|
HC NICU OR OB NURSERY R&B
|
Facility
|
IP
|
$2,362.67
|
|
| Hospital Charge Code |
17000001
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$1,488.48 |
| Max. Negotiated Rate |
$2,126.40 |
| Rate for Payer: Aetna Commercial |
$2,008.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,535.74
|
| Rate for Payer: Cash Price |
$1,890.14
|
| Rate for Payer: Cofinity Commercial |
$1,653.87
|
| Rate for Payer: Cofinity Commercial |
$2,031.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,653.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,890.14
|
| Rate for Payer: Healthscope Commercial |
$2,126.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,008.27
|
| Rate for Payer: PHP Commercial |
$2,008.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,535.74
|
| Rate for Payer: Priority Health SBD |
$1,488.48
|
|
|
HC NIFOMETER
|
Facility
|
OP
|
$84.13
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$75.72 |
| Rate for Payer: Aetna Commercial |
$71.51
|
| Rate for Payer: Aetna Medicare |
$42.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.68
|
| Rate for Payer: BCBS Complete |
$33.65
|
| Rate for Payer: Cash Price |
$67.30
|
| Rate for Payer: Cofinity Commercial |
$58.89
|
| Rate for Payer: Cofinity Commercial |
$72.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.30
|
| Rate for Payer: Healthscope Commercial |
$75.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.51
|
| Rate for Payer: PHP Commercial |
$71.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.68
|
| Rate for Payer: Priority Health SBD |
$53.00
|
|
|
HC NIFOMETER
|
Facility
|
IP
|
$84.13
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$75.72 |
| Rate for Payer: Aetna Commercial |
$71.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.68
|
| Rate for Payer: Cash Price |
$67.30
|
| Rate for Payer: Cofinity Commercial |
$58.89
|
| Rate for Payer: Cofinity Commercial |
$72.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.30
|
| Rate for Payer: Healthscope Commercial |
$75.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.51
|
| Rate for Payer: PHP Commercial |
$71.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.68
|
| Rate for Payer: Priority Health SBD |
$53.00
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
IP
|
$50.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.58 |
| Max. Negotiated Rate |
$45.11 |
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.58
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cofinity Commercial |
$35.08
|
| Rate for Payer: Cofinity Commercial |
$43.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.10
|
| Rate for Payer: Healthscope Commercial |
$45.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.60
|
| Rate for Payer: PHP Commercial |
$42.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| Rate for Payer: Priority Health SBD |
$31.58
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
OP
|
$50.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: Aetna Medicare |
$39.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cofinity Commercial |
$43.10
|
| Rate for Payer: Cofinity Commercial |
$35.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$45.11
|
| Rate for Payer: Mclaren Medicaid |
$20.52
|
| Rate for Payer: Mclaren Medicare |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.60
|
| Rate for Payer: PACE Medicare |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$42.60
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| Rate for Payer: Priority Health Medicare |
$38.28
|
| Rate for Payer: Priority Health SBD |
$31.58
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.75
|
| Rate for Payer: UHC Core |
$37.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.28
|
| Rate for Payer: UHC Exchange |
$37.09
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$21.55
|
| Rate for Payer: VA VA |
$38.28
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,084.48 |
| Max. Negotiated Rate |
$4,406.40 |
| Rate for Payer: Aetna Commercial |
$4,161.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,182.40
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cofinity Commercial |
$3,427.20
|
| Rate for Payer: Cofinity Commercial |
$4,210.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,427.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.80
|
| Rate for Payer: Healthscope Commercial |
$4,406.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.60
|
| Rate for Payer: PHP Commercial |
$4,161.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: Priority Health SBD |
$3,084.48
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Commercial |
$4,161.60
|
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,182.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cofinity Commercial |
$4,210.56
|
| Rate for Payer: Cofinity Commercial |
$3,427.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,427.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$4,406.40
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.60
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$4,161.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health SBD |
$3,084.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$1,004.40
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
OP
|
$901.67
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$766.42
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$721.34
|
| Rate for Payer: Cash Price |
$721.34
|
| Rate for Payer: Cofinity Commercial |
$775.44
|
| Rate for Payer: Cofinity Commercial |
$631.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$631.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$811.50
|
| 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 |
$766.42
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$766.42
|
| 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 |
$586.09
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$568.05
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$667.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$667.24
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
IP
|
$901.67
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$568.05 |
| Max. Negotiated Rate |
$811.50 |
| Rate for Payer: Aetna Commercial |
$766.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.09
|
| Rate for Payer: Cash Price |
$721.34
|
| Rate for Payer: Cofinity Commercial |
$631.17
|
| Rate for Payer: Cofinity Commercial |
$775.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$631.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.34
|
| Rate for Payer: Healthscope Commercial |
$811.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$766.42
|
| Rate for Payer: PHP Commercial |
$766.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.09
|
| Rate for Payer: Priority Health SBD |
$568.05
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
OP
|
$1,149.41
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$977.00
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$919.53
