCN Commercial |
$1,539.27
|
| Rate for Payer: Cash Price |
$1,588.31
|
| Rate for Payer: Cofinity Commercial |
$1,866.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,588.31
|
| Rate for Payer: Healthscope Commercial |
$1,985.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,925.83
|
| Rate for Payer: Mclaren Commercial |
$1,786.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,687.58
|
| Rate for Payer: Nomi Health Commercial |
$1,628.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,747.14
|
|
|
HC NM TUMOR LOCALIZATION SPECT 2 AREAS
|
Facility
|
OP
|
$1,985.39
|
|
|
Service Code
|
CPT 78831
|
| Hospital Charge Code |
34100081
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$685.59 |
| Max. Negotiated Rate |
$1,985.39 |
| Rate for Payer: Aetna Commercial |
$1,786.85
|
| 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 |
$1,925.83
|
| Rate for Payer: ASR Commercial |
$1,925.83
|
| Rate for Payer: BCBS Complete |
$719.87
|
| Rate for Payer: BCBS MAPPO |
$1,279.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,625.84
|
| Rate for Payer: BCN Commercial |
$1,539.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,279.08
|
| Rate for Payer: Cash Price |
$1,588.31
|
| Rate for Payer: Cash Price |
$1,588.31
|
| Rate for Payer: Cofinity Commercial |
$1,866.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,588.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,279.08
|
| Rate for Payer: Healthscope Commercial |
$1,985.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,925.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,279.08
|
| Rate for Payer: Mclaren Commercial |
$1,786.85
|
| 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 |
$1,687.58
|
| Rate for Payer: Nomi Health Commercial |
$1,628.02
|
| 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 |
$1,290.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,456.37
|
| Rate for Payer: Priority Health Medicare |
$1,279.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,165.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,279.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,747.14
|
| 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 TUMOR SCAN SPECT
|
Facility
|
IP
|
$1,975.72
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,284.22 |
| Max. Negotiated Rate |
$1,975.72 |
| Rate for Payer: Aetna Commercial |
$1,778.15
|
| Rate for Payer: ASR ASR |
$1,916.45
|
| Rate for Payer: ASR Commercial |
$1,916.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,610.01
|
| Rate for Payer: BCN Commercial |
$1,531.78
|
| Rate for Payer: Cash Price |
$1,580.58
|
| Rate for Payer: Cofinity Commercial |
$1,857.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.58
|
| Rate for Payer: Healthscope Commercial |
$1,975.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,916.45
|
| Rate for Payer: Mclaren Commercial |
$1,778.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,679.36
|
| Rate for Payer: Nomi Health Commercial |
$1,620.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,738.63
|
|
|
HC NM TUMOR SCAN SPECT
|
Facility
|
OP
|
$1,975.72
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
34100056
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$685.59 |
| Max. Negotiated Rate |
$2,404.64 |
| Rate for Payer: Aetna Commercial |
$1,778.15
|
| 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 |
$1,916.45
|
| Rate for Payer: ASR Commercial |
$1,916.45
|
| Rate for Payer: BCBS Complete |
$719.87
|
| Rate for Payer: BCBS MAPPO |
$1,279.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,617.92
|
| Rate for Payer: BCN Commercial |
$1,531.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,279.08
|
| Rate for Payer: Cash Price |
$1,580.58
|
| Rate for Payer: Cash Price |
$1,580.58
|
| Rate for Payer: Cofinity Commercial |
$1,857.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,580.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,279.08
|
| Rate for Payer: Healthscope Commercial |
$1,975.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,916.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,279.08
|
| Rate for Payer: Mclaren Commercial |
$1,778.15
|
| 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 |
$1,679.36
|
| Rate for Payer: Nomi Health Commercial |
$1,620.09
|
| 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 |
$1,284.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,404.64
|
| Rate for Payer: Priority Health Medicare |
$1,279.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,923.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,279.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,738.63
|
| 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 UNLISTED PROC ENDOCRINE S
|
Facility
|
IP
|
$1,757.18
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,142.17 |
| Max. Negotiated Rate |
$1,757.18 |
| Rate for Payer: Aetna Commercial |
$1,581.46
|
| Rate for Payer: ASR ASR |
$1,704.46
|
| Rate for Payer: ASR Commercial |
$1,704.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,431.93
|
| Rate for Payer: BCN Commercial |
$1,362.34
|
| Rate for Payer: Cash Price |
$1,405.74
|
| Rate for Payer: Cofinity Commercial |
$1,651.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.74
