|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
IP
|
$1,326.80
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$835.88 |
| Max. Negotiated Rate |
$1,194.12 |
| Rate for Payer: Aetna Commercial |
$1,127.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.42
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$1,141.05
|
| Rate for Payer: Cofinity Commercial |
$928.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$928.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Healthscope Commercial |
$1,194.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.78
|
| Rate for Payer: PHP Commercial |
$1,127.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.42
|
| Rate for Payer: Priority Health SBD |
$835.88
|
|
|
HC NM CARDIAC GATED WALL MUGA
|
Facility
|
OP
|
$1,326.80
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
34100030
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,194.12 |
| Rate for Payer: Aetna Commercial |
$1,127.78
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.42
|
| 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 |
$1,061.44
|
| Rate for Payer: Cash Price |
$1,061.44
|
| Rate for Payer: Cofinity Commercial |
$928.76
|
| Rate for Payer: Cofinity Commercial |
$1,141.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$928.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,061.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,194.12
|
| 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 |
$1,127.78
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,127.78
|
| 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 |
$862.42
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$835.88
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$981.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$981.83
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
OP
|
$874.85
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.38 |
| Max. Negotiated Rate |
$1,477.71 |
| Rate for Payer: Aetna Commercial |
$743.62
|
| Rate for Payer: Aetna Medicare |
$545.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.20
|
| Rate for Payer: BCBS Complete |
$295.45
|
| Rate for Payer: BCBS MAPPO |
$524.96
|
| Rate for Payer: BCN Medicare Advantage |
$524.96
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cofinity Commercial |
$752.37
|
| Rate for Payer: Cofinity Commercial |
$612.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$612.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.96
|
| Rate for Payer: Healthscope Commercial |
$787.37
|
| Rate for Payer: Mclaren Medicaid |
$281.38
|
| Rate for Payer: Mclaren Medicare |
$524.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.21
|
| Rate for Payer: Meridian Medicaid |
$295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.62
|
| Rate for Payer: PACE Medicare |
$498.71
|
| Rate for Payer: PACE SWMI |
$524.96
|
| Rate for Payer: PHP Commercial |
$743.62
|
| Rate for Payer: PHP Medicare Advantage |
$524.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.65
|
| Rate for Payer: Priority Health Medicare |
$524.96
|
| Rate for Payer: Priority Health SBD |
$551.16
|
| Rate for Payer: Railroad Medicare Medicare |
$524.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,477.71
|
| Rate for Payer: UHC Core |
$647.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.96
|
| Rate for Payer: UHC Exchange |
$647.39
|
| Rate for Payer: UHC Medicare Advantage |
$524.96
|
| Rate for Payer: UHCCP Medicaid |
$295.55
|
| Rate for Payer: VA VA |
$524.96
|
|
|
HC NM CEREBRAL SHUNT EVAL
|
Facility
|
IP
|
$874.85
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
34100041
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$551.16 |
| Max. Negotiated Rate |
$787.37 |
| Rate for Payer: Aetna Commercial |
$743.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.65
|
| Rate for Payer: Cash Price |
$699.88
|
| Rate for Payer: Cofinity Commercial |
$612.39
|
| Rate for Payer: Cofinity Commercial |
$752.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$612.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.88
|
| Rate for Payer: Healthscope Commercial |
$787.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.62
|
| Rate for Payer: PHP Commercial |
$743.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.65
|
| Rate for Payer: Priority Health SBD |
$551.16
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$281.38 |
| Max. Negotiated Rate |
$1,477.71 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna Medicare |
$545.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$656.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$656.20
|
| Rate for Payer: BCBS Complete |
$295.45
|
| Rate for Payer: BCBS MAPPO |
$524.96
|
| Rate for Payer: BCN Medicare Advantage |
$524.96
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Cofinity Commercial |
$714.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.96
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Mclaren Medicaid |
$281.38
|
| Rate for Payer: Mclaren Medicare |
$524.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$551.21
|
| Rate for Payer: Meridian Medicaid |
$295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$603.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: PACE Medicare |
$498.71
|
| Rate for Payer: PACE SWMI |
$524.96
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: PHP Medicare Advantage |
$524.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health Medicare |
$524.96
|
| Rate for Payer: Priority Health SBD |
$643.09
|
| Rate for Payer: Railroad Medicare Medicare |
$524.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,477.71
|
| Rate for Payer: UHC Core |
$755.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.96
|
| Rate for Payer: UHC Exchange |
$755.38
|
| Rate for Payer: UHC Medicare Advantage |
$524.96
|
| Rate for Payer: UHCCP Medicaid |
$295.55
|
| Rate for Payer: VA VA |
$524.96
|
|
|
HC NM CISTERNOGRAM
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
34100040
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$643.09 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.51
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$714.55
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health SBD |