|
| Rate for Payer: Cash Price |
$919.53
|
| Rate for Payer: Cofinity Commercial |
$988.49
|
| Rate for Payer: Cofinity Commercial |
$804.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$804.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,034.47
|
| 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 |
$977.00
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$977.00
|
| 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 |
$747.12
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$724.13
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$850.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$850.56
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
IP
|
$1,149.41
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$724.13 |
| Max. Negotiated Rate |
$1,034.47 |
| Rate for Payer: Aetna Commercial |
$977.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.12
|
| Rate for Payer: Cash Price |
$919.53
|
| Rate for Payer: Cofinity Commercial |
$804.59
|
| Rate for Payer: Cofinity Commercial |
$988.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$804.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$919.53
|
| Rate for Payer: Healthscope Commercial |
$1,034.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.00
|
| Rate for Payer: PHP Commercial |
$977.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$747.12
|
| Rate for Payer: Priority Health SBD |
$724.13
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
OP
|
$1,066.32
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$906.37
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$853.06
|
| Rate for Payer: Cash Price |
$853.06
|
| Rate for Payer: Cofinity Commercial |
$917.04
|
| Rate for Payer: Cofinity Commercial |
$746.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$746.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$959.69
|
| 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 |
$906.37
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$906.37
|
| 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 |
$693.11
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$671.78
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$789.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$789.08
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
IP
|
$1,066.32
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$671.78 |
| Max. Negotiated Rate |
$959.69 |
| Rate for Payer: Aetna Commercial |
$906.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.11
|
| Rate for Payer: Cash Price |
$853.06
|
| Rate for Payer: Cofinity Commercial |
$746.42
|
| Rate for Payer: Cofinity Commercial |
$917.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$746.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$853.06
|
| Rate for Payer: Healthscope Commercial |
$959.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$906.37
|
| Rate for Payer: PHP Commercial |
$906.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.11
|
| Rate for Payer: Priority Health SBD |
$671.78
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
OP
|
$1,296.09
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,166.48 |
| Rate for Payer: Aetna Commercial |
$1,101.68
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$842.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cofinity Commercial |
$907.26
|
| Rate for Payer: Cofinity Commercial |
$1,114.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$907.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,166.48
|
| 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 |
$1,101.68
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,101.68
|
| 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 |
$842.46
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$816.54
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$959.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$959.11
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
IP
|
$1,296.09
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$816.54 |
| Max. Negotiated Rate |
$1,166.48 |
| Rate for Payer: Aetna Commercial |
$1,101.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$842.46
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cofinity Commercial |
$1,114.64
|
| Rate for Payer: Cofinity Commercial |
$907.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$907.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.87
|
| Rate for Payer: Healthscope Commercial |
$1,166.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,101.68
|
| Rate for Payer: PHP Commercial |
$1,101.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.46
|
| Rate for Payer: Priority Health SBD |
$816.54
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
OP
|
$1,204.47
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$1,023.80
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$782.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$963.58
|
| Rate for Payer: Cash Price |
$963.58
|
| Rate for Payer: Cofinity Commercial |
$843.13
|
| Rate for Payer: Cofinity Commercial |
$1,035.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$843.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,084.02
|
| 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 |
$1,023.80
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,023.80
|
| 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 |
$782.91
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$758.82
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$891.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$891.31
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
IP
|
$1,204.47
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$758.82 |
| Max. Negotiated Rate |
$1,084.02 |
| Rate for Payer: Aetna Commercial |
$1,023.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$782.91
|
| Rate for Payer: Cash Price |
$963.58
|
| Rate for Payer: Cofinity Commercial |
$1,035.84
|
| Rate for Payer: Cofinity Commercial |
$843.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$843.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$963.58
|
| Rate for Payer: Healthscope Commercial |
$1,084.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,023.80
|
| Rate for Payer: PHP Commercial |
$1,023.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.91
|
| Rate for Payer: Priority Health SBD |
$758.82
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
OP
|
$1,765.95
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,589.36 |
| Rate for Payer: Aetna Commercial |
$1,501.06
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,147.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$1,412.76
|
| Rate for Payer: Cash Price |
$1,412.76
|
| Rate for Payer: Cofinity Commercial |
$1,518.72
|
| Rate for Payer: Cofinity Commercial |
$1,236.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,236.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,412.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,589.36