|
| Rate for Payer: Healthscope Commercial |
$1,757.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,704.46
|
| Rate for Payer: Mclaren Commercial |
$1,581.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.60
|
| Rate for Payer: Nomi Health Commercial |
$1,440.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,546.32
|
|
|
HC NM UNLISTED PROC ENDOCRINE S
|
Facility
|
OP
|
$1,757.18
|
|
|
Service Code
|
CPT 60699
|
| Hospital Charge Code |
36100267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,142.17 |
| Max. Negotiated Rate |
$8,860.40 |
| Rate for Payer: Aetna Commercial |
$1,581.46
|
| Rate for Payer: Aetna Medicare |
$5,716.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: ASR ASR |
$1,704.46
|
| Rate for Payer: ASR Commercial |
$1,704.46
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,438.95
|
| Rate for Payer: BCN Commercial |
$1,362.34
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Cash Price |
$1,405.74
|
| Rate for Payer: Cash Price |
$1,405.74
|
| Rate for Payer: Cofinity Commercial |
$1,651.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,405.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Healthscope Commercial |
$1,757.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,704.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,716.39
|
| Rate for Payer: Mclaren Commercial |
$1,581.46
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,493.60
|
| Rate for Payer: Nomi Health Commercial |
$1,440.89
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Commercial |
$6,288.03
|
| Rate for Payer: PHP Medicaid |
$3,063.99
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,539.64
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,231.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,546.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$8,860.40
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP DNSP |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
HC NM VENT AEROSOL/GAS AND PERFUS
|
Facility
|
OP
|
$1,666.35
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.68 |
| Max. Negotiated Rate |
$1,666.35 |
| Rate for Payer: Aetna Commercial |
$1,499.72
|
| 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 |
$1,616.36
|
| Rate for Payer: ASR Commercial |
$1,616.36
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,364.57
|
| Rate for Payer: BCN Commercial |
$1,291.92
|
| Rate for Payer: BCN Medicare Advantage |
$527.39
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cofinity Commercial |
$1,566.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.39
|
| Rate for Payer: Healthscope Commercial |
$1,666.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,616.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$527.39
|
| Rate for Payer: Mclaren Commercial |
$1,499.72
|
| 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 |
$1,416.40
|
| Rate for Payer: Nomi Health Commercial |
$1,366.41
|
| 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 |
$1,083.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$712.61
|
| Rate for Payer: Priority Health Medicare |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$570.09
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,466.39
|
| 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 VENT AEROSOL/GAS AND PERFUS
|
Facility
|
IP
|
$1,666.35
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
34100068
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,083.13 |
| Max. Negotiated Rate |
$1,666.35 |
| Rate for Payer: Aetna Commercial |
$1,499.72
|
| Rate for Payer: ASR ASR |
$1,616.36
|
| Rate for Payer: ASR Commercial |
$1,616.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,357.91
|
| Rate for Payer: BCN Commercial |
$1,291.92
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cofinity Commercial |
$1,566.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.08
|
| Rate for Payer: Healthscope Commercial |
$1,666.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,616.36
|
| Rate for Payer: Mclaren Commercial |
$1,499.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,416.40
|
| Rate for Payer: Nomi Health Commercial |
$1,366.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,466.39
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
IP
|
$1,219.18
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$792.47 |
| Max. Negotiated Rate |
$1,219.18 |
| Rate for Payer: Aetna Commercial |
$1,097.26
|
| Rate for Payer: ASR ASR |
$1,182.60
|
| Rate for Payer: ASR Commercial |
$1,182.60
|
| Rate for Payer: BCBS Trust/PPO |
$993.51
|
| Rate for Payer: BCN Commercial |
$945.23
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cofinity Commercial |
$1,146.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$975.34
|
| Rate for Payer: Healthscope Commercial |
$1,219.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,182.60
|
| Rate for Payer: Mclaren Commercial |
$1,097.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,036.30
|
| Rate for Payer: Nomi Health Commercial |
$999.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,072.88
|
|
|
HC NM VENTILATION AEROSOL OR GAS
|
Facility
|
OP
|
$1,219.18
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
34100071
