|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: ASR ASR |
$59.17
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS Trust/PPO |
$47.29
|
| Rate for Payer: BCN Commercial |
$47.29
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$57.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$61.00
|
| Rate for Payer: Healthscope Whirlpool |
$59.17
|
| Rate for Payer: Mclaren Commercial |
$54.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.51
|
| Rate for Payer: Priority Health Narrow Network |
$43.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.68
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: ASR ASR |
$48.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCN Commercial |
$38.76
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$50.00
|
| Rate for Payer: Healthscope Whirlpool |
$48.50
|
| Rate for Payer: Mclaren Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.50
|
| Rate for Payer: Priority Health Narrow Network |
$35.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.00
|
|
|
HC NICU LEVEL 2 R&B
|
Facility
|
IP
|
$3,363.24
|
|
| Hospital Charge Code |
17200001
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$2,354.27 |
| Max. Negotiated Rate |
$3,363.24 |
| Rate for Payer: Aetna Commercial |
$3,026.92
|
| Rate for Payer: ASR ASR |
$3,262.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,607.52
|
| Rate for Payer: BCN Commercial |
$2,607.52
|
| Rate for Payer: Cash Price |
$2,690.59
|
| Rate for Payer: Cofinity Commercial |
$3,161.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,690.59
|
| Rate for Payer: Healthscope Commercial |
$3,363.24
|
| Rate for Payer: Healthscope Whirlpool |
$3,262.34
|
| Rate for Payer: Mclaren Commercial |
$3,026.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,858.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,354.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,959.65
|
|
|
HC NICU LEVEL 3 R&B
|
Facility
|
IP
|
$4,986.03
|
|
| Hospital Charge Code |
17300001
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$3,490.22 |
| Max. Negotiated Rate |
$4,986.03 |
| Rate for Payer: Aetna Commercial |
$4,487.43
|
| Rate for Payer: ASR ASR |
$4,836.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,865.67
|
| Rate for Payer: BCN Commercial |
$3,865.67
|
| Rate for Payer: Cash Price |
$3,988.82
|
| Rate for Payer: Cofinity Commercial |
$4,686.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,988.82
|
| Rate for Payer: Healthscope Commercial |
$4,986.03
|
| Rate for Payer: Healthscope Whirlpool |
$4,836.45
|
| Rate for Payer: Mclaren Commercial |
$4,487.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,238.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,490.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,387.71
|
|
|
HC NICU LEVEL 4 R&B
|
Facility
|
IP
|
$5,221.18
|
|
| Hospital Charge Code |
17400001
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$3,654.83 |
| Max. Negotiated Rate |
$5,221.18 |
| Rate for Payer: Aetna Commercial |
$4,699.06
|
| Rate for Payer: ASR ASR |
$5,064.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,047.98
|
| Rate for Payer: BCN Commercial |
$4,047.98
|
| Rate for Payer: Cash Price |
$4,176.94
|
| Rate for Payer: Cofinity Commercial |
$4,907.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,176.94
|
| Rate for Payer: Healthscope Commercial |
$5,221.18
|
| Rate for Payer: Healthscope Whirlpool |
$5,064.54
|
| Rate for Payer: Mclaren Commercial |
$4,699.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,438.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,654.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,594.64
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$186.06
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$130.24 |
| Max. Negotiated Rate |
$186.06 |
| Rate for Payer: Aetna Commercial |
$167.45
|
| Rate for Payer: ASR ASR |
$180.48
|
| Rate for Payer: BCBS Trust/PPO |
$144.25
|
| Rate for Payer: BCN Commercial |
$144.25
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$174.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Healthscope Commercial |
$186.06
|
| Rate for Payer: Healthscope Whirlpool |
$180.48
|
| Rate for Payer: Mclaren Commercial |
$167.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.73
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$186.06
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$186.06 |
| Rate for Payer: Aetna Commercial |
$167.45
|
| Rate for Payer: ASR ASR |
$180.48
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: BCBS Trust/PPO |
$144.25
|
| Rate for Payer: BCN Commercial |
$144.25
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$174.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.85
|
| Rate for Payer: Healthscope Commercial |
$186.06
|
| Rate for Payer: Healthscope Whirlpool |
$180.48
|
| Rate for Payer: Mclaren Commercial |
$167.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.68
|
| Rate for Payer: Priority Health Narrow Network |
$46.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.73
|
|
|
HC NICU OR OB NURSERY R&B
|
Facility
|
IP
|
$2,250.16
|
|
| Hospital Charge Code |
17000001