|
| 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 |
$1,501.06
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,501.06
|
| 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 |
$1,147.87
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$1,112.55
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$1,306.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$1,306.80
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM BONE TOTAL BODY
|
Facility
|
IP
|
$1,765.95
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
34100025
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,112.55 |
| Max. Negotiated Rate |
$1,589.36 |
| Rate for Payer: Aetna Commercial |
$1,501.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,147.87
|
| Rate for Payer: Cash Price |
$1,412.76
|
| Rate for Payer: Cofinity Commercial |
$1,236.16
|
| Rate for Payer: Cofinity Commercial |
$1,518.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,236.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,412.76
|
| Rate for Payer: Healthscope Commercial |
$1,589.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,501.06
|
| Rate for Payer: PHP Commercial |
$1,501.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,147.87
|
| Rate for Payer: Priority Health SBD |
$1,112.55
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
OP
|
$1,735.24
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,561.72 |
| Rate for Payer: Aetna Commercial |
$1,474.95
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,127.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$1,388.19
|
| Rate for Payer: Cash Price |
$1,388.19
|
| Rate for Payer: Cofinity Commercial |
$1,492.31
|
| Rate for Payer: Cofinity Commercial |
$1,214.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,214.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,388.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,561.72
|
| 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 |
$1,474.95
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,474.95
|
| 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 |
$1,127.91
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$1,093.20
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$1,284.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$1,284.08
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM BONE W BLOOD FLOW 3 PHASE
|
Facility
|
IP
|
$1,735.24
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
34100026
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,093.20 |
| Max. Negotiated Rate |
$1,561.72 |
| Rate for Payer: Aetna Commercial |
$1,474.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,127.91
|
| Rate for Payer: Cash Price |
$1,388.19
|
| Rate for Payer: Cofinity Commercial |
$1,214.67
|
| Rate for Payer: Cofinity Commercial |
$1,492.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,214.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,388.19
|
| Rate for Payer: Healthscope Commercial |
$1,561.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,474.95
|
| Rate for Payer: PHP Commercial |
$1,474.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.91
|
| Rate for Payer: Priority Health SBD |
$1,093.20
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
OP
|
$1,296.09
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,166.48 |
| Rate for Payer: Aetna Commercial |
$1,101.68
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$842.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cofinity Commercial |
$907.26
|
| Rate for Payer: Cofinity Commercial |
$1,114.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$907.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,166.48
|
| 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 |
$1,101.68
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,101.68
|
| 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 |
$842.46
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$816.54
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$959.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$959.11
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM BRAIN <4 STATC VIEW W VAS F
|
Facility
|
IP
|
$1,296.09
|
|
|
Service Code
|
CPT 78601
|
| Hospital Charge Code |
34100038
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$816.54 |
| Max. Negotiated Rate |
$1,166.48 |
| Rate for Payer: Aetna Commercial |
$1,101.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$842.46
|
| Rate for Payer: Cash Price |
$1,036.87
|
| Rate for Payer: Cofinity Commercial |
$1,114.64
|
| Rate for Payer: Cofinity Commercial |
$907.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$907.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,036.87
|
| Rate for Payer: Healthscope Commercial |
$1,166.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,101.68
|
| Rate for Payer: PHP Commercial |
$1,101.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.46
|
| Rate for Payer: Priority Health SBD |
$816.54
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
OP
|
$1,183.46
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$1,005.94
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$769.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.88
|
| Rate for Payer: BCBS Complete |
$220.56
|
| Rate for Payer: BCBS MAPPO |
$391.90
|
| Rate for Payer: BCN Medicare Advantage |
$391.90
|
| Rate for Payer: Cash Price |
$946.77
|
| Rate for Payer: Cash Price |
$946.77
|
| Rate for Payer: Cofinity Commercial |
$828.42
|
| Rate for Payer: Cofinity Commercial |
$1,017.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$828.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,065.11
|
| 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 |
$1,005.94
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,005.94
|
| 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 |
$769.25
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$745.58
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$875.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$875.76
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM BREAST IMAGING BILAT
|
Facility
|
IP
|
$1,183.46
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
34100053
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$745.58 |
| Max. Negotiated Rate |
$1,065.11 |
| Rate for Payer: Aetna Commercial |
$1,005.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$769.25
|
| Rate for Payer: Cash Price |
$946.77
|
| Rate for Payer: Cofinity Commercial |
$1,017.78
|
| Rate for Payer: Cofinity Commercial |
$828.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$828.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.77
|
| Rate for Payer: Healthscope Commercial |
$1,065.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,005.94
|
| Rate for Payer: PHP Commercial |
$1,005.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.25
|
| Rate for Payer: Priority Health SBD |
$745.58
|
|