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,219.18 |
| Rate for Payer: Aetna Commercial |
$1,097.26
|
| 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 |
$1,182.60
|
| Rate for Payer: ASR Commercial |
$1,182.60
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$998.39
|
| Rate for Payer: BCN Commercial |
$945.23
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cash Price |
$975.34
|
| Rate for Payer: Cofinity Commercial |
$1,146.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$975.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,219.18
|
| Rate for Payer: Healthscope Whirlpool |
$1,182.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$1,097.26
|
| 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 |
$1,036.30
|
| Rate for Payer: Nomi Health Commercial |
$999.73
|
| 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 |
$792.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$936.60
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$749.28
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,072.88
|
| 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 VENTILATION PERFUS QUANT DIFF
|
Facility
|
IP
|
$1,666.35
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,083.13 |
| Max. Negotiated Rate |
$1,666.35 |
| Rate for Payer: Aetna Commercial |
$1,499.72
|
| Rate for Payer: ASR ASR |
$1,616.36
|
| Rate for Payer: ASR Commercial |
$1,616.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,357.91
|
| Rate for Payer: BCN Commercial |
$1,291.92
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cofinity Commercial |
$1,566.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.08
|
| Rate for Payer: Healthscope Commercial |
$1,666.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,616.36
|
| Rate for Payer: Mclaren Commercial |
$1,499.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,416.40
|
| Rate for Payer: Nomi Health Commercial |
$1,366.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,083.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,466.39
|
|
|
HC NM VENTILATION PERFUS QUANT DIFF
|
Facility
|
OP
|
$1,666.35
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
34100070
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.68 |
| Max. Negotiated Rate |
$1,666.35 |
| Rate for Payer: Aetna Commercial |
$1,499.72
|
| 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 |
$1,616.36
|
| Rate for Payer: ASR Commercial |
$1,616.36
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,364.57
|
| Rate for Payer: BCN Commercial |
$1,291.92
|
| Rate for Payer: BCN Medicare Advantage |
$527.39
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cash Price |
$1,333.08
|
| Rate for Payer: Cofinity Commercial |
$1,566.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,333.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.39
|
| Rate for Payer: Healthscope Commercial |
$1,666.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,616.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$527.39
|
| Rate for Payer: Mclaren Commercial |
$1,499.72
|
| 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 |
$1,416.40
|
| Rate for Payer: Nomi Health Commercial |
$1,366.41
|
| 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 |
$1,083.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,460.06
|
| Rate for Payer: Priority Health Medicare |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,168.11
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,466.39
|
| 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 VOID CYSTO
|
Facility
|
OP
|
$1,069.28
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.02 |
| Max. Negotiated Rate |
$1,069.28 |
| Rate for Payer: Aetna Commercial |
$962.35
|
| 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 |
$1,037.20
|
| Rate for Payer: ASR Commercial |
$1,037.20
|
| Rate for Payer: BCBS Complete |
$221.57
|
| Rate for Payer: BCBS MAPPO |
$393.70
|
| Rate for Payer: BCBS Trust/PPO |
$875.63
|
| Rate for Payer: BCN Commercial |
$829.01
|
| Rate for Payer: BCN Medicare Advantage |
$393.70
|
| Rate for Payer: Cash Price |
$855.42
|
| Rate for Payer: Cash Price |
$855.42
|
| Rate for Payer: Cofinity Commercial |
$1,005.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.70
|
| Rate for Payer: Healthscope Commercial |
$1,069.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,037.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$393.70
|
| Rate for Payer: Mclaren Commercial |
$962.35
|
| 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 |
$908.89
|
| Rate for Payer: Nomi Health Commercial |
$876.81
|
| 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 |
$695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$936.90
|
| Rate for Payer: Priority Health Medicare |
$393.70
|
| Rate for Payer: Priority Health Narrow Network |
$749.57
|
| Rate for Payer: Railroad Medicare Medicare |
$393.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$940.97
|
| 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 VOID CYSTO
|
Facility
|
IP
|
$1,069.28
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
34100049
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$695.03 |
| Max. Negotiated Rate |
$1,069.28 |
| Rate for Payer: Aetna Commercial |