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$1,575.11 |
| Max. Negotiated Rate |
$2,250.16 |
| Rate for Payer: Aetna Commercial |
$2,025.14
|
| Rate for Payer: ASR ASR |
$2,182.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,744.55
|
| Rate for Payer: BCN Commercial |
$1,744.55
|
| Rate for Payer: Cash Price |
$1,800.13
|
| Rate for Payer: Cofinity Commercial |
$2,115.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,800.13
|
| Rate for Payer: Healthscope Commercial |
$2,250.16
|
| Rate for Payer: Healthscope Whirlpool |
$2,182.66
|
| Rate for Payer: Mclaren Commercial |
$2,025.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,912.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,575.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,980.14
|
|
|
HC NIFOMETER
|
Facility
|
IP
|
$82.48
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$74.23
|
| Rate for Payer: ASR ASR |
$80.01
|
| Rate for Payer: BCBS Trust/PPO |
$63.95
|
| Rate for Payer: BCN Commercial |
$63.95
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$77.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Healthscope Whirlpool |
$80.01
|
| Rate for Payer: Mclaren Commercial |
$74.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.58
|
|
|
HC NIFOMETER
|
Facility
|
OP
|
$82.48
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.99 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$74.23
|
| Rate for Payer: ASR ASR |
$80.01
|
| Rate for Payer: BCBS Complete |
$32.99
|
| Rate for Payer: BCBS Trust/PPO |
$63.95
|
| Rate for Payer: BCN Commercial |
$63.95
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$77.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Healthscope Whirlpool |
$80.01
|
| Rate for Payer: Mclaren Commercial |
$74.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.06
|
| Rate for Payer: Priority Health Narrow Network |
$58.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.58
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
IP
|
$49.14
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$49.14 |
| Rate for Payer: Aetna Commercial |
$44.23
|
| Rate for Payer: ASR ASR |
$47.67
|
| Rate for Payer: BCBS Trust/PPO |
$38.10
|
| Rate for Payer: BCN Commercial |
$38.10
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cofinity Commercial |
$46.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.31
|
| Rate for Payer: Healthscope Commercial |
$49.14
|
| Rate for Payer: Healthscope Whirlpool |
$47.67
|
| Rate for Payer: Mclaren Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.24
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
OP
|
$49.14
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$49.14 |
| Rate for Payer: Aetna Commercial |
$44.23
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.56
|
| Rate for Payer: ASR ASR |
$47.67
|
| Rate for Payer: BCBS Complete |
$20.48
|
| Rate for Payer: BCBS MAPPO |
$35.65
|
| Rate for Payer: BCBS Trust/PPO |
$38.10
|
| Rate for Payer: BCN Commercial |
$38.10
|
| Rate for Payer: BCN Medicare Advantage |
$35.65
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cofinity Commercial |
$46.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.65
|
| Rate for Payer: Healthscope Commercial |
$49.14
|
| Rate for Payer: Healthscope Whirlpool |
$47.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$35.65
|
| Rate for Payer: Mclaren Commercial |
$44.23
|
| Rate for Payer: Mclaren Medicaid |
$19.50
|
| Rate for Payer: Mclaren Medicare |
$35.65
|
| Rate for Payer: Meridian Medicaid |
$20.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.77
|
| Rate for Payer: PACE Medicare |
$33.87
|
| Rate for Payer: PACE SWMI |
$35.65
|
| Rate for Payer: PHP Commercial |
$39.22
|
| Rate for Payer: PHP Medicaid |
$19.50
|
| Rate for Payer: PHP Medicare Advantage |
$35.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.72
|
| Rate for Payer: Priority Health Medicare |
$35.65
|
| Rate for Payer: Priority Health Narrow Network |
$34.89
|
| Rate for Payer: Railroad Medicare Medicare |
$35.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.24
|
| Rate for Payer: UHC Medicare Advantage |
$36.72
|
| Rate for Payer: VA VA |
$35.65
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$4,800.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$886.68 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$4,320.00
|
| Rate for Payer: Aetna Medicare |
$1,620.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: ASR ASR |
$4,656.00
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,721.44
|
| Rate for Payer: BCN Commercial |
$3,721.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Cofinity Commercial |
$4,512.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,840.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$4,800.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,656.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Commercial |
$4,320.00
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,080.00
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,783.08
|
| Rate for Payer: PHP Medicaid |
$886.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,678.10