$643.09
|
|
|
HC NM CSF LEAK
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$643.09 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.51
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$714.55
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health SBD |
$643.09
|
|
|
HC NM CSF LEAK
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
34100042
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$643.09 |
| Max. Negotiated Rate |
$3,583.96 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna Medicare |
$1,324.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,591.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,591.51
|
| Rate for Payer: BCBS Complete |
$716.56
|
| Rate for Payer: BCBS MAPPO |
$1,273.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,273.21
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Cofinity Commercial |
$714.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,273.21
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Mclaren Medicaid |
$682.44
|
| Rate for Payer: Mclaren Medicare |
$1,273.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,336.87
|
| Rate for Payer: Meridian Medicaid |
$716.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,464.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: PACE Medicare |
$1,209.55
|
| Rate for Payer: PACE SWMI |
$1,273.21
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,273.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health Medicare |
$1,273.21
|
| Rate for Payer: Priority Health SBD |
$643.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1,273.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,583.96
|
| Rate for Payer: UHC Core |
$755.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,273.21
|
| Rate for Payer: UHC Exchange |
$755.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,273.21
|
| Rate for Payer: UHCCP Medicaid |
$716.82
|
| Rate for Payer: VA VA |
$1,273.21
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$289.17 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$321.30
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health SBD |
$289.17
|
|
|
HC NMDA-R AB CBA, S
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200429
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Cofinity Commercial |
$321.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| 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 |
$390.15
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$390.15
|
| 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 |
$298.35
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$289.17
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Cofinity Commercial |
$321.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| 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 |
$390.15
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$390.15
|
| 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 |
$298.35
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$289.17
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC NMDA-R AB CBA, SERUM
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200420
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$289.17 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.35
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$321.30
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health SBD |
$289.17
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.25
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.25
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC NMDA-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200421
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.25
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$73.90
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.10
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: Priority Health SBD |
$52.43
|
|
|
HC N METHYLHISTAMINE, U
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100716
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$58.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$13.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.10
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health SBD |
$52.43
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$13.56
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
IP
|
$1,429.10
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$900.33 |
| Max. Negotiated Rate |
$1,286.19 |
| Rate for Payer: Aetna Commercial |
$1,214.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.91
|
| Rate for Payer: Cash Price |
$1,143.28
|
| Rate for Payer: Cofinity Commercial |
$1,000.37
|
| Rate for Payer: Cofinity Commercial |
$1,229.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,000.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.28
|
| Rate for Payer: Healthscope Commercial |
$1,286.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.73
|
| Rate for Payer: PHP Commercial |
$1,214.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.91
|
| Rate for Payer: Priority Health SBD |
$900.33
|
|
|
HC NM GASTRIC EMPTYING
|
Facility
|
OP
|
$1,429.10
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
34100019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,286.19 |
| Rate for Payer: Aetna Commercial |
$1,214.73
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.91
|
| 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 |
$1,143.28
|
| Rate for Payer: Cash Price |
$1,143.28
|
| Rate for Payer: Cofinity Commercial |
$1,229.03
|
| Rate for Payer: Cofinity Commercial |
$1,000.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,000.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,286.19
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,214.73
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,214.73
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.91
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$900.33
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$1,057.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$1,057.53
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM GE REFLUX
|
Facility
|
OP
|
$1,265.76
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,139.18 |
| Rate for Payer: Aetna Commercial |