$962.35
|
| Rate for Payer: ASR ASR |
$1,037.20
|
| Rate for Payer: ASR Commercial |
$1,037.20
|
| Rate for Payer: BCBS Trust/PPO |
$871.36
|
| Rate for Payer: BCN Commercial |
$829.01
|
| Rate for Payer: Cash Price |
$855.42
|
| Rate for Payer: Cofinity Commercial |
$1,005.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$855.42
|
| Rate for Payer: Healthscope Commercial |
$1,069.28
|
| Rate for Payer: Healthscope Whirlpool |
$1,037.20
|
| Rate for Payer: Mclaren Commercial |
$962.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$908.89
|
| Rate for Payer: Nomi Health Commercial |
$876.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$940.97
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
IP
|
$1,939.87
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,260.92 |
| Max. Negotiated Rate |
$1,939.87 |
| Rate for Payer: Aetna Commercial |
$1,745.88
|
| Rate for Payer: ASR ASR |
$1,881.67
|
| Rate for Payer: ASR Commercial |
$1,881.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,580.80
|
| Rate for Payer: BCN Commercial |
$1,503.98
|
| Rate for Payer: Cash Price |
$1,551.90
|
| Rate for Payer: Cofinity Commercial |
$1,823.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.90
|
| Rate for Payer: Healthscope Commercial |
$1,939.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,881.67
|
| Rate for Payer: Mclaren Commercial |
$1,745.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,648.89
|
| Rate for Payer: Nomi Health Commercial |
$1,590.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,707.09
|
|
|
HC NM ZEVALIN Y-90 THERAPY
|
Facility
|
OP
|
$1,939.87
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
34100065
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$117.71 |
| Max. Negotiated Rate |
$1,939.87 |
| Rate for Payer: Aetna Commercial |
$1,745.88
|
| Rate for Payer: Aetna Medicare |
$219.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.50
|
| Rate for Payer: ASR ASR |
$1,881.67
|
| Rate for Payer: ASR Commercial |
$1,881.67
|
| Rate for Payer: BCBS Complete |
$123.59
|
| Rate for Payer: BCBS MAPPO |
$219.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,588.56
|
| Rate for Payer: BCN Commercial |
$1,503.98
|
| Rate for Payer: BCN Medicare Advantage |
$219.60
|
| Rate for Payer: Cash Price |
$1,551.90
|
| Rate for Payer: Cash Price |
$1,551.90
|
| Rate for Payer: Cofinity Commercial |
$1,823.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,551.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.60
|
| Rate for Payer: Healthscope Commercial |
$1,939.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,881.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$219.60
|
| Rate for Payer: Mclaren Commercial |
$1,745.88
|
| Rate for Payer: Mclaren Medicaid |
$117.71
|
| Rate for Payer: Mclaren Medicare |
$219.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.58
|
| Rate for Payer: Meridian Medicaid |
$123.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,648.89
|
| Rate for Payer: Nomi Health Commercial |
$1,590.69
|
| Rate for Payer: PACE Medicare |
$208.62
|
| Rate for Payer: PACE SWMI |
$219.60
|
| Rate for Payer: PHP Commercial |
$241.56
|
| Rate for Payer: PHP Medicaid |
$117.71
|
| Rate for Payer: PHP Medicare Advantage |
$219.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,699.71
|
| Rate for Payer: Priority Health Medicare |
$219.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,359.85
|
| Rate for Payer: Railroad Medicare Medicare |
$219.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,707.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.60
|
| Rate for Payer: UHC Exchange |
$340.38
|
| Rate for Payer: UHC Medicare Advantage |
$219.60
|
| Rate for Payer: UHCCP DNSP |
$219.60
|
| Rate for Payer: UHCCP Medicaid |
$117.71
|
| Rate for Payer: VA VA |
$219.60
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: Aetna Medicare |
$0.51
|
| Rate for Payer: ASR ASR |
$0.99
|
| Rate for Payer: ASR Commercial |
$0.99
|
| Rate for Payer: BCBS Complete |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.84
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$1.02
|
| Rate for Payer: Healthscope Whirlpool |
$0.99
|
| Rate for Payer: Mclaren Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.89
|
| Rate for Payer: Priority Health Narrow Network |
$0.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.90
|
|
|
HC NO IMPLANT/INSERT DEVICE W/DEVICE-INTENS PROC
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
HCPCS C1890
|
| Hospital Charge Code |
27800125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna Commercial |
$0.92
|
| Rate for Payer: ASR ASR |
$0.99
|
| Rate for Payer: ASR Commercial |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$0.83
|
| Rate for Payer: BCN Commercial |
$0.79
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.82
|
| Rate for Payer: Healthscope Commercial |
$1.02
|
| Rate for Payer: Healthscope Whirlpool |
$0.99
|
| Rate for Payer: Mclaren Commercial |
$0.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.87
|
| Rate for Payer: Nomi Health Commercial |
$0.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.90
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
IP
|
$87.30