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,342.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,224.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$4,800.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,360.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$4,320.00
|
| Rate for Payer: ASR ASR |
$4,656.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,721.44
|
| Rate for Payer: BCN Commercial |
$3,721.44
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Cofinity Commercial |
$4,512.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,840.00
|
| Rate for Payer: Healthscope Commercial |
$4,800.00
|
| Rate for Payer: Healthscope Whirlpool |
$4,656.00
|
| Rate for Payer: Mclaren Commercial |
$4,320.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,080.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,224.00
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
IP
|
$883.99
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$618.79 |
| Max. Negotiated Rate |
$883.99 |
| Rate for Payer: Aetna Commercial |
$795.59
|
| Rate for Payer: ASR ASR |
$857.47
|
| Rate for Payer: BCBS Trust/PPO |
$685.36
|
| Rate for Payer: BCN Commercial |
$685.36
|
| Rate for Payer: Cash Price |
$707.19
|
| Rate for Payer: Cofinity Commercial |
$830.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.19
|
| Rate for Payer: Healthscope Commercial |
$883.99
|
| Rate for Payer: Healthscope Whirlpool |
$857.47
|
| Rate for Payer: Mclaren Commercial |
$795.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$751.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$777.91
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
OP
|
$883.99
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$883.99 |
| Rate for Payer: Aetna Commercial |
$795.59
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$857.47
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$685.36
|
| Rate for Payer: BCN Commercial |
$685.36
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$707.19
|
| Rate for Payer: Cash Price |
$707.19
|
| Rate for Payer: Cofinity Commercial |
$830.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$883.99
|
| Rate for Payer: Healthscope Whirlpool |
$857.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$795.59
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$751.39
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$804.43
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$627.63
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$777.91
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
OP
|
$1,126.87
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,126.87 |
| Rate for Payer: Aetna Commercial |
$1,014.18
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,093.06
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$873.66
|
| Rate for Payer: BCN Commercial |
$873.66
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cofinity Commercial |
$1,059.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$901.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,126.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,093.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,014.18
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$957.84
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$753.73
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$602.98
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$991.65
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
IP
|
$1,126.87
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$788.81 |
| Max. Negotiated Rate |
$1,126.87 |
| Rate for Payer: Aetna Commercial |
$1,014.18
|
| Rate for Payer: ASR ASR |
$1,093.06
|
| Rate for Payer: BCBS Trust/PPO |
$873.66
|
| Rate for Payer: BCN Commercial |
$873.66
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cofinity Commercial |
$1,059.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$901.50
|
| Rate for Payer: Healthscope Commercial |
$1,126.87
|
| Rate for Payer: Healthscope Whirlpool |
$1,093.06
|
| Rate for Payer: Mclaren Commercial |
$1,014.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$957.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$991.65
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
IP
|
$1,045.41
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$731.79 |
| Max. Negotiated Rate |
$1,045.41 |
| Rate for Payer: Aetna Commercial |
$940.87
|
| Rate for Payer: ASR ASR |
$1,014.05
|
| Rate for Payer: BCBS Trust/PPO |
$810.51
|
| Rate for Payer: BCN Commercial |
$810.51
|
| Rate for Payer: Cash Price |
$836.33
|
| Rate for Payer: Cofinity Commercial |
$982.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.33
|
| Rate for Payer: Healthscope Commercial |
$1,045.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,014.05
|
| Rate for Payer: Mclaren Commercial |
$940.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$888.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$919.96
|
|
|
HC NM BONE MARROW WHOLE BODY
|
Facility
|
OP
|
$1,045.41
|
|
|
Service Code
|
CPT 78104
|
| Hospital Charge Code |
34100011
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,045.41 |
| Rate for Payer: Aetna Commercial |
$940.87