$1,075.90
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.74
|
| 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 |
$1,012.61
|
| Rate for Payer: Cash Price |
$1,012.61
|
| Rate for Payer: Cofinity Commercial |
$886.03
|
| Rate for Payer: Cofinity Commercial |
$1,088.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$886.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,139.18
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.90
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,075.90
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.74
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$797.43
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$936.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$936.66
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM GE REFLUX
|
Facility
|
IP
|
$1,265.76
|
|
|
Service Code
|
CPT 78262
|
| Hospital Charge Code |
34100018
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$797.43 |
| Max. Negotiated Rate |
$1,139.18 |
| Rate for Payer: Aetna Commercial |
$1,075.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.74
|
| Rate for Payer: Cash Price |
$1,012.61
|
| Rate for Payer: Cofinity Commercial |
$1,088.55
|
| Rate for Payer: Cofinity Commercial |
$886.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$886.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,012.61
|
| Rate for Payer: Healthscope Commercial |
$1,139.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,075.90
|
| Rate for Payer: PHP Commercial |
$1,075.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.74
|
| Rate for Payer: Priority Health SBD |
$797.43
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
OP
|
$1,020.78
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,103.16 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.51
|
| 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 |
$816.62
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Cofinity Commercial |
$714.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$643.09
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$755.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$755.38
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM GI BLOOD LOSS
|
Facility
|
IP
|
$1,020.78
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
34100020
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$643.09 |
| Max. Negotiated Rate |
$918.70 |
| Rate for Payer: Aetna Commercial |
$867.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.51
|
| Rate for Payer: Cash Price |
$816.62
|
| Rate for Payer: Cofinity Commercial |
$714.55
|
| Rate for Payer: Cofinity Commercial |
$877.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$714.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.62
|
| Rate for Payer: Healthscope Commercial |
$918.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.66
|
| Rate for Payer: PHP Commercial |
$867.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.51
|
| Rate for Payer: Priority Health SBD |
$643.09
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
IP
|
$1,476.56
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$930.23 |
| Max. Negotiated Rate |
$1,328.90 |
| Rate for Payer: Aetna Commercial |
$1,255.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.76
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,033.59
|
| Rate for Payer: Cofinity Commercial |
$1,269.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,033.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Healthscope Commercial |
$1,328.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: PHP Commercial |
$1,255.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: Priority Health SBD |
$930.23
|
|
|
HC NM LIVER BILE TRANSPORT WO PHARM
|
Facility
|
OP
|
$1,476.56
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
34100072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$210.06 |
| Max. Negotiated Rate |
$1,328.90 |
| Rate for Payer: Aetna Commercial |
$1,255.08
|
| Rate for Payer: Aetna Medicare |
$407.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.76
|
| 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 |
$1,181.25
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,269.84
|
| Rate for Payer: Cofinity Commercial |
$1,033.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,033.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.90
|
| Rate for Payer: Healthscope Commercial |
$1,328.90
|
| Rate for Payer: Mclaren Medicaid |
$210.06
|
| Rate for Payer: Mclaren Medicare |
$391.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.50
|
| Rate for Payer: Meridian Medicaid |
$220.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: PACE Medicare |
$372.31
|
| Rate for Payer: PACE SWMI |
$391.90
|
| Rate for Payer: PHP Commercial |
$1,255.08
|
| Rate for Payer: PHP Medicare Advantage |
$391.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: Priority Health Medicare |
$391.90
|
| Rate for Payer: Priority Health SBD |
$930.23
|
| Rate for Payer: Railroad Medicare Medicare |
$391.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,103.16
|
| Rate for Payer: UHC Core |
$1,092.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.90
|
| Rate for Payer: UHC Exchange |
$1,092.65
|
| Rate for Payer: UHC Medicare Advantage |
$391.90
|
| Rate for Payer: UHCCP Medicaid |
$220.64
|
| Rate for Payer: VA VA |
$391.90
|
|
|
HC NM LIVER BILE TRANSPORT W PHARM
|
Facility
|
IP
|
$1,476.56
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
34100073
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$930.23 |
| Max. Negotiated Rate |
$1,328.90 |
| Rate for Payer: Aetna Commercial |
$1,255.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.76
|
| Rate for Payer: Cash Price |
$1,181.25
|
| Rate for Payer: Cofinity Commercial |
$1,033.59
|
| Rate for Payer: Cofinity Commercial |
$1,269.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,033.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,181.25
|
| Rate for Payer: Healthscope Commercial |
$1,328.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,255.08
|
| Rate for Payer: PHP Commercial |
$1,255.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.76
|
| Rate for Payer: Priority Health SBD |
$930.23
|
|