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna Commercial |
$78.57
|
| Rate for Payer: ASR ASR |
$84.68
|
| Rate for Payer: ASR Commercial |
$84.68
|
| Rate for Payer: BCBS Trust/PPO |
$71.14
|
| Rate for Payer: BCN Commercial |
$67.68
|
| Rate for Payer: Cash Price |
$69.84
|
| Rate for Payer: Cofinity Commercial |
$82.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.84
|
| Rate for Payer: Healthscope Commercial |
$87.30
|
| Rate for Payer: Healthscope Whirlpool |
$84.68
|
| Rate for Payer: Mclaren Commercial |
$78.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.20
|
| Rate for Payer: Nomi Health Commercial |
$71.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.82
|
|
|
HC NONCONC SLIDES W/INTERP
|
Facility
|
OP
|
$87.30
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
31100001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Aetna Commercial |
$78.57
|
| Rate for Payer: Aetna Medicare |
$38.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.08
|
| Rate for Payer: ASR ASR |
$84.68
|
| Rate for Payer: ASR Commercial |
$84.68
|
| Rate for Payer: BCBS Complete |
$21.65
|
| Rate for Payer: BCBS MAPPO |
$38.46
|
| Rate for Payer: BCBS Trust/PPO |
$71.49
|
| Rate for Payer: BCN Commercial |
$67.68
|
| Rate for Payer: BCN Medicare Advantage |
$38.46
|
| Rate for Payer: Cash Price |
$69.84
|
| Rate for Payer: Cash Price |
$69.84
|
| Rate for Payer: Cofinity Commercial |
$82.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.46
|
| Rate for Payer: Healthscope Commercial |
$87.30
|
| Rate for Payer: Healthscope Whirlpool |
$84.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.46
|
| Rate for Payer: Mclaren Commercial |
$78.57
|
| Rate for Payer: Mclaren Medicaid |
$20.61
|
| Rate for Payer: Mclaren Medicare |
$38.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.38
|
| Rate for Payer: Meridian Medicaid |
$21.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.20
|
| Rate for Payer: Nomi Health Commercial |
$71.59
|
| Rate for Payer: PACE Medicare |
$36.54
|
| Rate for Payer: PACE SWMI |
$38.46
|
| Rate for Payer: PHP Commercial |
$42.31
|
| Rate for Payer: PHP Medicaid |
$20.61
|
| Rate for Payer: PHP Medicare Advantage |
$38.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.49
|
| Rate for Payer: Priority Health Medicare |
$38.46
|
| Rate for Payer: Priority Health Narrow Network |
$61.20
|
| Rate for Payer: Railroad Medicare Medicare |
$38.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.46
|
| Rate for Payer: UHC Exchange |
$59.61
|
| Rate for Payer: UHC Medicare Advantage |
$38.46
|
| Rate for Payer: UHCCP DNSP |
$38.46
|
| Rate for Payer: UHCCP Medicaid |
$20.61
|
| Rate for Payer: VA VA |
$38.46
|
|
|
HC NONINVASIVE PROGRAM STIM
|
Facility
|
OP
|
$2,469.74
|
|
|
Service Code
|
CPT 93642
|
| Hospital Charge Code |
48100043
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$637.54 |
| Max. Negotiated Rate |
$2,469.74 |
| Rate for Payer: Aetna Commercial |
$2,222.77
|
| Rate for Payer: Aetna Medicare |
$1,189.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,486.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,486.80
|
| Rate for Payer: ASR ASR |
$2,395.65
|
| Rate for Payer: ASR Commercial |
$2,395.65
|
| Rate for Payer: BCBS Complete |
$669.42
|
| Rate for Payer: BCBS MAPPO |
$1,189.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,022.47
|
| Rate for Payer: BCN Commercial |
$1,914.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,189.44
|
| Rate for Payer: Cash Price |
$1,975.79
|
| Rate for Payer: Cash Price |
$1,975.79
|
| Rate for Payer: Cofinity Commercial |
$2,321.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,975.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,189.44
|
| Rate for Payer: Healthscope Commercial |
$2,469.74
|
| Rate for Payer: Healthscope Whirlpool |
$2,395.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,189.44
|
| Rate for Payer: Mclaren Commercial |
$2,222.77
|
| Rate for Payer: Mclaren Medicaid |
$637.54
|
| Rate for Payer: Mclaren Medicare |
$1,189.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,248.91
|
| Rate for Payer: Meridian Medicaid |
$669.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,367.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,099.28
|
| Rate for Payer: Nomi Health Commercial |
$2,025.19
|
| Rate for Payer: PACE Medicare |
$1,129.97
|
| Rate for Payer: PACE SWMI |
$1,189.44
|
| Rate for Payer: PHP Commercial |
$1,308.38
|
| Rate for Payer: PHP Medicaid |
$637.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,189.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$637.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,605.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,163.99
|
| Rate for Payer: Priority Health Medicare |
$1,189.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,731.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1,189.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,173.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,189.44
|
| Rate for Payer: UHC Exchange |
$1,843.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,189.44
|
| Rate for Payer: UHCCP DNSP |
$1,189.44
|
| Rate for Payer: UHCCP Medicaid |
$637.54
|
| Rate for Payer: VA VA |
$1,189.44
|
|