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,014.05
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$810.51
|
| Rate for Payer: BCN Commercial |
$810.51
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$836.33
|
| Rate for Payer: Cash Price |
$836.33
|
| Rate for Payer: Cofinity Commercial |
$982.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,045.41
|
| Rate for Payer: Healthscope Whirlpool |
$1,014.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$940.87
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$888.60
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$951.32
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$742.24
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$919.96
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
IP
|
$1,270.68
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$889.48 |
| Max. Negotiated Rate |
$1,270.68 |
| Rate for Payer: Aetna Commercial |
$1,143.61
|
| Rate for Payer: ASR ASR |
$1,232.56
|
| Rate for Payer: BCBS Trust/PPO |
$985.16
|
| Rate for Payer: BCN Commercial |
$985.16
|
| Rate for Payer: Cash Price |
$1,016.54
|
| Rate for Payer: Cofinity Commercial |
$1,194.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.54
|
| Rate for Payer: Healthscope Commercial |
$1,270.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,232.56
|
| Rate for Payer: Mclaren Commercial |
$1,143.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,080.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,118.20
|
|
|
HC NM BONE MULTIPLE AREAS
|
Facility
|
OP
|
$1,270.68
|
|
|
Service Code
|
CPT 78305
|
| Hospital Charge Code |
34100024
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,270.68 |
| Rate for Payer: Aetna Commercial |
$1,143.61
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,232.56
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$985.16
|
| Rate for Payer: BCN Commercial |
$985.16
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$1,016.54
|
| Rate for Payer: Cash Price |
$1,016.54
|
| Rate for Payer: Cofinity Commercial |
$1,194.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,270.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,232.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,143.61
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,080.08
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,156.32
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$902.18
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,118.20
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
OP
|
$1,180.85
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$200.54 |
| Max. Negotiated Rate |
$1,180.85 |
| Rate for Payer: Aetna Commercial |
$1,062.76
|
| Rate for Payer: Aetna Medicare |
$366.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$458.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$458.26
|
| Rate for Payer: ASR ASR |
$1,145.42
|
| Rate for Payer: BCBS Complete |
$210.58
|
| Rate for Payer: BCBS MAPPO |
$366.61
|
| Rate for Payer: BCBS Trust/PPO |
$915.51
|
| Rate for Payer: BCN Commercial |
$915.51
|
| Rate for Payer: BCN Medicare Advantage |
$366.61
|
| Rate for Payer: Cash Price |
$944.68
|
| Rate for Payer: Cash Price |
$944.68
|
| Rate for Payer: Cofinity Commercial |
$1,110.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.61
|
| Rate for Payer: Healthscope Commercial |
$1,180.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,145.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$366.61
|
| Rate for Payer: Mclaren Commercial |
$1,062.76
|
| Rate for Payer: Mclaren Medicaid |
$200.54
|
| Rate for Payer: Mclaren Medicare |
$366.61
|
| Rate for Payer: Meridian Medicaid |
$210.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.72
|
| Rate for Payer: PACE Medicare |
$348.28
|
| Rate for Payer: PACE SWMI |
$366.61
|
| Rate for Payer: PHP Commercial |
$403.27
|
| Rate for Payer: PHP Medicaid |
$200.54
|
| Rate for Payer: PHP Medicare Advantage |
$366.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$547.98
|
| Rate for Payer: Priority Health Medicare |
$366.61
|
| Rate for Payer: Priority Health Narrow Network |
$438.38
|
| Rate for Payer: Railroad Medicare Medicare |
$366.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,039.15
|
| Rate for Payer: UHC Medicare Advantage |
$377.61
|
| Rate for Payer: VA VA |
$366.61
|
|
|
HC NM BONE SINGLE AREA
|
Facility
|
IP
|
$1,180.85
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
34100023
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$826.60 |
| Max. Negotiated Rate |
$1,180.85 |
| Rate for Payer: Aetna Commercial |
$1,062.76
|
| Rate for Payer: ASR ASR |
$1,145.42
|
| Rate for Payer: BCBS Trust/PPO |
$915.51
|
| Rate for Payer: BCN Commercial |
$915.51
|
| Rate for Payer: Cash Price |
$944.68
|
| Rate for Payer: Cofinity Commercial |
$1,110.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$944.68
|
| Rate for Payer: Healthscope Commercial |
$1,180.85
|
| Rate for Payer: Healthscope Whirlpool |
$1,145.42
|
| Rate for Payer: Mclaren Commercial |
$1,062.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,003.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,039.15
|
|
